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It never fails. You start your day with the best nursing time management intentions. You started your assessments and meds on time (woo hoo!), and then all of a sudden three doctors round at once and expect you to implement their orders immediately. One patient needs to pee, one needs pain meds, lab is on the phone with an alert lab value, a family member is on the phone waiting for an update, and the STAT med you called for an hour ago hasn’t shown up yet.
Good. Lord. What do you do now?
While this may seem extreme, it’s kind of not because all day you will be prioritizing and re-prioritizing. When you think you have your next two hours figured out, something inevitably comes up. The key is being able to re-prioritize in an instant. Learning nursing time management is essential to being a successful nurse.
I will tell you what I do when I find myself suddenly so overwhelmed that I don’t even know what to do next…
Learning nursing time management is a process
You may want to be perfect right away, but that is an unrealistic expectation. Stephan Curray didn’t become a lights-out point guard overnight, Harry Potter didn’t learn a Patronous charm in one session with Lupin, and Adele didn’t learn how to sing like an friggin angel with her first note. You will do things inefficiently. You will learn some things quickly, and some will require multiple explanations and attempts to sink in. You’ll think you have something figured out, then a new doctor comes on the scene and changes things up… please, have patience with yourself and don’t beat yourself up when it takes time to become efficient. Remember, you’re not only learning what to do, you’re also learning how, where, and when.
Stop and take a deep breath
Calm yourself down first and get in control. Don’t just go run and complete whatever task is fastest first… you need a plan to maximize your time.
The first pulse you take is your own.
Think about which patient is the LEAST stable and address them first
Please keep in mind; this is not always the one complaining the loudest. While one patient may be extremely upset that it’s taken 45 minutes to get them their 4 mg IV morphine, your other patient who just had a graft placed with a blood pressure of 192/91 is your priority.
What can you delegate?
If a patient needs to pee and a CNA is available – delegate. If a patient needs pain medication and you know another nurse is caught up, ask if they can give the med for you. Nursing is a TEAM sport. We all are taking care of the entire unit together. That means when you’re caught up, you’re helping others who are behind. Trying to do everything on your own when others are caught up is a disservice to yourself and your patients. You will be running ragged and your patients’ needs will take forever to get addressed. Working together as a team is an essential part of a well-functioning and safe nursing unit. I know it can be hard to ask others to help you, but please do. Most are more than willing to help.
What can you do simultaneously?
If a family member is on the phone wanting an update but you also need to see what meds you can give another patient, look that up while you’re on the phone. Whenever I’m on the phone and anticipating being on hold, I always get by a computer and chart or look things up simultaneously. Consolidating tasks, trips, phone calls, etc. is essential. When you see a patient, always ask if there’s anything else they need before you leave. It’s incredibility inefficient to be with a patient and try to leave immediately without asking if they need anything first, because they will inevitably put on their call light 7 minutes later for something you could have addressed while you were in the room.
Remember that charting is now the last priority
If you do have a second, chart the random/difficult to remember thing, but this matters the least right now. Always chart your medications in real-time, but charting assessments can wait when you’re that far behind. Make notes if you need to, but if you’re running from an unstable patient to a new admit to a screaming discharge, charting is going to wait.
Apologize for being late with things to patients and families
Never respond with excuses – they don’t help the situation (and honestly they can make it worse). Sincerely provide a heart-felt apology even if it was not your fault. Knowing that you are truly sorry for taking so long to get their pain medication (even though you were hanging blood, rounding with an upset physician, and giving an antihypertensive med for a patient with an BP of 238/104) really means a lot to people. Additionally, apologizing immediately can smooth things over before they get rough. Having a grumpy patient or family can make the shift pretty tough.
- Example of what not to say: “Sorry it’s taken so long for me to get here. We’re so short staffed today it’s not even funny!”
- Why this is no bueno: Techincally you’re apologizing, but you’re also telling them there’s not enough staff there to quickly address call lights. While that may be true, it will make your patient and their family uneasy and nervous, which won’t help your situation…it will only make it worse.
- Example of what to say: “I’m really sorry it took a while for me to get your medication. How have you been feeling? Is there anything I can get for you while I’m here?”
- Why this is better: You apologize and acknowledge their concern/frustration immediately and quickly center everything on how they are feeling and their needs.
I know it’s really frustrating to be short-staffed and drowning all day. I’ve definitely been there and it’s pretty overwhelming, even for experienced nurses. However, it’s not the patient’s fault that 3 nurses called out and we couldn’t get the CNA’s we need, so just apologizing to them is the best approach. That frustration and need should be directed towards management, staffing, or whoever would be appropriate in your facility – not the patient, even if they’re really upset.
Remember: it’s a process
Even though I’ve been a nurse for seven years, I still have to remind myself of the above things. Sometimes I get overwhelmed and can’t figure out what to do next and have to remind myself to stop and go through the steps. Occasionally, I have to talk to a coworker… “Ok, I’m really overwhelmed and I’m not sure what to do next right now?” …just talking through it out loud to someone else helps me focus and figure out my priorities.
Looking for more nursing time management help written by nurses?
- The Ultimate Nursing Brain Sheet Database (22 free nursing report sheet templates)
- How to Prioritize When Everything is Urgent
- Episode 011 of the FreshRN Podcast: Time Management
Sharon Schwarz says
Been nursing 43 years and time as far as getting charting done by end of shift remains a problem. You are right, there is no magic 30″ block of time to chart. I am using the tip to open time stamp with the abnormal or the note to the random/ difficult item. It does save time. Tedious does describe some charting functions. Keep encouraging us and keep the time management tips coming!