Tips and Tricks for an efficient shift

SCSTxRN · Jan 27, 2013

When I worked med-surg, a life saver for me was a brain that I made - I had 7 columns, one for each patient. I had last name, room number, and then I wrote times for scheduled PO meds on left column and IV meds on right column. I wrote if they were FSBS and put myself two blanks for that (I worked 7p to 7a). If they had prn pain meds other than tylenol, I wrote the name and when next available (from report).

When I made my first nursing round, I short handed the entry on my brain and did my flow sheet assessment, then hit my 9pm meds, reviewed any LVN assessment, then charted everything, midnight lined, midnight meds, charted everything, 0200 rounds, charted ... so on and so forth.

I checked things off as I did them, filled in the blanks as it got done, and highlighted charting as I entered it into the patient record. If things came up that could wait an hour, I'd write it on the brain and go back and check it off when it got done (assuming I couldn't do it right then). I also gave report from my brain. My paper brain saved my real one. :)

The nurses that I worked with were all more than happy to give me the outline of their brain, and I tried and worked until I found the outline that worked well for me.

RNperdiem, RN · Jan 27, 2013

Get off to a good start. If there is time, do it now.

Really push through the beginning of the shift getting the assessments and first rounds of meds done and charted.

Once this milestone is passed, I find I can handle anything else that comes up.

mappers · Jan 27, 2013

I agree that your "brain" is key. Mine was a chart with pt names down the side and hours across the top. I would put meds, dressing changes, accuchecks and other things that were time sensitive into this chart. Then I could get a good look at my day, when would be busy with a lot of things due and when I had possible free time. I could then plug those non-time-sensitive things into those free-time slots. Plus, if something unexpected happened, I could take a look at my chart to see where I was when I was ready to catch up. This chart was always being edited as the day went on and orders changed.

The other side of my paper was divided into 8 squares, one for each patient, where i could keep notes (Usually had 6-7 pts). You knew it was a bad day when I needed a 2nd brain because of all the DCs and admissions. I also had an assessment sheet where I could circle things, jot down abnormals, etc on each patient. My "brain" was folded in my pocket at all times. The assessment sheets, I might have left on my clipboard at the nurses station on occasion because it wasn't as vital at all times.

MicMcRN · Jan 30, 2013

Thank you all for your comments I really appreciate the insight.

msjellybean · Jan 30, 2013

Get off to a good start. If there is time, do it now.
Really push through the beginning of the shift getting the assessments and first rounds of meds done and charted.
Once this milestone is passed, I find I can handle anything else that comes up.

This. try to assess & chart on two of my four patients before 8am. Then I assess and pass meds on the remaining two sometime between 8 and 9am. I then do a med pass for the first two patients and then finishing up the second set of assessments. Having that big chunk of charting done by 10am means that I'm in for a smooth day.

mappers · Jan 31, 2013

I was usually able to get my meds and assessments done by 10:00 as well (Med Surg 6-7 pts). I could usually have most of my charting done by 11:00 (assessments anyway.) The only part of the assessment that might not be done was head-to-toe skin on a bed-bound patient. I worked with the PCAs to do it with them when they did a bath or a clean-up, so it might not be at the same time as the rest of the assessment.

DedHedRN · Jan 31, 2013

Effeciency will come with experience, it always does. When I was a new nurse, filling out a incident report for a fall could take me an hour, now I can do one in ten minutes or less if I'm in a hurry.

anotherone, BSN, RN · Jan 31, 2013

i work nights med surg. i go in 30mims early ( i know i do not get paid for this time and many frown on this, but to me it is worth it, if i dont my anxiety is through the roof). i look up all of my patients charts for orders, what meds i will be giving, labs, last set of vitals and last few drs notes. then i get report. if a pt is really unstable i see that one first if not i go to the one ringing first or if none are, the easiest pt with his/her meds. i go in and assess them and give meds . easiest to hardest. faster to go in assess a walkie talkie and give them a few meds than to go in to the turn repo , incontinent, peg tube meds and a trach. this way at least one pt is done with. i might even chart on this person right awAy as i can chart super fast ( emr). lately i have come on after report and quickly introduced myself to my pts saying , "hello, i am anotherone your nurse for tonight. i will be back with your medications and to do an assessment. please ring your call bell if you need any thing before then" some shifts are awful from the start and you never get caught up. comming in to 4 pts, one needs blood . now pacu is calling report and a whiny post op with 546 family members. etc. i just try to remember it will end sometime

mitral · Feb 1, 2013

i love this question and the answers so far! I do as others have said for the mornings, makes the rest of the day a lot easier. Now I just need to figure out how to speed up my admissions, they take me sooo long and kind of throw my little brain chart system... I tend forget to check the new ones but I will get there! Also I try to do documenting as it comes along- its fresher in the memory and easier in little slices, too.

Tarabara · Feb 15, 2013

Group as many things together as you can. For example, its now a habit for me to check if my patient needs more water or another blanket or anything if I'm leaving the room for something else so that I can grab all things at once. Also, our policy is we have a 1 hour window before and after med times to give the med. So if the pt has an 1100 and a 1230 med I can give them both at 1130 and save time.

Also write down EVERYTHING, don't just assume you'll remember. That's something that I had to learn.

mitral · Feb 16, 2013

Beautiful advice, thank you!!