Time Management Tips

[marmaduke]

Hi everyone,

I am a new grad who got my first job in October, so I have about 6 months experience working as a nurse on night shift (4 off of orientation). I work on a ~36 bed general pediatric med-surg floor, so we see a wide variety of patients (3 days old to 18 yrs old), and our unit census can vary widely (some nights we are full and get loads of admissions, other nights we have only 10 pts on the floor). I feel more and more like I am getting the hang of things and feeling more competent in what I am doing and getting in stride (although still sometimes go home feeling dumb). My biggest problem seems to be that I never seem to have time to chart and often end up staying late to finish up my charting bc whenever I sit down to chart I end up getting an admission, or one of my pts needs something, etc.

Because I am new I think I am slower and take more time to do things than more experienced nurses, and I am also a perfectionist so I probably worry about little things too much and therefore take longer doing things. But I often feel like I am running around like a chicken with my head cut off, or at least not sitting down for 5 hours and eating lunch while charting, whereas other nurses might just be sitting and chatting and take their full lunch break. I also tend to spend a lot of time in pt rooms, rounding and making sure that they have everything they need, and talking with pts and families/explaining things to them.

I don't want to be learning bad habits i.e. to cut corners this early in my career, and I want to make sure that I do a thorough assessment of all of my patients (i.e. actually count the respirations and HR not just look at monitors, check med doses, etc.), actually going into check or explain when the monitors alarm, answering call bells promptly if a tech or other nurse is not available, and I usually write detailed nursing notes, probably with more information than necessary (although our hospital requires them every 8 hrs anyway). Still, I don't want to get in trouble with management for staying late, or be judged as slow by all of the day shift nurses, and I want to have my charting done early so that the residents can look up the information they need before they round on the patients. I know it is probably best to chart right as you are doing something, but I just don't understand how I can sit and chart a full assessment and note on one patient at the beginning of the shift when I have three other pts who I need to see first to make sure they're ok, and might need meds/etc (which I sometimes see nurses do).

Any advice would be greatly appreciated!

[NightOwlPsyRN]

I think a few things could be considered to help you with time management.

1) A timely "brain". - When I was doing med/surg clinicals in nursing school and was given a full patient load during my capstone rotation, I made a custom "brain" sheet. I'll try my best to explain how I did this! I used legal paper and organized it so that every hour of my work day was sorted on it, along with slots to for me to write the patient's names and background info. I would go into shift a little early to find out what patients I had, look them up to see their background and treatment, and write it in. I would then write each vital signs time, med pass time, other miscellaneous interventions according to the hours they are scheduled on my sheet. When listening to report I would make notes and jot it down. After report is finished, my brain sheet gave me a good overview of what the day is going to look like, how to plan my time with each intervention so I don't fall behind with another patient. I would also reserve chunks of time according to what time was available on that sheet for charting.

2) Delegation. - Remember, you work with a team and realistically cannot accomplish everything on your own (as much as I'm sure you would like to!). If you are in a bind for time and techs or a fellow nurse is available, delegate it to them, just make sure you provide them with any pertinent information necessary for that task (and of course, make sure it's within their scope of practice). I know NCLEX teaches us not to "pass the buck", but if there's another patient that needs something of priority than another patient, delegate!

[VANurse2010]

Your charting is just as important as patient care - unfortunately. When you sit down to chart and your patient(s) start hitting the light, delegate to your CNA. It is not appropriate or really safe to save all your charting for the end of the day. What if your patient codes at 1500 and you don't even have an AM assessment charted? Doesn't look good.

[BlueDawnRN, BSN]

I've been working for 6 months also, on a tele floor, and also find it is extremely hard to get charting done, for the same reasons. Sometimes I wish I could just barricade myself in a room with a computer.

I also frequently answer call lights for patients that are not my own, or do things that would normally be delegated to a CNA because there simply are not enough CNAs to answer all the call lights and toilet everyone. I would delegate, but there are no available CNAs to delegate to, and I'm not going to let someone lay in bed with a dirty diaper. Also, if you're the one sitting at the nurses station charting, you're the one who will be asked for help to turn someone, grab something, answer a call light etc. because you're "just" charting.

Being a new nurse, I also need time to look up stuff on my patients so I can understand what's going on with them and be able to give a good report in the morning, which takes time.

So I don't really have answers for you, but I hear you.

That being said, I don't often stay late to chart, but I do sometimes. It helps me to have a brain sheet. This way I can jot down in a short hand form my assessment as I do it, to refer to when charting which saves time. I'm also realizing I don't need to write a book report when I chart, I can keep it concise. I'm trying to learn to anticipate what will be needed later, such as by bringing in a fresh water with my meds regardless of whether the patient has some water, hanging a new fluid bag with meds even if it's got a couple hours worth left, making sure there's diapers & pads in the room with my incontinent patients, putting an IV sleeve on my dementia patients so they are less likely to pull it out, etc. Sometimes it helps.

But it's still hard!

[motor_mouth, MSN, RN]

Another person who uses a "brain sheet." It not only gives me a list of what I need to do for each patient, but also reminds of things during charting. "Oh yeah, I need to chart that the wound dressing was dry and intact" type of things.

[toERortonot]

learn short cuts and start delegating.

[thinwildmercury]

I am new too, although not as new as you... here is what I've found to help:

Realize that a patient can wait a few minutes for a juice or a pillow. It's so easy to think "I'm just gonna do one more thing and then chart!" but you need to let the unimportant things (or rather, less important) go for a while so you can have your charting completed.Also realize a colace can be 30 min late if that will help you chart for those 30 min. If appropriate, I will give my morning meds due for 9 at 7 when I do my assessment and for pts who need help, I offer to toilet them at that time as well. If they need to go I will attempt to delegate it but if the aides are busy and I need to be in the room and wait for the pt to finish toileting, I stand there and chart. I also take care of any pain or nausea.

I, too use a brain sheet and organize it by hour so I can see ahead of time what meds or tasks are due and that has helped me "cluster care" a ton! I was so frazzled when I had just started out because I'd make 10 trips to my patients room in an hr due to not foreseeing things that needed to be done in the near future that could have been clustered into one trip.

[thevez]

The NUMBER ONE reason for me that made me do overtime due to charting is because I HELP TO ANSWER CALL LIGHTS OF OTHER NURSES EVEN THOUGH THEY ARE FREE. So what I did is I answered the call lights and DELEGATED to those nurses or if the CNA is not so busy, who are free and whose patients are calling. Sadly, that's how it is, don't feel bad. You will get the hang of it. Keep it together!

[lorichka6]

I don't have much more experience than you but I was in the same exact position (in peds too :) ). Here is what has changed and helped (though I'm still the one who never sits down...). Some of these may seem really stupid, I had no clinical experience prior to my job and had a preceptor with tons of experience who didn't need brain sheets, etc to make it through her day!

Brain sheet - used well. For example, when I had hourly I/Os I'd always be checking to see which hours I had charted. It took me 4 months to realize that if just crossed that hour off of my brain sheet I wouldn't have to go back into the electronic chart to check. Duh. So now as I chart I "x" out that hour on my sheet. I'll still glance at the end of a shift to make sure I didn't skip an hour by mistake but not double and triple checking all that charting helps. Same thing for all the other random charting - I have 4 letters (Q, A, P, N) for the hospital specific charting that is required each shift - pt classification, assessment, nursing note, nutrition assessment. I cross them off as I do them - again, I spent a lot of time checking "did I actually write the assessment for this kiddo...?".

Getting better at chunking care. I used to always forget to bring the 10AM meds in with the 9 AM meds... I was so "in the moment" I didn't look ahead. Got a baby who has PO meds? Try to give them with feeds - 10ml of formula in a bottle with the meds and then the rest of the feed. If its something like a vitamin and the admin time is flexible don't go in twice - chart it as not on time because it was given with meal/feed.

Do you have computers in the rooms? Sometimes doing a daily assessment while you are in the pt room helps because then when you realize they looked like they had increased WOB with subcostal retractions and accessory muscle use but you can't remember if they actually had nasal flaring you don't need to walk back in to check.

Delegate. Its ok. Don't sit on your ass looking at FB on your phone and delegate - but if you need to chart or see another pt - delegate - its ok. When you get better and have some free time help the assistant staff out - offer to do vitals, get equipment, etc - do so.

Don't double chart. If you put in a long note mid shift about something, don't say the whole story again for an end of shift note. Say "see previous nursing note" for the details.

Eventually you will just get faster at things too. You'll begin to learn meds and their appropriate doses and infusion times and what IV fluids are compatible with what meds and you won't need to check all the time.

Just keep plugging away!