Time Management

TexasPediRN · Oct 20, 2005

you've actually picked up some very good tips there!

I too, give my meds together if not contraindicated. What a pain it can be going into a persons room every hour.

When I worked 3-11 I would come out of report, go assess all of my patients. During report I will have written on my paper the times that each patient receives a med so I dont skip any. Give all meds, come back, chart opening note & assessment. This really saves time. We have a flow sheet method, and just to get that done ASAP really helps.

As hard as it is, it also helps not talking to other people ( ie coworkers) until you can get to all of your patients.

Make sure everything is done the first time. Gather all the info you need from the patient so you arent in the room 80 times.

You've really covered the basic ones, good job! I cant think of others, but then again I just got up..so I will try and think of more.

As you go along you will become more time management oriented.

I recommend having a schedule that you follow though of doing things like I do. I find that that really helps as long as you can stick to it. Sometimes it doesnt happen, but when it does its helpful. Its just my way of going about things, you'll find your own in due time :)

perfectbluebuildings, BSN, RN · Oct 20, 2005

The meds thing is really good. Also if the patient/parent asks me for something I have learned to ask, "Is there anything ELSE I can get for you or for ANYONE in this room?" cause many times when I get back to the room they will say, "Oh yeah, I was just wondering if I could get another... real quick..."

I have a particular sheet of paper I use with the pt's names at the top, and the hours down the side, where I write assessments, and any meds or labs or treatments due at each hour. At the bottom it has spots for new orders, the diet, IV fluids, any tests to be done the next shift, and check marks for what we do in room checks at the beginning of the shift (e.g. emergency drug sheets, armbands, O2, etc). It is really, really a lifesaver for me!! We have "boards" we print out with a lot of detail on them that are great for report and charting, but esp. for a quick glance or to carry in my pocket room to room, the single sheet of paper is a lot better for me and I can write down my assessments and the #s right away because otherwise I forget them almost immediately esp. the #s!

and if I get a moment to sit down early in the shift I like to make a "plan" for each of my pts and (since it's night shift) how I can figure it so they will get as much sleep time possible uninterrupted by ME!

OK I guess I have run on a little bit. Sorry!! This is a great topic and it will be neat to hear what everyone does.

Bambury · Oct 20, 2005

Here's how we work on my unit (med/surg):

Soon after the report, everyone checks on the med schedule for each patient. Some check it before the report is given, while they wait for the report to start. We find that this is key to starting the day. That way, by 7:30A when all the reports have been received, and we check that a patient has a med at 8:00A, we prioritize our assessments with that in mind. Anyway, we jot down on a column next to the pt's name on our flow sheet, that pt A has med at 8__, 10___, 12___, 16___, etc. We check these off after they are given. Also, another thing I do in particular, is I write down how many meds there are in for a particular time in parentheses. So, mine looks more like the follow: 8A (2)____, 10A(3/1IV)____, 12 (1)___. This usually works for me, as it makes me more efficient, and careful that I don't miss any med.

Afterwards, we go into each pt's room with our big roll of germicidal wipes. Before we begin our assessment, we introduce ourselves, and then move to quickly swipe the major areas around the patient. This usually builds trust between pt and nurse. The pt is made aware that she cares about his stay. The pt is given an extra time to acquaint with the nurse for that shift during that extra minute spent cleaning up. Then, after that's done, we find that the pt is usually more at ease with getting assessed.

If we know that the pt is getting a bag of fluid (as seen in the MAR), and that their time is up for a change of bag, we go in with a bag of fluid, and hang it then.

Before we leave the room, we know what's in the patient's bedside table, or surrounding area, i.e. extra gauze, saline bottle, etc, etc, so that we don't waste resources bringing things into the room that the pt may already have when we come to change dressing or such. We check these things, either when we are germicidal wiping in the beginning, or before leaving the room.

I quickly jot down everything I've noted in the room and with the pt's assessment as soon as I step out of the room before moving onto the next pt. This saves me a ton of time during documentation, and helps me be accurate.

I've enjoyed reading everyone else's tips. Time management is surely an art that comes with experience. Things become easier with routine.

HappyNurse2005, RN · Oct 20, 2005

Do assessment first thing after report and chart by exception only.

I don't agree with this. Charting by exception, I mean. How do you know if nothing was really wrong, or if you just didn't write anything? By me writing a note saying "no c/o pain or sob. instructed to call for assistance in getting out of bed" or whatever, then anyone can read it and know FOR SURE that nothing was wrong w/ my patient at that time.

Maybe I write too much, take too much time, but you won't doubt what i've taught my patients, or what happened to them.

KatieBell · Oct 20, 2005

I'd agree with the above poster regarding charting by exception. It's difficult to chart everything- and the new computer charting is helping that a lot. It is better to have documented your full assessment rather than just problems.

I was once called to be a witness in court. It was because I had taken care of a patient who had been assaulted. It was some sort of strange love triangle. It really had nothing to do with nursing care. Still, the cross examination from the lawyer was very very intense. I made up my mind at that point that I never wanted to be brought to court for my nursing actions. better to take the extra time writing...so its clear.

LouisianaNurse2006 · Oct 21, 2005

Good point! The way we were taught was to go down the check off sheet initialling everything normal (&record #'s) and then on the narrative go into detail with the abnormal. No need to initial that it was normal and then say again in narrative that it was normal, but it is ALWAYS best to CYA! Thanks.

Another one:

Check your med draw for each patient early in the shift for any missing meds that will slow you down later!

LouisianaNurse2006 · Oct 25, 2005

What about any good Nursing Time Management Books?? Have any of you ever come across one that really helped and was not packed with useless, common sense type stuff?

Thanks for all of your quick time saving tips.

I forgot an obvious one:

Keep tape, scissors, and alcohol pads in your pocket.

synkitty · Oct 27, 2005

I always carry Panadol and Nurofen as well, because they are allowed to be nurse initiated on our ward and it saves a hell of a lot of time not having to walk and get it all the time.

MrsMinor · Oct 28, 2005

TGIF!!!!

I broke down in tears today....taking 4 patients in orientation & just don't feel that there's enough time to get everything done!!

I don't know how other nurses do it.

I don't feel like I'm slow, but I always feel behind.

Today was one of those days I thought how good it would feel to leave and never come back! But, I'm in hopes I'll eventually get the hang of things.

How do most people organize their mornings?? So much to do...Looking at the caredexes, getting report, checking labs, fingersticks, am meds, assessments, am hygiene/care, changing beds, admission/discharges, md orders, call bells....ahhhhh!!

(Not always is there the extra help of aides available--usually only when someone is taking 5 or have lots of total care pts)

I feel that I know how to prioritize & have a great tool I use to keep track of what needs to be done, but I still don't seem to be able to handle it all. Maybe I need to work on more multi-tasking!

I wouldn't have made it without my preceptor today....her patience, encouragement, & sense of humor are endless & much appreciated!

Please keep the tips coming....I need all I can get about now

Indy, LPN, LVN · Nov 3, 2005

We listen to taped reports as a group. Takes 15-30+ minutes depending on how many people on the tape rambled on and on about nothing. I keep a highlighter and highlight things on the report sheet that will need attention. I'm describing nights so throw out what doesn't apply to you. Things like NPO status, fluids, out of date IV's, diabetics, people who got narcotics in the last 2 hours, etc. Also highlight procedures for the next day that require prep.

When I get out of report I get my brain ready. Brain = whatever you carry in your pocket that you scribble on while working. For me it's a notebook. For some it's the back of the report sheet; I put stickers on the pages for my patients (sticker = barcode thing that has ID info like the armband), write down the date, room #. And yes, end of shift these things go in the shredder bin. But they help me during the shift.

I look around. Who's doing what at the desk? Do they need me to count narcs or is that being done? Did everybody suddenly rush off to do assessments? Is everybody standing around trying to find a place to stick their lunch? I throw my stuff in a corner, and do the opposite of what the crowd is doing at the moment. A lot of times this means I can have my assessments and vitals done by 8pm.

While in the room I take a snack order if it applies and find out if the patient needs or normally takes a sleeping pill, unless I know specifically that it doesn't apply to them. If I know they are getting a prep or going to be NPO I let 'em know what and why when I first meet them. No surprises if I can help it.

When I come back, find my MAR's and such, because by now the crowd is gone from the desk and I can move around without bumping into people. Grab charts for my patients. Look for new orders. Look for stuff that don't make sense. Believe me there is going to be something. That can take a half hour to straighten out. Then take up to an hour doing med pass for my patients, with snack and sleeping pill included if appropriate, and after that settle down for chart checks.

Chart checks and charting assessments and first notes should be done by 11 or so, get MN vitals, if everybody's alive and ok, and coworkers not freaking out over something, get lunch. Eat, chart MN notes, read chart if something bugged you. This would be a good time to get admissions but of course they don't tend to come between 1 and 4 am. They like to be here at 5:30.

At 3:30 double check to see who needs to be weighed, do 4 am vitals and weigh people, help coworkers with weights if they have big people, quickly chart if new med sheets aren't on floor yet. When med sheets arrive, drop everything that isn't emergent and fix 'em for morning 'cause they make you double check everything again and you can catch mistakes. When that's done, tape report if able. Then at 6 look at med sheets and possibly start 7 am meds; usually don't have a lot but one morning I had a whole med pass on all of mine almost equal to the evening one. Not fun. While doing this, grab I&O info on patients and jot down before leaving room. Make sure room is neat and urinals/bedside commodes/hats in toilets are emptied. Say something nice if patient is awake.

Come back to desk, it's 6:30 and somebody from dayshift wants to know if I've made coffee. Sure, I made it at 2 am, should be really strong now. Grab notes, chart closing notes, sit back and wait to hear good things about report so I can go home.

Anything you find in there that helps, feel free to use. This is the ideal night, not the OMG-what-ran-over-me night.

Daytonite, BSN, RN · Nov 4, 2005

I learned over many years to never leave a patient, no matter what I had been in their room to do, without stopping and turning to them and asking, "is there anything that I can get for you before I go?" It cuts down on the use of the call light and is another way to let the patient know that you are concerned and care about them, no matter how busy they might perceive that you are; no matter how busy you are. Those few seconds can make a big difference in the way your shift is going. It also will help to encourange the patient to tell you about any problems you are going to need to know about. Of course, sometimes it kind of backfires. Some patients won't think of anything until you've left the room and are halfway down the hall. That's just one of the drawbacks of the game.