Time Management Woes!

Graduatenurse14 · Feb 9, 2015

BUMP!!! I think it's ok that I do that on here to get some replies, right??

RunBabyRN · Feb 9, 2015

You've posted a lot of gripes of things that are beyond your control. At least for now. Are there any committees at your facility that you could join to try to help improve these areas?

In the meantime, time to focus on what YOU CAN CHANGE. Look at how much time you're really spending speaking with patients that isn't time for assessment, teaching, etc. We all speak to patients and build rapport, but this shouldn't be getting in the way of your time.

Next, what does your brain sheet look like? How are you utilizing it? One thing that really helps me is taking a moment at the beginning of the shift to write out the times and my patients and everything that needs to be done by what time. I put check boxes next to everything, including one for documentation as appropriate. I use a multi-colored pen to color-code everything. I take report in blue, make my notes in black throughout my shift, underline or write anything I need to pass on to the next nurse in green, and use red for anything EXTREMELY important or for check boxes (red is to be used very conservatively). Lots of good visual cues this way, and it helps me to see what needs to be done when. If I have some time, I can work ahead on certain things, and I can see what is coming up soon that will fit in.

I think it comes down to taking ownership- you seem to blame a lot of outside forces. No barcode scanners? Okay, so what?? Stop dwelling on things like that that you don't have available now. What DO you have? Are you maximizing the tools at your disposal? THAT is what you need to discuss with your nurse educator. Also, if the nurses are all sitting cut off from everything, isn't that risking patient safety? I would ask about that. Call lights not being answered is a safety hazard.

Graduatenurse14 · Feb 14, 2015

Thanks for replying!!

I use a multi-colored pen to color-code everything. I take report in blue, make my notes in black throughout my shift, underline or write anything I need to pass on to the next nurse in green, and use red for anything EXTREMELY important or for check boxes (red is to be used very conservatively). Lots of good visual cues this way, and it helps me to see what needs to be done when.

I'm going to get one of those and try this approach. I am a visual person and use post-its but this may work better!

I think it comes down to taking ownership- you seem to blame a lot of outside forces.

I would respectfully disagree with the assessment that I blame a lot of outside forces. I stated the reality of my workplace but I clearly understand by quotes below that I know that change must begin with me first and foremost.

Me- "but that's not going to happen any time soon so I'm trying not to dwell on those since it won't help me presently!"

Me- "that's not going to change anytime soon either so not going to dwell on it!"

Me- "I need to try to fix me before looking to change other things even if they are contributors."

Me- "I feel like the Serenity Prayer is fitting for this situation!"

Also, if the nurses are all sitting cut off from everything, isn't that risking patient safety? I would ask about that. Call lights not being answered is a safety hazard.

Yes, this is true. My boss sees it everyday and does nothing about it though.

unicoRNurse · Feb 15, 2015

I'm glad to have found this post, so I didn't have to write it myself! I am a new nurse on a busy stepdown unit and I am having trouble managing my time as well; it is so frustrating. On one hand, it feels like "time management" means "wizardry" -- it seems impossible to get everything done on time when things go sideways, yet others seem to manage. I don't know what changes I can make, and I have yet to find someone who can articulate some specific, concrete ideas on how I can improve (I have asked, but believe it or not, "be faster" is simply not a helpful suggestion). I manage to stay mostly above water when things are normal -- meaning we are "properly" staffed at 4:1 and we have a PCA -- but more often than not we are short staffed, having to take more (very heavy) pts, and often work without a PCA. Even the veteran nurses are struggling under those circumstances, and morale is not the highest. I don't think the OP is blaming these outside forces for her struggles; I think she is simply acknowledging the reality of the situation, and recognizing that those conditions have an impact on the training and practice of a new nurse. Like the OP, I freely admit that my newness is the primary issue, and my need to improve my time management is undisputed; tips on how to do that are what I would hope to gain from this this thread.

I spent the better part of a day off making a brain sheet specific to my unit, but I don't have time to fill it out when I'm working. I pre-made dozens of post-it notes with my charting to-do list, so I don't have to write that out for each pt at the beginning of each shift; that saves a few minutes, anyway. I am definitely going to try the color-coded ink suggestion made by the previous poster, as it seems like a great way to organize information so it is more readily navigable at a glance. I hope this thread will produce more ideas -- from color coding notes to how successful nurses organize their shifts, handle occurrences that tend to derail new nurses, and save time.

Thanks to the OP for posting this, to those who have already responded, and in advance to those will respond. I look forward to reading more responses, and to hopefully finding among them more ways to improve my time management skills.

middleagednurse · Feb 15, 2015

The reality is that when you're working, things probably WON'T go well. Not enough staff which is a fact no matter where you go. Your speed will improve with time. Just like running a race your time improves with practice. Just do your best.Eventually your speed will improve.

guest464345 · Feb 15, 2015

For what it's worth (I just finished one year of hospital experience myself, not an expert), this is what I did:

I started coming in 30-40 minutes early to look up my patients. This was the only way I had any chance to glance through the H&P, radiology/lab reports, and progress notes. I skimmed those things quickly and then carefully noted orders for each patient before getting report.

This was helpful when I got report from not-so-diligent coworkers...because I already knew the score, and I could ask informed questions instead of finding out three hours later that something wasn't done, or that there were new findings. And really it was the only way I could ever manage to actually understand what was happening with my patients, before getting caught up in tasks. (I was resentful about this - because of course it was unpaid, and it's ridiculous enough to work 13 hours or more with maybe 20 minutes to scarf down food, without adding another 40 minutes of unpaid work - but for a while it was the only way I could survive).

I made a fantastic 2-sided brain sheet specific to my unit, four patients to a sheet. One side was for taking report/orders and noting questions for the doctor. The other side was an hourly schedule. It had pre-printed check boxes for things we do on every patient every shift - charting an assessment, etc. After getting report I would go through each patient and write in meds due, check boxes for blood glucose and insulin on diabetic patients, an extra reassessment for tele patients, reminder to get an MRI or surgical consent if those were ordered, restraints checks every 2 hours, or whatever extras were needed, in the box for that hour.

That way I could glance at my sheet and easily group tasks. Instead of giving one med at 14:00, running in later with an MRI consent form, and then remembering neuro checks were due, and then coming back again because I noticed the IV fluids were about to run out, and then giving a 16:00 med...I could see on my sheet that those things were close together, and knock them all out at 15:00. I could see that my patient had two different IV antibiotics due at 18:00, and that I was going to have to start one early if I wanted to leave work on time.

The other thing I did....sadly...is let go of the ideas from nursing school. The fact is, you really do have to think about minimizing your time in patients' rooms, especially at first (I remember a preceptor commenting to me that I was wasting a lot of time priming IV tubing in patients' rooms rather than at the desk - "because you end up spending an extra couple minutes talking to them every time you go in, and if you have two patients with four IV meds each you're losing close to 20 minutes" I was horrified, but he was right).

You really don't have much time for the human interaction we all would like to have. When you're in a room, do every single thing you can imagine them needing - bring water, reposition them, make sure fluids don't need a new bag, offer the bedpan, take out the food tray, ask them at least twice if they need anything else, explain you will be with another patient for a while and want to make sure they have EVERYTHING they need for at least an hour.

Your coworkers are in the back part of the unit to avoid answering the call lights. Since they're not answering call lights, they have a better shot of getting their charting done and leaving on time. I will admit that sometimes I charted my assessments in patients' rooms. I actually think it's clinically much better to chart an assessment at the bedside - but I didn't do it for that reason. I did it so that I could get it DONE without five interruptions from call lights.

When I had my own head above water, I never sat at the desk. I answered call lights and helped my coworkers...I would do an admission for coworkers who were drowning...I would offer to start IV's on hard-stick patients, or cheerfully suit up for a code brown. But not until I had my own stuff more or less under control. After it was clear that I would help other people, they started helping me too.

If you are lucky enough to have coworkers willing to help...ALWAYS walk around with two things in mind that someone could do for you. When you're busy and another nurse says, "Can I give you a hand?" it's not helpful to start rambling about how you already have two new admissions and one patient who's total-care. It's helpful to say, "Yes, thanks so much, could you hang my antibiotic in 502?"

It's not the way we'd like nursing to be - hospitals often feel pretty inhumane. Which is why I no longer work in a hospital. "Time management" in some ways is a euphemism for "keeping yourself and your patients alive in a system that's not good for either of you."

Nienna Celebrindal · Feb 15, 2015

You said you need to work on delegating more, I know it can be hard to do when you know you are short staff on NAs. But you have to do it if its something they can do. Does it suck if it means a patient needs to wait a little longer, sure it does, its not ideal but you have to do it. I've been an NA, its hard when nurses give you another task when you are stuck with so much already, but its our job. We know what we can do and not do also. So don't be afraid to delegate more.

Having a brain that works for you is vital.

Figure out where you are losing the most time and focus on improving that first. Good luck!

Curious1alwys, BSN, RN · Feb 16, 2015

I swear nurses must provide 90% of the sales for those colored pens, and the other 10% must be children under 10!!! :)

Otherwise, cross your fingers it will get better with time and go ahead and chant your serenity prayer. Good luck, it is so hard I know.....