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New RN guidance: So I am a Nurse, now what? (Time Management)
Time Management (part one)
This blog is about thriving as a nurse in an acute care setting. Not just surviving, but thriving, it can happen. We will discuss such areas as time management, alarm fatigue, proper charting, and effective communication. First, my background as a nurse:
I have been a nurse for over 10 years
I have my graduate degree in nursing management
I have worked as an RN in three states
I have worked at multiple hospitals in multiple settings
Most places I worked had a patient nurse ratio of 7-8 to one nurse
I receive excellent Hcahps scores as a nurse in the acute care setting
Let us get started in an area I find to be the most important to a nurse, time management. This aspect is so crucial to nursing. Without time management there is improper\ineffective charting (it is rushed and you forgot or mix up things), unsafe patient conditions (bed alarms missed), and poor communication to all. Why do we see some nurses getting their tasks done and leaving on time and others seems to stay hours past their shift (and looked stressed throughout the day too)? The answer is proper time management. Do these tips guarantee thriving as a nurse every day on the job? No, there will still be bad days, but this will help reduce the amount of bad days you experience.
You need to be organized (http://www.sanfordbrown.edu/student-life/blog/march-2014/5-nursing-time-management-tips). Now, that seems to be an easy deduction, if you are more organized the day goes better. Here are some steps to provide a better organized environment at work:
Organize your kardex
Prioritize your day and patients
Take your scheduled breaks
Know the time at all times
These five steps will assist you in getting through the day. Let us break down each item to better understand it. First, remove clutter. IF you have to dig through old papers, messy notebooks, or even a messy workspace, that take time, more time than you think. Start to throw some of that away. If there is an online location for some of the learning papers you are saving, then get rid of it, especially if it is a once a quarter situation. Also, try not to crinkle your papers or have them any which way. Having to organize your kardex and papers takes time, and when you have to do it every time a doctor calls, it can lead to a long, unhappy day. Even having extra stuff on your cart or on your person can lead to delays because you are having to dig through that stuff to get what you need.
Next, organized your kardex. We briefly talked about it and such a way to have the papers in an organized fashion, but there is more. Try highlighting vital information on each of your patient’s kardex. I like to highlight the doctor’s name, room number and patient’s name\DOB with diagnosis. That way when I am talking to a doctor, nurse, or family about the patient my eye catches those items so I can quickly get into and out of the conversation. It also helps you to plan you day too, seeing who need to be first priority in the morning, afternoon, or evening. An example, if I highlight a patient’s name, room number, and diagnosis I can usually figure out in a split second, this patient may need pain medication this afternoon, since they had a total hip yesterday. Plus when I go and get the pain medication I can locate the patient’s name and room number quick, and that saves time. It is all about saving time.
Third, organize your day and patients. Take a look at your patient list, and decide who will need to be seen first, second, third and so on. After report, go see your patients! I see more and more nurses after report go for breakfast or wait in line to get their medications for their patients. That is a waste of time. Waiting in line for medications wastes time. I find while others are waiting in line, I am in each room assessing my patients. When my assessments are done, the line is usually gone and I save 30 minutes of my morning because I choose to assess than to wait. Then I get my medications and give them out. Now I have seen all my patients twice in the morning and had a chance to assess and reassess them too. The more the patients see you, the less likely they are going to use the call light. My next issue with nurses is their defensive time management skills. They wait for the call lights all day and basically play catch up. The solution is hourly rounding. Now, you are thinking, I do not have time for that, and some days that is true, but not most days. I had eight patients, at once, and was able to basically round on all of them every hour. Now, I do not stay in the room longer than a minute, unless they need something. If a patient knows you will be coming back soon, they will hold off hitting the call light. I have seen it work. An example at a hospital I worked at: A nurse was rounding hourly and someone noticed his call lights were not going off. They were impressed, but the truth is, the hourly rounding reduced the call lights. Also, keep in mind when pain medication is due. Give the medication when it is due and do not wait. If you wait, the patient calls for it, and you are caught up in something at that time and delay the medication. If you are going on break, see if the medication is due and give it if they need it. When you come back from break and do not give it, the pain may be so great, there needs to be more time needed to get that patient comfortable. That wastes time! Also, if you can delegate, that also saves time. Someone needs ice and someone needs a medication, you give the medication and see if someone (maybe the CNA can because they are going in there to bathe the patient) can give the ice. Maybe get ice for all your patients at once and move to the next task, be wise with you time, at all times. Patient teaching, which will be covered more in the effective communication part is vital. Teach every time you enter the room. That sounds like a lot of teaching, but not really. I am not talking about getting 15 pages of material and going over it in one sitting, I am talking about phrases such as, “Do not let your pain get so great, let me know so we can keep the pain under control.” That was a basic pain management teaching opportunity that that patient will remember. Some nurses like to think they are teaching a class or tutoring a student when they teach a patient. Most times, those 15 pages and 15-20 minute lectures are lost to the patient, but the quick phrases, they remember. What that means, is you need to know your stuff in such a way you can effectively present it in a short amount time it so they retain it. In closing, patient rounding is a must and think ahead, do not get behind.
Fifth, take your breaks. You are thinking, I have some much to do, I cannot even use the bathroom. When a person gets that stressed, dehydrated, and hungry, they tend to slow down, miss things and waste time. So that missed lunch may have saved you 30 minutes, but in the afternoon you cannot think or react in a timely manner, so you waste three hours while saving the 30 minutes. People who have to use the bathroom and do not, waste time too. All they think about is using the bathroom and they forget things that need to do, and that wastes time too. With the topic of breaks, find an activity that relaxes you on your days off, you cannot go strong like that 7 days a week, you need to unwind, which clears your mind for the start of your next day of work. Clear your mind and save time!
Lastly, know the time at all times. Keep a watch or something that keeps time. By seeing the time you are reminded of what is next and what the tasks of the next hour are. Be efficient and know your time at all times. I hope this helps, it sure helped me when I was learning time management as a new nurse, and it is so vital.