Working smarter, not harder?

[frenchtoastwaffles, BSN, RN]

Hey everyone,

I recently changed jobs from subacute rehab to tele, and I'm having a bit of a hard time managing my time when there are so many different things going on. There are different goals of care in rehab than in the hospital, and my previously successful methods are not working in this environment. I feel like a new grad again, and it is a little bit overwhelming?

What tips do you have to work smarter instead of harder in acute care at the bedside?

How do you organize yourself to make sure you're not missing anything? How do you successfully cluster care?

I'm asking nurses on my unit about this as well, but I figure I'm not the only one and this thread might be helpful to others too ?

Help!

[JBMmom, MSN, NP]

You can be successful in this transition, try to break it down in manageable chunks. First, you probably had more patients in a rehab facility and you weren't as focused on each of them. Do you have a good report sheet? With the proper set up at the beginning of a shift, you can easily see at a glance where you need to be at certain times, barring unexpected occurrences (which will happen often). Write down med times, important things you know are coming (tests off unit, timed treatments), and focus on one thing at a time. The clustering of care takes time, you will keep improving over time. Good luck!

[subee, MSN, CRNA]

Tincture of time. You're back to the bottom of the curve and it's not comfortable.

[BSN-to-MSN, ADN, BSN, RN]

Hi, I work on tele and stroke unit, here is my process.

I use the same report sheet as my unit. In the morning I make 4 copies of a blank one, then get my assignment. That way I can write whatever I need on my sheets. Look up names, then vitals, write down, then any resulted labs for the morning. Lookup meds and write those on the opposite, blank side of report. For all 4 patients. If I'm still waiting for report ,look up h&p. Most of the time only 1 or 2 before report. Get report, get Tele strips asap, interpret, finish looking up h&ps, labs are still coming in.

8 o'clock, the real *hit starts. See the sickest first, do assessment, address immideate needs. Let sleeping people sleep in the morning as much as you can, that's the beauty of the tele monitor- you can tell they are alive!- unless they are Neuro check. Start charting assessment in room. By 9 am, everyone wants their meds, bring in meds, do assessment, give meds, start charting in the room. People call you, tell them you are with the patient, so you will do what that person wants next.

And people will take your time with the patient away. If they ask you a favour, respond that after you finish what you are currently doing, don't jump to do it right away, unless it's an emergency of course.

I also came from snf and it took me a good 6 months to adjust and develop a system, you will too! Best wishes!

[AlwaysLearning247, BSN]

It definitely is a change but the more shifts you have, the more comfortable you will become. I always get to work a little early to get my assignment and look up my patients and their orders. I always review and print out a tele strip at the very beginning of my shift so I know if anything has changed during the shift. For time management I always make little check boxes, if I have 1600 and 1800 meds due I’ll group them together at 1700. I find that making lists for when the blood sugar checks, meds, treatments, etc are due I’m able to be more organized.

I find that looking at the notes from when the patient came in, any reports on diagnostic imaging, and the latest progress notes really help. I’m able to let my patient know their plan of care at the beginning of the shift and update the whiteboard in the room.

Good luck!!

[myoglobin, ASN, BSN, MSN]

I have worked Med/tele, PCU, overflow (which combines those plus Psych/Baker Acts) and mainly ICU. I'm pretty "ADHD" and a mechanical moron, but these are the things that have helped me the most:

a. I try not to leave the room (the first time) before completing/charting an initial assessment. However, when working Med/tele this isn't reasonable so I add a "status check" first to take care of Prn/pain, acute situations (pulled out IV's) ect. I cannot relax at all until that initial assessment is in place.

b. If you can manage nights, it is less hectic than days. Less family, and less management (and more pay). I've known many nurses who worked 4 days, who were able to make it on three nights due to the extra pay.

c. If you can work "three in a row" it helps a bit, IF you work at a unit that prioritizes giving your patients back. This is because you "get to know them "at least a bit and this foundation of knowledge is quite helpful.

d. Around two hours before the end of the shift start "getting your head together" with regard to report. You will probably want to be a bit more detailed than in rehab/LTC, but tele nurses usually just want the "down and dirty" although you will sometimes get that nurse who thinks she/he is at the Johns Hopkins CVICU getting report on the President. This is problematic when you have six, seven or even eight patients to care for.

e. You will usually be in "triage" mode if you have a six, or more patient assignment. Think who must I respond to first in order to keep them from becoming a rapid response, or a fall. Then think about who has priority meds/treatments (say colonoscopy prep for example). After this comes your "care wish list" things you hope to do (Picc line dressing change), but may or may not accomplish. Remember while the "bend but don't break" strategy is lousy for the NFL is it the backbone to survival in Med/surg. That is to say when you get behind, and things go wrong, keep "working the plan".

[StevieRay BSN RN]

The transition can be difficult, but isn't impossible. I work on a cardiothoracic/tele unit and some days are better than others. Some days I clock out with my head spinning and others, I leave feeling accomplished. We are severely under staffed currently but my manager does everything in her power to ensure that the daylight nurses only have 4 patient's each..and 5 if we are truly desperate & have exhausted other options.

I agree w the other user who mentioned coming in early. That was one of the biggest things I did that seemed to help start my day off on a better foot. We make our own report sheets, but I usually come in at 06-0615 & begin looking up my patients. I write down all their med due times (and cross them off as I complete them later on). I write a few quick notes about who they are consulted to, who the attending is, what brought them in, any lab/testing results, any scheduled procedures, and whether they are accuchecks. I also write down on the back of my report sheets anything that I need to remember to do, any orders I need to obtain when the physicians start rounding, chest tube dressing changes, neurovascular checks etc.

I then go to the omni to pull my morning meds. Then I prioritize care. If I have two patient's in the same room, I'll go in, take V/S, do my initial assessments, chart them (if I have time) then I'm usually able to begin passing meds.

We get a lot of CABG/Cardiac cath/TAVR/VATS patients. As well as, Amiodarone, Tridil, heparin & cardizem gtts...so I always try to prioritize my day based on how stable my patients are. If I know that the ICU will be bringing me my post- CABG pt who was a difficult intubation, I may ask another RN or my charge to grab my accuchecks while I assess that pt.

I'm super lucky to work on a floor where everyone works as a team. On nightshift, when one of us gets an admission, there is ALWAYS another RN in that room helping us with V/S, monitor placement, etc.

I truly wouldn't be able to handle most days if it weren't for my charges, aides, and co-workers.

Keep trying different methods and routines until you find one that works for you. You'll do great in no time!