time management

jeepgirl, LPN, NP · May 7, 2005

well, first of all, there is nothing wrong with being too descriptive. don't let anyone tell you that. if you are accurate, there is nothing wrong with it. it might just save your butt in the long run.

pricklypear · May 7, 2005

Are you ending up staying late because you are behind? Or are you just wondering why you are the last one sitting down to chart? If it's the 2nd one, don't worry about it! It just means you are doing a good job taking care of your patients! Jeepgirl is right, nothing wrong with good assessment and documentation. I think you just need to study yourself a little and find out where time is being wasted (it it really is). If you're spending too much time on assessment of each patient, maybe you need to do more focused assessments: 60y/o chest pain, no other history - rhythm, heart tones, lung sounds, chest pain?, edema, iv site. I don't have any advice on how to get away from talkative patients!! Just back out slowly!

bemory · May 9, 2005

Its usually that I can only get to my charting much later. I am not staying hours late like I used to do. I guess the problem is that I just feel like I will miss something if I dont assess everything. I know that a lot of the nurses chart by exception..i.e WNL except..but I have never felt comfortable doing that. I had a classmate of mine lose her license the second month on the floor (after orientation) because her patient passed and she didnt chart anything leading up to the sudden demise. I guess I worry about something like that.

nurstudnt546, BSN, RN · May 9, 2005

Hi bemory. Unfortunately I do not have a solution as I am in the same boat as you (except for I'm a new grad w/ only 4 months experience on a step-down/progressive care unit). But I can definately relate to your situation all too well. I get behind every time I work and when I do, I'm in a bad mood and all the joking and friendliness disappears. One problem I noticed for myself is that I don't like to start charting my assessment until I've assessed everything too - and if I started charted at 0900/1000 am, there's no way I've seen everything (i.e. gait, skin on bottom, etc.); some things I don't notice until later on in the day.

Anyway, I'd love to hear other's tips/tricks on time management.

BTW, what exactly happened to your friend's pt that caused her to lose her license??? (so I can learn from it) - this is one of my worst fears.

pricklypear · May 10, 2005

I would be interested in knowing what about that situation caused your friend to lose her license, too. There had to be more than just not charting - unless she had the opportunity to chart after the fact and didn't do it.

nursestudent - I see your point about not being able to chart a head to toe assessment including skin, gait, etc. However, there is nothing wrong with charting what you DO see on your initial assessment - including a focused assessment around the patient's primary problem. Then, when the patient is up wallking after lunch, charting "pt ambulating in hall with steady gait" If you have a bedridden patient who was just repositioned at shift change, you can do a skin assessment and chart it when you turn the patient. It's better to chart what you do see, when you see it, than waiting several hours until you've seen everything.

rach_nc_03 · May 10, 2005

I will be completing my one year as a nurse on the cardiac floor and I feel that I have honed a lot of my skills except one...time management. I always see nurses finishing their charting hours before I even get to sit down. A lot of times my error is getting stuck in talkative patients rooms or waiting on medications that have not come to the floor. A lot of the time nurses I follow say that I give too descript assessments in the computer. A lot of times I get very stressed and unfortunately I make it known by complaining to other nurses how I am so busy doing this and that, it makes me so angry later when I think about how incompetent that makes me look. Does anyone know of a good schedule they have or maybe a checklist (we had an old one in nursing school thats not really relevant) with how to budget time. I really appreciate any posts.

I was watching two nurses I worked with last semester (while I was a cna) in the icu- one seemed to stay 2 hours late every shift (she'd been there for 15 years, so it wasn't being new), and the other was able to finish her charting before reporting off to the next shift almost every time. both of these nurses had reputations among the staff of having excellent documentation, so I was curious how the 2nd nurse had so much more time.

The slower nurse would wait to do every assessment- shift assessment, plus q2 hour neuro checks- at the end of her shift. She rarely kept any paper notes during the day. She seemed to remember very detailed info from the entire shift, but each neuro check, even using drop-down menus, took a while.

The second nurse did 2 things that seemed to help a lot: first, she kept a clipboard with an hourly flow sheet at her station. She had her meds and interventions listed on one side- 0900 might read 'lasix, turn, tube feed, etc.'...and on the other side, she documented any assessments she did; if it was partial, she noted which variables she observed, and any findings outside of normal limits. if it took 4 trips into the room to get the entire assessment completed, she said it was ok, as she had a record of what she'd done when.

she also put charting time in her hourly schedule. if it was at all feasible, she charted as she went, but she also kept her flow sheet, which was in her own short-hand. that way, if she found she'd missed something in her computer charting, she could correct it pretty easily. she said she tried to schedule at least 4 times to sit and chart during the shift- even if she didn't make that goal, she always got in more than 1 charting session.

I think part of her sucess is that she's a great multi-tasker....the rooms in the unit are set up so she can sit at the computer and chart while still talking to a family member in the room (the back of the screen faces the room, so they weren't able to see her charting).

hope this helps....I start my RN position this summer, and I'm planning on using this nurse's system.

cursenurse · May 11, 2005

I will be completing my one year as a nurse on the cardiac floor and I feel that I have honed a lot of my skills except one...time management. I always see nurses finishing their charting hours before I even get to sit down. A lot of times my error is getting stuck in talkative patients rooms or waiting on medications that have not come to the floor. A lot of the time nurses I follow say that I give too descript assessments in the computer. A lot of times I get very stressed and unfortunately I make it known by complaining to other nurses how I am so busy doing this and that, it makes me so angry later when I think about how incompetent that makes me look. Does anyone know of a good schedule they have or maybe a checklist (we had an old one in nursing school thats not really relevant) with how to budget time. I really appreciate any posts.

i totally understand the getting caught up talking to pt's and/or families for extended times thing. that used to happened to me too. my time management got alot better when i started setting time limits for unneccessary conversation with people. i look at my watch and i say to myself, in two minutes i am terminating this conversation. when the 2 minutes are up, i politely let them know that i must go because i must get to my next pt. i never give a pt or family the impression that this pt is my only one. it may sound harsh but you are not there to be a paid friend to the pt/family. once you start setting limits on other's behavior, you will get alot more done.

as far as documentation, i wouldn't tell you to be less descriptive. you describe things the best you can to illustrate the high level of care that you have provided the pt. in time, you will probably find more concise ways of doing this that will save you more time.

TooterIA · May 11, 2005

Rachel had an excellent example of what it takes for some nurses to be timely. One word of warning-Rachel mentioned one nurse writes down meds that are due like Lasix-although it is essential to make note of when your meds are due and it is nice to know what you will be giving, remember to check the chart again when it is actually time to give the med. We have a nurse that will write down on her cheat sheet 'Lasix 80 mg IV'. Although this is good, she never looks at the chart again when it is time to give it until after she gives it-by that time sometimes the order has been changed or she wrote it down wrong. I hope you continue to get useful tips!

Jessica

pricklypear · May 11, 2005

Rachel had an excellent example of what it takes for some nurses to be timely. One word of warning-Rachel mentioned one nurse writes down meds that are due like Lasix-although it is essential to make note of when your meds are due and it is nice to know what you will be giving, remember to check the chart again when it is actually time to give the med. We have a nurse that will write down on her cheat sheet 'Lasix 80 mg IV'. Although this is good, she never looks at the chart again when it is time to give it until after she gives it-by that time sometimes the order has been changed or she wrote it down wrong. I hope you continue to get useful tips!
Jessica

Really good point, Jessica! I used to write down just the times that meds or treatments were due for each one. I would never trust myself to give meds that I didn't directly get from the medex when I was getting them out of the machine.

But I think the secret of time management is multi-tasking. It is essential when you're trying to manage a patient load. Alot of time is wasted going back and forth to get supplies or whatever.

Franlpntorn · May 11, 2005

i will be completing my one year as a nurse on the cardiac floor and i feel that i have honed a lot of my skills except one...time management. i always see nurses finishing their charting hours before i even get to sit down. a lot of times my error is getting stuck in talkative patients rooms or waiting on medications that have not come to the floor. a lot of the time nurses i follow say that i give too descript assessments in the computer. a lot of times i get very stressed and unfortunately i make it known by complaining to other nurses how i am so busy doing this and that, it makes me so angry later when i think about how incompetent that makes me look. does anyone know of a good schedule they have or maybe a checklist (we had an old one in nursing school thats not really relevant) with how to budget time. i really appreciate any posts.

chart as you go. if you have lots of computers. do a focus assessment on problems you find or what ever brought them into the hospital. chart every time you go into the room, why and what you did. if your assessment shows wnl state that. working on the cardio floor you should have a good assessment tools and layout in the computer.

you did'nt say if you worked days or nights. how many pt's do you care for? there's a lot going on in the daytime. i work nights, so it's quiet unless we do 3 or 4 admits. :eek:

have a cheat sheet, works well with the report and sometime with charting. our program is in system order, make a cheat sheet in the same order as you chart in your system. add a spot for labs and extra stuff.

our mar has iv fluids in it so all we do is click it, charted. same way with prn iv fluids but we do have to label them also when to change the tubeing stickers. get a red pen and use it to chart exceptions. when you do your assessment use your cheat sheet to note iv fluid changes, wound change any thing that needs to be done. use this information to plan the rest of your shift, you can get what you need before you go into the room. if you have a med pass at the same time take the meds with you and assess the pt. get a set of vs and look at the labs on the ptt, ect before you give related meds. if your waiting on meds chart.

our doc's come in between 5am and 11am so the is always something new to look for. we might get a doc or 2 at night so there is not much to look for.

i think everyone should start on noc then go to days, you can learn the computer system and what's in the charting menus. we have a lot of pre-worded statements and this helps. we can edit them as well.

hope this helps.

life is a learning curve. fha rn

barefootlady, ADN, RN · May 12, 2005

It is acceptable to excuse yourself from patients room if talking to family is only reason you are there. I mean, some families want to just chat but you do not have time, so say, well, got to go and finish these meds, dressings, check on other patients light, etc. Chart as you go is only way to keep up. WNL is prefectly ok to chart if things are indeed WNL. I make it my priority to check my charts hourly to know if changes have been made to meds, activity, etc. If your AM assessment is indepth, then you can say patient has/shows no changes in cardiac status, pain level, respirations, or whatever since AM assessment completed. ( OOB w/o assist. Gait steady. Walked in hall and room several times this am. ) Make it simple by charting clear, short, to the point notes. Hope these help. Experience will be your best teacher. Do not let what others do or don't do dictate all of your practice model. :balloons: