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Time Management Tips for New Critical Care Nurses

Critical   (72,213 Views 28 Comments)
by nursey246 nursey246 (Member)

1 Article; 9,652 Visitors; 22 Posts

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After I get report on my two patients, I print and interpret my telemetry strips and verify their alarms on the monitor. I then decide which one is less stable (or more labor intensive if they are both stable) and start there.

At 0730, I complete a full assessment, turn, mouth care, check my drips for appropriate concentrations and rates, check lines that need to be changed, tuck and fluff them. Then I hop on my EMR and check out all of my active orders. I chart my assessment, vitals, and work lists, and give my 0800 meds. I order more drips, if needed. I check what's going on for the day by looking at any radiology/special procedures/tests scheduled and then peek at the latest MD note. Then I talk with the patient and family and let them know what's up for the day.

Side note: families of patients in critical care are naturally very emotional and concerned. I always make sure to over communicate with them about plans for the day. This establishes a professional relationship and allows you to assert your nursey authority. You're running their care for the day; you're in charge. If you are confident and professional, it puts them at ease and makes them feel safe with you. They need to trust you. If you give them any reason to doubt you as a caregiver, they will be stressed to the max all day. Stay confident! Even if you're not sure about something, be confident in your communication. Provide a structured plan for the day. The more structure, routine, and communication you can provide these patients + families, the better everyone's day will be.

Usually, by this time it's around 0750 or 0800. I then grab my 0800 + 0900 meds for my next patient and repeat the above process with them. After this, it's usually 0830. I then grab my 0900 meds for my first patient and administer those.

If that's done efficiently, I'm done around 0915-0930 with all meds, charting, and care. Being done this early allows you some cushion time for when physicians round, ask you a bunch of questions, and enter new orders. After that, I'll check on my other staff members and see if they need anything. If one of my patients needs a bath, I'll grab my tech and knock that out. And if no one really needs anything, I grab a snack!

At 1000, I go to my second patient's room and do a 1000 neuro assessment and chart it. I'll give any 1000 + 1100 meds and change any IV or enteral tubing due or start new IV's/change central line dressings that are due. I'll grab my tech and we'll do their 1000 turn. Then I'll go back to my first patient, do their 1000 neuro exam, their 1000 + 1100 meds, turn, and change lines/IV's at that time.

Theoretically, I'm completely charted and caught up by no later than 1030.

It's important in critical care to constantly be caught up. You never know who is going to deteriorate or code and that can change in seconds. You also never know what may be coming through the door at any time.

Critical care time management is very different from the floor. I've worked in both areas and it was a huge learning curve for me at the beginning. But once I became efficient at managing my time, I was more aware and able to catch things before they became a bigger issue because I wasn't so worried about how far behind I was.

Something to always ask yourself when trying to figure out what to do first is who is more stable?

Things may seem like an emergency to everyone, but you have to use your critical thinking skills to know who truly needs you more this very second. Everyone will need you all at once sometimes, but you really have to think about who cannot stand to wait.

So remember to stop. Breathe. And think. Who is more stable?

Edited by Joe V

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KeepItRealRN has 28 years experience and works as a RN CVICU.

10,490 Visitors; 379 Posts

OK, I'll be the first to comment. Great advice to newbies and old timers alike. I always say pay attention and stay caught up. The last thing you want is to be caught with your pants down.

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1 Article; 9,652 Visitors; 22 Posts

Haha I agree. And I love your profile pic.

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3,530 Visitors; 49 Posts

Great advice and I love your blog btw! (I'm a subscriber!) What would you say are the biggest time suckers and how can they be better managed?

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ausrnurse has 4 years experience.

3,917 Visitors; 128 Posts

I'm lucky enough that in Australia, we can only be assigned one ventilated/unstable patient to one nurse. I will usually write out my entire day on a piece of paper (0800, 0900, etc) and write in the obs/drugs/nursing care due for each hour. Then in a side column I will write jobs that need to be completed, but can be done at any time (dressings, restocking etc) - I can fit that in at a slower time, like after lunch, and I always leave dressings until the doctors have been, since you can be sure if you get in early, they will want to pull it down on their rounds. If there is a line change due, I will do that when I put up a new infusion. If anything happens, I document it straight away (eg., hypotensive on turning). NEVER leave notes until the end of your shift.

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1 Article; 9,652 Visitors; 22 Posts

I think one of the biggest time suckers is inefficient charting. You want to chart everything right away but sometimes it's not always possible and then before you know it, you're late with more important things like meds or you miss something when you were too focused on charting. I also would try to clump things together, almost too much. I'd clump so much together that I'd be in a room for over an hour and it was inefficient and I wouldn't see my other patient. Efficiency is key!

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calivianya works as a Registered Nurse.

35,138 Visitors; 2,418 Posts

These are great tips! :)

I think some of this is definitely dependent on the culture in your facility. The physicians show up whenever they feel like showing up here - sometimes it's 0400, sometimes it's 0700, and sometimes it's not until 2100 at night, so what was most important was fully assessing both patients as quickly as humanly possible so if the physician was in one of your rooms at 0715 with questions and the previous shift nurse was already gone, you could answer questions with something other than, "Well, I heard in report that..."

We also restrict visiting hours between 0630-0730 on either shift but otherwise have open visitation, so if you want to see your patient's butt without making the family all rebellious about having to wait longer before they are allowed back or asking them to step out of the room, well... both patients really need to be seen and assessed before 0730/1930.

I like your way better. It sounds like a much less chaotic start to the shift!

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1 Like; 40,332 Visitors; 1,939 Posts

I when I started in CVICU ( no longer work in ICU) I would arrive to work every day 15 min. early every single shift. During that 15 min. I would print of tele strips, skim over each patients History/physical. I would look up labs/medications and write them on my brain sheet. I accessed a wonderful brain sheet from AN.com for critical care ( thanks to ESME12) that I also used for my time management. For every hour of the shift there was a space where I can write down meds, labs,and procedures that were due. I would constantly refer to my timed to do list so that I make sure everything got down.

People think having two patients is a piece a cake, but when they are very sick you will find yourself running all shift. It is imperative to be organized, prioritize, and manage your time efficiently.

Great post !

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16,286 Visitors; 1,026 Posts

Great advice. Thanks for sharing. Time management is indeed important not only for professionalism but our personal life as well.

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744 Visitors; 3 Posts

Where can I get that brain sheet for crítical Care nursing?

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Esme12 works as a emergency ,critical care,cath lab,open heart,traum.

15 Likes; 3 Followers; 3 Articles; 145,699 Visitors; 20,896 Posts

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9 Likes; 7 Articles; 37,291 Visitors; 1,142 Posts

This is great advice-- but what throws me off is when one of my two patients suddenly needs a lot more attention and intervention, and I still have to somehow run next door to the more stable one to do my assessments or give meds or turn. Teamwork is great here, but it's still my patient and I still need to lay eyes on them hourly.

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