June 6, 2017

8 Tips To Mastering Time Management | Bedside Nursing

So you've finished nursing school. Started your first day of real nursing and you are overwhelmed, huh? Feeling like you're drowning and can't catch your breath because someone or something constantly needs you? Does your list of tasks cause you panic? Well, take a deep breath and know this - we have all been there. Whether you're an obstetrics nurse or an intensive care nurse, we all have been there. The expertise you see around you, as other nurses perform their job flawlessly, comes with time. It is not intelligence. It's the discipline that allows them to make nursing look easy. Know that you are not alone and that the key to success is to be organized and purposeful in your actions. That sentence sounds fancy but let's break down what the means. 

Patient Details

Before you we get into organizing your day, you need to know your patients like a book, from cover to cover. You must know the characters and plot in great detail. You are a nursing professional, and you must know your patients’ backgrounds and plans of care before you attempt to make any interventions or assess their current medical condition. Sit down, take a deep breath, and begin the change of shift report. Write down all the details and specifics. Once the conversation has concluded, conduct the necessary research needed for you to see the full clinical picture. This is the foundation - the building blocks - of nursing care. Micro research sessions will occur throughout your shift. But, you must know your patient well before you start your shift. Disastrous things occur when nurses act first and don't conduct proper research. For example, you have a patient with a documented history of atrial fibrillation. You fail to examine this patient's history and call the provider about this assumed new onset of atrial fibrillation. After being told otherwise, you hang up with the provider. Congratulations, you've wasted 15 minutes running around like a chicken with your head cut off, and for what? You've accomplished zilch. Yeah, research isn't glamorous or fun, but it will save you time in the end. You are that patient's lifeline - respect the role and know your patient inside and out.

Current Issues

After you have the patient's background and you have reviewed the most recent progress notes, it's time to see what you're working with. Meaning, you need to put eyes on your patients and make sure they're stable before you take the time to layout your shift. I've seen many new nurses create cute little documentation forms as their patients were going into respiratory distress. You must make sure your patients are stable enough for you to set up your day. Plus, you want to assess their condition and determine which patient is the sickest. Once you find the sickest of the bunch, see that person first. Some patients can't wait until you get organized. Unstable patients are the priority at the beginning of your shift. You must assess them and make sure their needs are taken care of before you take the time to manage your own needs. A patient can only breathe fifty breaths per minute for so long until they decompensate and take a turn for the worst.

Floor Priorities

This section depends on where you work and your unit standards and expectations. If you work on a psychiatric unit, your priorities are probably safety-related. But, if you work on a neurology unit, your priorities are mentality based. Each unit requires different levels of concentration and alertness. You must know your floors priorities. Usually, the educator or unit manager gives you this information. If you don't know, make sure you ask. Assumptions will always get you into trouble. For example, I floated to a neurological intensive care unit years ago. I assumed the blood pressure parameters were the same as in my unit (a medical-surgical intensive care unit), which was to keep systolic blood pressure between 90-165 mmHg. My neurology patient's blood pressure at the time was 130/45 mmHg. I was within my floor's parameters, and I was feeling great. Until, the charge nurse ran over and told me their unit standards were to keep the systolic blood pressure greater than 170 mmHg. The pressure of 130/45 mmHg was unacceptable and inappropriate for their patient population. I made an assumption, and I was wrong. I could have hurt that patient, caused some real harm. Don't be like me - ask!

Documentation Forms

Now that your urgent matters are out of the way, it's time for you to get organized. Sit down and fill out your documentation form. Fill out when you have medications due, write out your serial lab schedule, and layout what needs to be done during your 12-hour shift. If you don't have one, you can either create your own or pick one from my blog here. A documentation form will keep you on track and assist you in creating short-term goals. With time, you won't need as many visible reminders (to-do lists or checklists). But initially, you need a form that breaks down your day, hour by hour. If you don't have a chart, sit down right now and create one. You have no idea how many things must be done in your shift. There is no way to remember them all without prompts or reminders. Forms keep you on track and reduce the chances of you forgetting to perform certain tasks. When I made my first form, it took me three hours. But, that form helped me immensely during my first year as a graduate nurse.

Short-Term Goals

Short-term goals must be a part of your documentation sheet. Your success centers on you getting things completed. I use the word "completed" because some people don't complete tasks. They start something and stop midway, never returning to finish the job. Multitasking is great if you can do it. I get it. Nursing will have many starts and stops, as you can't control when your patients or providers need you. But you must write down tasks and actions, remembering to do them at some point. Create short-term goals. For example, by 9:30 p.m., I will have my 9:00 p.m. medication administered. Then, by 11:00 p.m., I will have at least one of my patient's chlorhexidine gluconate (CHG) baths completed. The goal is the have hard limits rather than timeframes within which the task should be executed. If you leave tasks open-ended, your success will be delayed or halted.

Being Human

Only nurses would need to be reminded they have to find time to eat and pee. I've been a nurse for five years now. I've been the full-time, part-time, PRN, and float nurse. I'm going to be honest with you, there will be moments when you just can't eat or pee. Healthcare is unpredictable, and it requires a certain level of adaptability. With that in mind, you are human and you must take care of yourself. You can't care for others if you're on empty, physically and mentally. On that fancy documentation form, you must write in when you plan on eating your lunch or going on break. Create a plan and get do what needs to be done so you have that window to replenish and refuel. For example, your patient is on an insulin drip, and you are checking the patient's blood sugar every hour. It's 8:30 p.m., and at 9:00 p.m. you have the next blood sugar assessment due. Furthermore, at 9:15 p.m., your patient's labs are scheduled. You see these tasks and tell a co-worker, "Hey, I want to go eat at 9:30 p.m. I'm completing all my upcoming tasks right now. Can you watch my patients once I confirm all my drips are okay and tasks are completed?" The goal is to get all your tasks out of the way, so you have no reasons to be called back on your floor. You must set yourself up for success. I know, it's annoying to have to do this, but healthcare requires constant attention and focus. If you want personal time, you have to carve it out and make it happen. 

Clustering Care

Clustering care improves with practice. Hence, experienced nurses are more proficient at this than new nurses. It's not due to intelligence. It's due to practice and experience. How do you know what you will need if it's an entirely new process to you? When you walk into a patient's room, ask yourself, "What needs to be done within the next 30 minutes?" The goal is to walk into your patient's room and accomplish as much as you can. Walking in and out of a room five times will only slow you down (and annoy you). Get all the supplies, linens, or tools you will need to perform the task before getting started. Become the Lego Master Builder! See the plan in front of you, visualize the situation, and create a mental list of the tools needed to complete the task. If you don't remember everything, it's okay. You will get better at this with time. For example, if you have medications due at 3:00 p.m., and at 3:15 p.m., pull them both from the automated medication dispenser at the same time. By the time you perform the six rights of medication administration, scan the medications, and administer the drugs, it will be 3:15 p.m.

Evaluate Assistance

Lastly, if you can't perform a task within the required timeframe, ask for help. What most nurses forget to do is evaluate what support is available. You are the nurse. You can delegate duties, but you can't ever delegate responsibility. If someone performs a task for you, the responsibility still lies on your shoulders. The triumphs, victories, and consequences are all on your head. You must evaluate any tasks you delegate. Remember the concept of "completion" we spoke of earlier? That remains true even when seeking assistance. The task isn't done until you - the nurse and the caregiver - confirms it's been successfully completed. Never assume something will be done or should be done soon by someone until you verify that is true.

In conclusion, remember that the following 8 actions will help you manage your time and treat your patients with the care they deserve:

1.     Learn your patients’ backgrounds and plan of care.
2.    Visualize your patients and categorize them based on acuity.
3.     Seek out the floor priorities and confirm you are in compliance.
4.     Fill out your documentation form and get organized for the day.
5.     Write down tasks as short-term goals, incorporating timeframes.
6.     Schedule time to take care of your own needs. You are human.
7.     Cluster care by obtaining supplies and minimizing duplicate efforts.
8.     Delegate if you need assistance, remembering to evaluate progress.

The key to success is to be organized and purposeful in your actions. Take one day at a time and know that the commitment you make to these steps will eventually lead to expertise and flawless practice as a nurse.

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