Time management

I also work the PM shift. I created a cheat sheet and it has been a huge time saver for me. I stick to my routine and I am very OCD about it. I keep my folder and by nurse bag handy. I have room for those oh crap moments and I do not panic when something throws a wrench in my routine. There will be a fall or even two. Someone will need to be sent out or there will be a new admission. No matter what, you need to be prepared. Took me a few years to get my time management down. I get report, I count the narcs, I make my cheat sheet, I put eyes on my residents, I grab vitals, I delegate tasks to my CNAs and I start my PM med pass. I take a break around 530-6 pm. After my break, I chart what vitals/bath audits I have obtained, collect any remaining vitals, do any treatments that need to be completed. By 7-715, I am starting my HS med pass. I normally work the TCU unit and it is pretty hectic with skilled charting, vitals and wound care. The long term unit has its share of routine vitals for quarterlies and the occasional fall/skin tear. The hospice residents I find are the most time consuming because you are medicating every 1-2hrs and you are talking to family quite a bit. You can spend 10-15 mins talking with the family.

My nurse bag is also a must-have. I bought it at Walmart in the sewing section. I have different color pens, pencils, black sharpie, note pad, measuring tape, highlighters, rubber bands, my lotion, snack, hair ties/clip, change for the vending machine, pixie sticks for my diabetics that like to crash, thermometer, stethoscope, oximeter, BP cuff.

I attached my cheat sheet. Feel free to use and tweak it if you would like.

vitalscheatsheet.docx

Awesome!! Thank you! I’m going to print it out and give it a try. Take care?

Sorry to hear about your time management struggle; I feel it, too. Best ideas I can recommend (though a disclaimer: I don’t always practice) are to arrive 15+ minutes early to read up on patients charts, figure out their plan of care and map out your evening. I use a detailed brain sheet I made myself to stay organized.

Also, I work nights, so I sleep ALL day to maximize my potential energy reserve throughout the night. I try to eat midday and/or prior to going in so I am well fueled, but avoid over-eating so I don’t go in in a food coma. Having a good handle on my responsibilities outside of work helps me to stay focused on the job and therefore better economize time on the job - I tend to zone out, work slower and make more mistakes when distracted/preoccupied.

I chew gum and listen to fast tempo music on my way into work to get amped up; this helps to counterbalance the slow-down I inevitably hit five hours into my shift.

Obviously, patients with the most pressing needs should come first; I usually let the first-due meds dictate who I see first (apart from post-handover meet-and-greet.) Sometimes though I see merit in handling the easier/less needy (and less chatty) patients first to get more done in less time. That way, I can spend more time with those who need more attention and I can give them my undivided attention.

Being comfortable delegating tasks is huge; I’m still working on this area but getting more comfortable because I know it’s not a reflection on my failure as a nurse, it’s about the patients’ needs. Most CNAs/PCTs understand this. If I’m not comfortable asking someone to do something for me, I ask them to help me so together we get it done in half the time.

Lastly, a minute of prevention is greater than an hour of cleanup; we’ve implemented hourly rounding to ensure bed alarms are on, call bells are within reach, pumps are plugged in, everyone has some water or whatever other basic need met. We’re not obligated to chart it, just move the hand forward on a small paper clock inside the doorway. I would much rather do this than have a fall occur on my watch.

Best of luck (to all of us)!

On 9/25/2019 at 11:28 PM, ltcnurse4u said:

I also work the PM shift. I created a cheat sheet and it has been a huge time saver for me. I stick to my routine and I am very OCD about it. I keep my folder and by nurse bag handy. I have room for those oh crap moments and I do not panic when something throws a wrench in my routine. There will be a fall or even two. Someone will need to be sent out or there will be a new admission. No matter what, you need to be prepared. Took me a few years to get my time management down. I get report, I count the narcs, I make my cheat sheet, I put eyes on my residents, I grab vitals, I delegate tasks to my CNAs and I start my PM med pass. I take a break around 530-6 pm. After my break, I chart what vitals/bath audits I have obtained, collect any remaining vitals, do any treatments that need to be completed. By 7-715, I am starting my HS med pass. I normally work the TCU unit and it is pretty hectic with skilled charting, vitals and wound care. The long term unit has its share of routine vitals for quarterlies and the occasional fall/skin tear. The hospice residents I find are the most time consuming because you are medicating every 1-2hrs and you are talking to family quite a bit. You can spend 10-15 mins talking with the family.

My nurse bag is also a must-have. I bought it at Walmart in the sewing section. I have different color pens, pencils, black sharpie, note pad, measuring tape, highlighters, rubber bands, my lotion, snack, hair ties/clip, change for the vending machine, pixie sticks for my diabetics that like to crash, thermometer, stethoscope, oximeter, BP cuff.

I attached my cheat sheet. Feel free to use and tweak it if you would like.

vitalscheatsheet.docx

Hi Itcnurse4u!

I made a similar cheat sheet. It's nice to know that I'm not alone. My co-workers look at me like a crazy person for taking the time to make it at home. I'm currently 2.5 months (only three, eight-hour shifts a week though) into my first ever nursing job, at a SNF. I see a mix of LTC and subacute, usually around 20, but up to 26 patients.

How many patients and what acuity are your patients? I'm trying to figure out what is reasonable because...

I'm on the cusp of quitting.

My fellow nurses tell me that it's impossible to complete all of the treatment orders and assessments, especially if there's a change of condition, transfers, and or bunches of orders. I think most of them just don't bother but chart as if they did.

Some patient are like, "what are you doing?" when I assess them, ask for a pain score, or count respirations, as if no one done such a thing with them before. Some patients get mad when I won't give them extra Tums and act like they have somehow triumphed when they refuse their meds until you break it down and say, "This one is to keep you heart working well..." They then take at least that one.

It all takes time, but I don't feel like I'm doing extra. I feel like what I'm doing should be the minimum. None of this would bother as much if all or most of the patients were staying stable or improving, but I watch too many deteriorate. Among other things, I've seen red, purulent, oozing (one slightly bloody) G-tube stomas on two patients. Thinking I should chart a change of condition and call the doctor, I showed one to a supervisor and the other time to a very experienced nurse. The supervisor waved her hand at me and said it was fine. The experienced nurse said that, "if was infected you would know. It would stink, be painful, and warm..." I figure that's what it will look like if no one deals with it now. Why should we wait for that? I watch patients deteriorate and I wonder "what if everyone had done more?"

Is this just how it is? Should I have just done the COC and called the doctor anyway or just chart what happened? Following the doctors orders, I did a COC for low BP on a patient and my co-workers were like, "why?" Won't going over their heads cause a riff even if I think it's the right thing? It's my license...

I should just part ways with the SNF system now?

I appreciate your feedback!