Time savers....please.

I have been working Med Surg about 7 months now, previous worked as a LTC nurse for more years than I care to reveal....I'm slowly getting the gist of things...HOWEVER...I am so damn slow....seems I'm always working a half hour overtime...while the other nurses have gone home.

I think part of the problem is with little things that add up to big time consuming chunks...like walking back and forth rather than gathering all the supplies at one time.

If you can share any time saving tips with me I would GREATLY appreciate it, that would be a TREMENDOUS help.

Thank you.

This is an excellent question and since I am a new grad starting med/surg next week......I would love to see the responses! Thanks for asking!

I kept a paper in my pocket with everything I was told in report on one side and everything I saw on the other. For each patient I wrote down in red what I needed to do in time order; I did not include meds on scheduled times but other things like Flagyl IV 2300, dressings I needed to do, misc other things. I could pull out the paper and look down and see what needed to be done and at what times. Often could get dressing done when going in to hang med. Was a system shown to me by experienced nurse and I changed it a bit to fit my needs. Hope this is somewhat clear to you and tweaks some ideas that help.

Stuff your pockets. Buy uniform tops that have large patch pockets in front(kangaroo pockets look comical when full). Most med-surg units have only one supply room and no supplies in the room. Have your needles, alcohol swabs, tape all right there.

With a little experience you will learn which order to do your asessements in. The stable and talkative guy goes last, the sickest first, and the nonverbal bedridden patients in the middle generally.

I'm not sure what shift you work or if this is possible, but I try to group as many activities at once as possible. When I go see my pts, I do vitals, assessment and any med due at that time. By the time that's done, I start my 2200 meds at 2100. If there are 2300 meds due, I wait untill 2200 for those, technically you can do the 2100, 2200 and 2300 at the same time at 2200, as long as you aren't giving a double dose of the same med or something. Whenever I am in the pt room I check the urinal/toilet, water pitcher, blankets, pain, comfort level, etc real quick, to minimize call light use. If you anticipate their needs, they will (hopefully) call a bit less. In the morning I usually do my 0400 vitals, I&O, daily wt and some meds all at the same time.

I continually group as many things as possible, using that "hour rule" to my benefit to save on time. There will always be a bit of running back and forth in floor nursing, its the nature of the beast, but having the supplies you need will definitely save your sanity. Many times when I get rushed I have to physically tell myself to slow down and just THINK for a minute, or I will start forgetting things amid the madness. It may take me a bit longer to get something done but its usually done right the first time if I remember to actually slow down a bit.

Overall I think it just takes a lot of time to work at the pace required. Also, you didn't mention what kind of help, like CNAs, if any, that you have, and what your ratio is. Maybe some of this is just out of your control. If that's the case, don't be too hard on yourself, just do the best you can.

One thing that will really help you is to chart as you go. Don't wait till the end of your shift, or you're going to be spending a lot of time at the end trying to remember things. Also, there's a much greater chance of something important being left out. It's so tempting to put it off till later, but it literally takes about 2 minutes to chart an assessment, and less than that to make a short note.

Something else that helps me is my "brain". That would be the cover sheet I use on my papers. We get a 1-3 page printout on each pt and their orders. I staple them together with my coversheet (8.5 x 11 divided into 5 sections) on top. Mine is very bare bones. It has the room number on the left. Next to that going vertically I write down that pts' scheduled med times - I cross those off as I give them. Under that, I put a line for each blood suger (if the pt is on them). Next to the room number about 1-2 inches away I have the VS for my shift going horizontally across the page. In the lower right hand corner is a box for what IV/IVF the pt has and a line for my to counts when I clear my pumps (e.g. SW PICC or 0.9@75_____________tc). Anyway, that helps me keep track of I&Os. The rest of the space is blank for me to be able to jot down notes. For example, if the nurse I'm following passes something on, like "so and so needs labs drawn and they are an RN draw", or anything else out of the ordinary (we don't normally draw labs on my shift), I add it as I go. And cross it off when I'm done. It really helps me to stay organized and on track, and make sure I don't go home feeling like I'm forgetting something every time!!!!!

Hope this helps, and good luck!

All suggestions above are good. Also try not to get side tracked. Its easy to go in the room for one thing and pt asks for tons of other things someone else can do or it can wait. I get report, and I put all info including vitals and new orders on one paper. too many papers can distract you. report in black, new orders in red. use front and back. then I just eye ball my pt to make sure they are ok. then I look at labs and go start meds. do assessments when you go in to give the morning med. look at your paper after each pt to make sure you are not forgetting anything. I think once you get down the pattern that you like it will be much better. dont be hard on yourself. we all were slow at first. good luck

Multi-task. While a pt is in the bathroom, I'll do the bed, get fresh ice water, even do a quick charting. Ask pts if they need anything else before you leave the room, and tell them when you will be back to check on them again. On an evening shift, I'll ask people in the early evening if they like hs sedations, pain meds at hs. This saves me running back and forth. On a day shift, I'll set up pt A in the bathroom, get them started and then move on to Pt B. By the time Pt B is set up, Pt A is ready for me to do the areas they can't do. By the time I'm done with Pt A, Pt B is then ready.

Prioritize - in the am, I'll give my meds and set up the pts who can eat independtly first, then go to the one that needs to be fed.

I also use the alarm on my watch - if I have a med at an unusual time, or a pt that has to be somewhere at a certain time, I'll set my alarm so I don't lose track of time.

Tag-team, If you have someone that requires the care of two nurses and someone else also has a similar pt, agree to help each other - "I'll help you with Mr B , then you can help me with Mrs G"

Thank you all for your insights, and thank you all who will reply later....this really helps

I really love the above suggestions. I may be repeating a bit, but here are some of my VERY simple tips:

- Make up some sheets at home with information like "miko" said. Print a few out each day, and carry them around in a folder or clip board. This will not only help you, but if an aid or doctor needs information, it's right next to you and you do not have to run around looking for information. Use this as a second "chart" for yourself.

- As said, do several things while in the room. Asses anything and everything while you're in there (not medically, but things such as comfort level, water, temperature, etc.). Be sure to ask the patient if there is anything you can do for them.

EX: Enter the room. "Hi Mr./Mrs XXX. I'm just here to check your heart and blood pressure and help you with anything you may need right now". After doing this, check the water, confirm that the patient is comfortable, make sure the temperature is okay (I find it works best if you ask the pt if specific things are okay, since they may not be thinking of something at the time you're in the room). After you're all done, chart what you need to, ask once again if they need anything. Thank them and get on out.

- When you're doing your medications, be sure to ask the patient again if they need anything. Don't just "Okay, I'll be back at 6 for your next medications" - they may want to say something but know that you're busy. Answer any questions or fix anything while you're in there. This saves time so you don't have to run back into the same room when you're half way down the other end of the hall.