Learning your own time management style is one of the toughest parts about being a new grad. Here are tips I developed after working on an acute care nursing floor with cardiac and stroke patients. I typically had 4-5 patients on day shift and 5-6 on night shift. Report was 30 minutes and ended at 0730 and 1930. On days, I’d be wrapping up charting at 1030 and on nights, 2300 (given that I didn’t get an admission or someone decompensated during that time).
1. Write quickly for report and don’t interrupt with questions – the faster you get through report, the sooner you can start your day. If you do have questions, wait until the reporting nurse is done and then ask. They may answer your questions, they just give report in a different order than you do. It makes report much longer if the person keeps getting interrupted with questions they would have answered anyway. However, do not let them leave without getting all of your clarifying questions answered! That is important for patient safety!
2. If family members call for an update during or shortly thereafter shift change, tell them (or the person who answered the phone) that you will call them back once you have assessed them and introduced yourself. That kind of non-emergent stuff can wait until you see what kind of shape all of your patients are in.
3. Pay attention to time sensitive medications when you’re deciding which order to see your patients. Insulin is a major one, especially if you work day shift and their breakfast tray arrives right after shift change.
4. 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. You would rather be late on one person’s medications rather than be late on 4-5 people’s medications and have one person’s on time.
5. Chart in the room right after you assess, if possible. If you can’t chart your entire assessment, chart only the things that are different/not normal and go back later to fill in the stuff that is normal/the same for most patients when you have time.
6. Do not wait until you’ve seen everyone and attempt to sit down to chart. Rarely will you go 30 minutes uninterrupted to chart, so you might as well do it in the room where people are less likely to bother you. Charting in the nurse’s station = constant interruptions.
7. Save your non-emergent/urgent questions for when the doctor rounds. Things that may have seemed like an emergency in nursing school aren’t so much of an emergency in the real world. For example, if their blood pressure is slightly lower and they have a few scheduled BP meds due at 0900, wait to do their meds until you’ve done everyone else’s. Maybe the doc will round before you get to them and you can ask instead of stopping what you’re doing to page.. and waiting, and therefore wasting time. However, if you’re getting past due time and their BP is still marginal, go ahead and page them or their mid level.
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8. When you’re giving medications, don’t go do something else. Someone may say, “hey can you help me get Mr. Smith on the bedpan real quick?” Let them know you’re in the middle of passing meds to this patient and once you’re done, you’ll help them. Interruptions during med passes are when medication errors occur. Focus during that time.
9. If possible do this: grab your meds, bring the into the room and do your assessment, then give your meds, and when they’re taking them.. chart the assessment you just did. While you’re charting you can chat a little bit and build report. The best is when you can knock out meds, assessment, and charting all at once.
Keep your head up! It’ll get better once you’re more efficient. I can chart an entire assessment in 2 minutes, but that’s because I’ve done it a million times and could probably do it with my eyes closed. Once you’re extremely familiar with the charting system and have a routine of how you go through charting, you’ll get much faster. Managing all of those tasks will get easier when you’re faster at completing them.
I used to dread when I got similar orders to these: Insert feeding tube, start fluids, give 40 mg IV lasix, give 2 units PRBC’s.
I’d freak out because it would take forever to do all that.. I’d have to get the tube, the lube, the tape, find the fluids, the IV pump, the tubing, get 2 flushes, get the lasix, get a syringe, and blunt needle, do a blood consent, fill out a blood request form, send down for the blood, get more fluids, more tubing, another pump..etc.
Now, I could probably do all of that in less than 10 minutes and chart real time.
I promise you, it gets easier. You will get better. You just have to believe that every single day you’re becoming a better nurse.