When will I ever get time management?

BSNbeauty, BSN, RN · Oct 21, 2014

Time management will come with time and experience. Have you tried starting your med pass earlier? If meds are due at 0600 start around 0430-0500. Cluster your care. Prioritize and use your CNAs to help.

Wave Watcher · Oct 22, 2014

You're not a failure. You're a nurse. :-) Time management comes with...well....time. I bet in a month you will have a pattern down and knock those meds/procedures/admissions right out of the way!

LordErrorProne-RN · Oct 22, 2014

what i find most new nurses try to achieve is a strict routine. that is honestly a giant mistake in my opinion; if you make a rigid schedule for yourself you end up setting yourself up for failure. the best thing i find is make a very general guideline for your day. if you don't leave enough wiggle room then it all falls apart when u get an admission or when your patient goes down the tubes. when i plan my day i seperate it into thing i MUST do and things i should do and things that if i do would be icing on the cake. musts usually include meds dressings dr orders and the such. shoulds usually include showering, teaching etc. and extras are like talking to the pt and their family, doing things that nursing school tells you to do therapeutic touch just things that you can do when u have extra time in your day. if you organize your day like that then when u get an admission you cut out the extras and when your pt goes down the tubes you cut out the shoulds. when you have to cut the musts then its time to look into drooping some patient load cause you cant cope like that.

OneDuckyRN · Oct 22, 2014

You'll get there! I don't think time management is something that can really be taught. 7 patients are a lot to handle. Here's how I get through my night - keep in mind this might not exactly apply to you, depending on how often you have to do assessments and vitals, and what your patients need. I work on a medical stepdown floor that also takes ventilator patients, MOST of the patients are on telemetry, everyone gets VS/assessments q4, and nurses have to do all their own VS.

7-7:30ish: get report on everyone (realistically this takes until about 7:45).

7:45-8ish: look at my patients' work lists and print off my first set of tele strips.

8-9: First round of assessments/vitals. Prioritize according to what I learned in report, or just go in room order if nobody needs to be prioritized. I usually plan about 15 minutes per patient for this first round.

9ish: Start med pass: I combine any 8, 9, and 10 meds unless contraindicated. Unless someone has immediate medication needs or has things overdue, I usually start with the person who has the fewest meds and no problems taking meds. If I have a trach/vent patient, they also have a feeding tube of some sort, and I save them for last because they will take the longest. This person is the most likely to have meds passed late, but the same thing probably happened on days so it's not as big a deal.

As long as all my other patients are OK for a while, when I go into my trach/vent room to do meds, I go in with plans to be in there for a while. I do meds first, then I do trach care, then I change out the Kangaroo feeding pump bag, formula, and supplies. Because this patient is more time consuming, and I'm probably late with meds, I will combine, 8, 9, 10, and 11 meds on this one.

I should be done with all of this around 11pm. This gives me time to catch up on charting, take my turn watching telemetry for a while (no, we don't have centralized monitoring at my hospital, sadly), and help anyone who needs it.

12:00 - print next set of tele strips, VS/assessments. Lunch sometime after this is done. Maybe have some IV abx to hang.

4:00 - last set of tele strips, VS/assessments. Watch some more telemetry. Fill in care plans/patient education done during shift.

6:00 - weights, IV totals, foleys, feeding volumes, anything else I need for I/O. Yes, my PCT should be doing weights and Foleys, but the weights especially get missed a lot, and I've been chewed out for not making sure they're done, so I've taken to doing my own. I probably have a few IV abx and early morning meds to do during this hour too.

The holes in the schedule usually get filled up doing q2 turns, and unless my assignment is already full, I will get an admit somewhere in there too.

This schedule took me a long time to get the hang of...the bottom line is that you have to come up with what will work best for you, as long as you take prioritization into account. Good luck...you can do this!

blondy2061h, MSN, RN · Oct 22, 2014

A habit I have gotten into that has been tremendously helpful for me is getting report, then quickly rushing to the supply room and getting all meds and supplies I think I'll need for the whole day stocked on my cart. I'm not sure if you have carts, push computers, or anything like that you can stock. Then I go back and look up unfamiliar meds, review orders and vitals from the previous shift, etc, while other nurses are getting into the supply room.

I beat the rush gathering supplies and eliminating the back and forth trips to the supply room saves tons of time.

RNnewbie2014 · Oct 22, 2014

Thanks for the encouragement! I just feel overwhelmed at times. It's nothing like nursing school that's for sure. We didn't have but 1 tech this weekend and honestly she doesn't like to do anything or isn't speedy about it at all if she does need to do something which frustrates me greatly. I have had quite a few people with a peg tube and did usually wait for them to be last because of how much longer it took. I guess it's the patients that want to chat all night and I just can't! Breaks my heart too. They will just be complimenting me and just being so nice but I have a hard time evacuating the room. I am generally not a mean person at all. We have computer on wheels but our narcotics are in a McKesson which is generally what I have to go in and out the med room for. Most pts are on Dilaudid 1 mg every 2. I feel like I get better then i get two admissions back to back and feel like I'm drowning. I'm slowly learning the tricks at getting quicker but I feel like it's just taking me longer to catch on. I think I am just gonna start passing meds earlier if I know they aren't harmful to give out. I try to help day shift out too when I see something due at 730 that I know I can give. Oh and our tech is bad about doing our blood sugars late so by the time I'm at my last pt given out 2200 Meds the blood sugar popping up high! We are under a new sliding scale too which is giving 1 unit of humalog at bedtime if pts blood sugar is above 150 which drives me insane!

**NickiLaughs, ADN, BSN, RN** · Oct 22, 2014

It takes a while. Everytime I went to a different specialty it took about 6 months to feel confident enough to handle it or feeling as though I could survive there. After about a year, you feel better, and feel more confident, heck you might even have time to help others sometimes.

And as time goes by it gets even better, but every once in a while, no matter what you will have day throw you for a loop, but that's where the learning comes in. :)

firstinfamily, RN · Oct 24, 2014

You are giving yourself a schedule that will help you stay organized and give you some structure to your day. It does take time to get the system to work for you. I get frustrated with all the interruptions and it seems it is hard to get a rhythm in my shift. There are certain things that have to be done and those get priority. The patients come first no matter what else is going on. Taking care of 7 patients, sometimes 8 is a daunting task. You will continue to improve your skills and time management will come, but it does take time.

anon456, BSN, RN · Oct 24, 2014

Sometimes you have to complete bits and pieces of the tasks if you have a lot to do in a short amount of time. For example you have meds to pass and an admission. Pass as many meds as possible before admission gets there. When admission arrives, do an assessment, a quick intro, tuck them in (assuming they are stable) and explain you will be back in awhile to finish getting them settled in. Then pass the rest of the meds and come back to do more admission. It sometimes takes me 3-4 trips into the new patient's room to complete everything (or more) and that's okay. The deadline is on the meds, not completing the entire admission. In a perfect world we could all be efficient and on time with everything, but we don't live in a perfect world. Nursing is controlled chaos and constantly prioritizing tasks based on safety and need.

HouTx, BSN, MSN, EdD · Oct 24, 2014

I have found that time management is an outcome... it will come with the ability to prioritize and multi-task. There are just too many 'one of' tasks in any nurse's day & trying to handle them in a linear fashion is nearly impossible. Experienced nurses see things in 'patterns' or 'clusters' rather than as individual tasks.

Like experienced waitresses, they never enter a patient room with only one task in mind - checking IVs, drainage collection, comfort/pain, dressings.. etc. - while checking VS at the same time. They're documenting while talking to the patient to conduct education, provide information or check understanding. They have 'stuff' on hand/in pockets before they enter the room rather than having to dash down the hall hunting & gathering.

As additional tasks arise (more orders, changes in patient condition, real-time interruptions, etc), experienced nurses automatically prioritize in order to determine how to modify their work plan. Does it need to be done NOW, within a couple of hours? By the end of the shift? Can I pass it on to the next shift?

Don't worry, You'll get there in time.

RNnewbie2014 · Oct 27, 2014

Crazy at this may sound, I've had 6 patients this past week and admitted someone and charting was done and everything on time. I feel like I am getting better each time. I have just decided blood draws will have to be started earlier because I feel like before I wanted to draw blood plus pass meds and I was not guaranteed that the patient was going to be a simple stick! I am having to get use to the whole feeling for the veins and not counting on sight. I'm generally pretty good at it but have my off nights I guess you could say. I am learning so much really and I love it. I guess that's why I really like my job even though it's really difficult at times I like that using my brain critically is imperative. I love talking to my patients though and that's the only part I don't like about having 7 patients. I just can't talk to them all night although some of them I would love too..