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Who You’ll Hear

Kati Kleber, MSN RN – Nurse educator, former cardiac med-surg/stepdown and neurocritical care nurse, author, and speaker.

Elizabeth Mills, BSN RN CCRN – highly experienced neurocritical care nurse, current Stroke Navigator for a Primary Stroke Center.

What You’ll Learn

• Report
• Order to see Patients
• Medications
• Utilizing CNAs
• Tips for Critical Care

Time Management Tips for Floor Nursing

Please note, some of these tips can be applicable to both ICU and floor and even other units

Report

• Write quickly, use abbreviations, ask clarifying questions once they’re done, visualize the patient, look at when lines are due to be changed and plan when to do that during the shift

Don’t take non-urgent calls at the beginning of the shift

• If family members call for an update during or shortly thereafter shift change, have call them back once you have assessed your patients and introduced yourself

Which order to see patients?

• Pay attention to time sensitive medications when you’re deciding which order to see your patients
  • Insulin is a big time-sensitive med given frequently
• Start with your easiest patient’s/least amount of medications first
• Then progress to your most time consuming patients/patients with the most amount of medications last

Do not wait until you’ve seen everyone and attempt to sit down to chart

• Chart in the room right after you assess, if possible

Save your non-emergent/urgent questions for when the doctor rounds, if possible

When you’re giving medications, don’t go do something else

• Multi-tasking while giving meds opens you up majorly for

Possible timeline

• Grab your meds/supplies
• bring the into the room and complete your assessment
• Give your meds
• While they’re taking their taking their meds, chart the assessment
• Ask if they need anything else before leaving the room

Maximize the time of the CNA

• If they’re giving a bed bath, help them turn the patient and use that time to assess their skin
• Help them out and they’ll help you out

Consolidate trips into the room

• Don’t do blood sugars on everyone, then turn everyone, then do meds for everyone
• Do one patient’s blood sugar, turn, and meds in one trip

Tips for Critical Care

Have a consistent systematic routine

• Rarely do things work perfectly, but you need to have a consistent, efficient and comprehensive routine that you stick
• Less likely to miss things
• Use a worklist

Chart in real time as often as possible

• Chart only the abnormals if you don’t have time
• Creates a timestamp, enables you to go back later and fill in the normals
• Stay on top of it because you never know what will happen and if you’ll have time to chart later

Introduce yourself and educate the patient / family at the beginning of the shift

• Gives them some predictability
• Establishes trust and rapport
• Prevents call lights/questions later
• Explain monitor and alarms at the beginning to decrease their anxiety/call lights

Stay ahead, anticipate, and prepare

• When you’re caught up on tasks, don’t kick it… chart
• Anticipate issues (this gets easier with experience) like potential procedural hypotension after conscious sedation is administered, diuretics in between blood products, pain meds timed with therapy
• Prepare for things to change (like patient assignments due to incoming admissions), have rooms ready for last second admissions, make sure you have the meds you need
• Bring things in the room that you know you’ll need at some point

Be meticulous

• Most nurses in intensive care have Type-A personalities and are meticulous and detailed
• If you don’t care about the details, you can miss something BIG and it would be your fault

Prioritizing

• ABC’s!
• Nursing is a continual process, sometimes the smaller tasks don’t get done because you were busy addressing more pressing issues
• You’re not a bad nurse if you don’t get every little thing done

More resources

• Nursing Time Management For When You’re Totally Overwhelmed
• Nursing Time Management Scenarios
• How to Manage Your Time in Critical Care: Part I
• How to Manage Your Time in Critical Care: Part II