July 2, 2018

Delays, Delays, Delays | Report, Supplies, Computers Oh My!

When I'm working, there are many instances where someone's lack of preparation or follow through COULD cause a delay in my job and me getting home on time. For example, the previous shift had a rough day, and all the nurses are catching up on their charting. So now, there are day and night shift nurses all looking for computers to chart and do their research. This massive need then causes a shortage of available computers. Or perhaps, the nurse who is supposed to give you bedside report isn't available for 20 minutes, and you're just sitting and waiting. I, personally, don't allow someone's unsatisfactory or delayed performance to alter the plan for my shift. The nurse can be as late as he or she needs to be in completing tasks. That is the timetable they have decided to function within. My performance will continue to be on time regardless of the chaotic surroundings. Here is how I get my job done on time, regarding delays in obtaining bedside report, getting supplies, and finding a computer.

The shift has started, and the nurse who is supposed to give you report is running around. This happens to the best of us, no judgment. We can't determine when a patient crashes. At first, you sit there and look up information. After 15 to 20 minutes, you realize it's time to get it in gear and get your day started. Sitting and waiting is unproductive. You have most of the information already (you have obtained 2/3 of the report with sheer research). Now, get up and greet your patients (and their family members), update those dry erase boards, stock your rooms with the supplies you will need for your shift, tidy up, and confirm proper safety measures are in place. The point is to be active and start your shift out right. Sitting and waiting simply delay your progress.

Yes, the nurse is busy, but that doesn't mean you should just be sitting there. Often, I flag the nurse down and tell him or her that I'm in the patient's room. When they are ready, they can find me. They can't go home until they give me bedside report, I'm not worried about it. My 19:30 medications will not be late (if deemed appropriate and after proper research has been obtained) because the nurse wasn't ready. If I have a significant amount of time, I also perform my initial assessment and check tubes and drains. I don't need a bedside report to assess my patient. I launch all the tasks I can while I'm waiting, but I don't have sit and stare. Sitting delays the million of things I need to do. Again, their lack of readiness will not affect my current level of preparedness.

Okay, at the beginning of my shift I check my patient's room for supplies. I also walk over to the stock room for a quick stock review. I've worked every weekend for the past FIVE YEARS. We always run out of washcloths, saline flushes, medication stickers, and tube feeding pumps on Sundays. I know this. So, I review my patient's room inventory and see what my options are in the stock room at the beginning of my shift or close to. If flushes are low, I put three in my pocket for emergency needs. If my patient's tube feedings start at midnight, I have the secretary order me a pump right at the beginning of the shift. The goal is to see the problems before they happen and act accordingly. Will this level of preparation work all the time? Of course not, but many hurdles I face at work involve lack of supplies. This early intervention approach has lowered my inability to perform tasks because I lacked supplies.

Now, I know each institution is different. Some units use computers on wheels (COWs), some use stationary laptops or desktops. Either way, we have all been in a situation where finding a computer is challenging. You need a computer to chart and delays in charting cause you to stay late. When I'm faced with this problem, I immediately notify the charge nurse of the problem. That way, if I do stay late, he or she is aware of the problem early on. I don't know where you work but overtime, where I work, must be approved. Staying late is not an okay event and you will be questioned as to why your time management is lacking. So, with that in mind, I hunt for a computer. You can't NOT chart all shift. That is insane. Worst case scenario, I walk to another unit and beg for a device. Worst-worst case scenario, I call the nursing supervisor for a hospital-wide search. I can't chart my entire shift with late entries. That is a problem and not per the majority of hospital policies. This a one of those hurdles that must be solved quickly because you MUST chart in real-time and have access to electronic charts and orders.

There are a million reasons why nurses can't do their job on time or at all. I know, I'm not saying these tips will work 100% of the time. But they will keep you on track and get you home on time. I work 12-hour shifts. I'm not trying to work 13 or 14 hours. 12 hours is enough. I need to go home, rest and restore from the inside out. I hope you are able to do the same.