Typical Clinical Day/Time Management

nananurse14 · Sep 20, 2011

I wish someone would have commented on this post, I am having the same problem, I just had my first clinical and am feeling super overwhelmed and I didn't even give a bed bath! I definitely need some help managing time and planning out the day.

RADIATION_RN · Sep 20, 2011

I'm about one month into level 2 and we have two patients in clinical. Since you only have one for right now I will gear this towards time management for one patient.

I might be wrong about this but since you are first semester are you only giving p.o. meds and injections?

In my program we went the night before to choose our patient. What I did was read and write down all I could from the H&P if there was one in the chart. The clinical site we were at last semester had EMR so everything was at our fingertips. Once I got a good basic understanding of the status of the patient, ie. if they were ambulating, foley, diet, fluid restrictions, I would start to try and plan my day accordingly.

If you had a patient who needed a bed bath, start doing your assessment while doing the bed bath. What better way to do a complete head to toe assessment than while bathing?? If they are alert and oriented, while doing the bath is a great time to ask questions..."oh how long have you had this sore? Are you in pain?" and so on. In my experience a bed bath does not have to be done immediately. Typically I would wait until after the hectic 0900 med pass and things settled down, then offer the bath. Here is typically what I did with one patient :

0630 - 0700 : Check the chart for any new orders since I saw the chart the night before. Look at the night shift's nursing notes to get a good idea of how their night went. Morning lab results. See if there are any diagnostics to be done on my shift, ie. x-rays, procedures, consults.

0700 - 0715 : get report. Of course this will change depending on how your clinical site does report. Last semester the nurses did face to face door to door report. So we had to be outside the patient room door waiting for report so we didn't miss it. This semester is completely different as the nurses record report on the telephone and we listen to report when we first get on the floor.

0730 : get morning vital signs. This is a good time to spend a few minutes in the room. I introduce myself, tell them what I will be doing for them today, and do my vitals. Once I do my vitals I stay and start to ask them questions on how their night was, any pain, what they want to accomplish today, and so on. I start my assessment right then and there. Listen to lungs, abdomen, check foley bag (if present) ask them about bowel movements. Since the meds were kept locked in my patient's room last semester I would take time and make sure all my meds were there, checking doses against the MARS, and right patient name so when I was ready to give meds with my instructor I knew they were there.

0800 - 0900 : depending on if my patient was on insulin I would keep watch out for the techs to do their morning blood sugars so I knew if I needed to give insulin or not. My instructor wanted us to have the meds, the MARS, and sliding scales readily available when they came with us to give our meds. Totally understandable as they had 9 other students to pass meds with.

0900 - 1100 : If I couldn't get my morning assessment completed I would do this now. Either way, I would do my bath. I never felt comfortable charting my skin assessment until I actually layed eyes on the skin myself. Linen change is done at this time too.

The rest of the day after the morning chaos and my patient was settled, I would offer to help my primary nurse with anything I could. Same with the techs, even though you might feel timid and not comfortable with patient care yet, you can still do vitals. I work as a tech also and can tell ya, sometimes I am assigned 15 - 30 patients and welcomed any help I could get. Trust me, they will be so appreciative and remember you.

Of course others may have different ideas of time management. This is just what I typically did and it worked for me. In nursing you have to learn to be flexible. Even if you plan out your day to the minute, it isn't always going to work out that way. Hope this helps a little.

Pneumothorax, BSN, RN · Sep 21, 2011

in addition to radiations post... try to get your hands on a report sheet so you can have your must know info with you all the time, like vitals, meds due, if you need to d/c a foley blah blah ya know...it will help you out TONS...i live by my report sheet and im always scribbling something on it but it keeps me on track :)

NurseMaybeBaby · Sep 22, 2011

We do pre-clinical before, so I have already looked up the patho and all of the meds. And any surgeries or procedures.

We arrive at 6:30. From there I try and get my hands on the MAR to make sure nothing has changed. I also try and pull the chart to see if there are any new MD orders since the day before.

Once the day nurse gets there, I follow for report. By 7:30 I try to be in the room to do vitals and quick head to toe. From there I try and chart all of the info on the flow sheet for the hospital.

If I'm giving meds, my instructor wants to start that for 8:30. As soon as that is done, or if I'm not doing it, I head in to do the bath. I'm a very chatty person, so I get the rest of my info during the bath if possible. This has not been a problem for me yet. My first patient needed a complete bed bath and was as sweet as pie, so I knew his entire life story by the time I was done. My second patient showered herself, but I was able to get the rest of the info from her no problem.

Then I spend time doing charting and helping others out if needed.

Around 10:45, I get ready to get next set of vitals and give report to the nurse. We are off the floor for 11:30.

I haven't had any time management issues, but I've only had two clinicals. And both times I have followed my patient for some kind of procedure.

Hope this helps, good luck!!!!

NurseMaybeBaby · Sep 22, 2011

Oh, we also have some kick a$$ documents for pre-clinical and clinical that helps us remember to get all of the info we need. Helps out a TON.

hydra10134, ADN, BSN · Sep 22, 2011

NurseMaybeBaby: are these general docs that you could share with me?

hydra10134, ADN, BSN · Sep 22, 2011

Thanks for everyone's reply! I WISH we had the info about our patient the night before. That would be so helpful. I have actually completed 2 quarters of clinicals so far. I will be starting 3rd (out of 6) quarter tomorrow (Thursday). Clinicals start next week. I guess I just need to practice my head to toe so its in my head so I can try to take care of that while I am doin the bed bath. Last quarter, every patient got a bed bath, everyday per agency protocol. Which I didnt have a problem with but they couldve given the patients the option to shower on their own considering they had showers in their rooms. If anyone has anymore advice, I would appreciate it! :)

Nurse Kyles, BSN, RN · Sep 22, 2011

i attached a copy of my favorite report sheet/ timeline. it is for two patients, but some of my peers use it for one patient. they will write report on the left side and their assessment findings on the right. this is set up for a pm clinical, but you can easily change the times for ams. i hope this helps you visually plan out your patient care! good luck! :nurse:

Report Sheet-2.doc

BacktotheBeach, ADN, BSN, RN · Sep 22, 2011

Kylee, love this report sheet! thanks

hydra10134, ADN, BSN · Sep 23, 2011

Kylee, thanks so much!!

kalevra, BSN, RN · Sep 23, 2011

We walk onto the floor and our names are listed with what room numbers/bed numbers we are assigned to. For the most part we are on our own and if we have questions we should ask our clinical instructor, coming up to her without first thinking through the problem and trying to trouble shoot it first is a huge no no. So here goes a typical day.

0600-0700: Walk onto floor check and check the roster. Grab patient chart and start reading through MARS, History, Diagnosis etc. Start filing out our care plans with the information on hand, including the 12 pages of meds the patient is one...yay.

0700-0715: Receive report from outgoing nurse. Introduce yourself to patients and to incoming nurse you will be working with.

0715-0730: Get vitals from patient. Perform your assessments.

0730-0800: Breakfast is served. Assist them if needed, but don't baby them. If they can feed themselves then let them, we are not to trying to make them reliant on us to do their regular daily routine that they are well enough to do at home.

0800-0900: Ask if they would like to freshen up. This is where bed bath, shower assistance, bed change etc comes in. This is also where you can put in one on one face time with them making sure they know someone is always nearby.

0900-1300: The rest of the time is split doing random stuff that pops up until we go to lunch at 1300. Random stuff can mean scheduled finger sticks, med pass, butt wiping, walk them up and down the floor, talking to them, helping out other people with their patients, whatever pops up in general. At 1100 I perform my second set of vitals and assessment.

We also have to turn in our care plans everyday to be evaluated by our instructor and how well we did our jobs that day. She will also make her rounds and ask us for updates on our patients. We fill her in on her disease and what our primary focus is on, she will also ask us about lab results and how it applies to the patients condition. It is very much frowned upon to not have answers for her when she asks about your patients. She will answer questions but you better have a firm understanding on what is going on, by doing your research prior to asking. Deer caught in the headlights scenario is definitely not encouraged.

I try to get most of the time consuming work done early in the shift. Afterwards its just monitor until something else happens. Realistically I don't spend hours on end talking about their family and stuff, most of the time the meds knock them out anyway. Looking at the RNs on the floor, they don't spend all their time talking to patients either. They have other patients and tasks to perform, so I emulate their routine for when I am out in my first acute care facility.