Time Management Tips for New Nurses

welcome to the fresh rn podcast the information contained in this podcast is meant to supplement your existing knowledge and not replace it always refer to your state board of nursing standards of care and respective institutions policies to guide your practice all identifying patient details have been changed to protect their privacy and remain compliant with the health insurance portability and accountability act of 1996. thanks nurses stay [Music] here fresh wait for them to round we would love to have our patients all packaged perfectly what's up guys thank you for joining us for the fresh rn podcast i'm katie cleaver hey guys i'm elizabeth mills and today we're going to chat about time management tips for you new nurses so we're not really going to go into why it's important because it's pretty obvious you got to do it all the time you can't get your stuff done if you don't manage your time there's just too many things so we're going to talk specific tips about the floor i'm going to go into tips for working on a nursing floor and elizabeth is going to talk about some stuff specific to the icu um so let's just kind of jump right in the floor we're going to split these up because the floor you have more patience and you're not going into depth as much so there's the managing your time there is very different i remember working on the floor and a guy would float to the ice from the icu to the floor to pick up shifts and man that guy spent way too long in every room [Laughter] he was like two hours behind like two seconds into the ship let me just let me just interrupt and just say floor nurses you guys are incredible and awesome because you guys really have to get time management down to an art and um i actually started out as a nurse on the floor before i moved to the icu and if i had to go back to the floor now i would i would die i would i would crawl into an empty room into the corner squat down get in fetal position and just cry because i can't imagine that many patients i i mean your thought process your thinking is just different but kudos to you you're greatly appreciated yes so it it is different you have to and if you've been working in icu for a while it's hard to kind of change your thinking back to the the way you need to manage your time on the floor so here's my here's my tips number one do maximize your time and report right quickly ask clarifying questions and then don't like kick it and report like the more thorough and concise you can get report and all of the information you need the sooner you can get started while you're getting report if the patient's got iv fluids if the patient's got a central line or whatever like looking at that stuff with the off-going nurse at the same time is really important because you kind of know okay i've got a couple hours left in my iv bag or hey this nurse is leaving me with no fluid i'm going to ask them to go hang a new bag of fluid before they live leave that's a big one a second tip if a family member calls for an update during or shortly after shift change tell them to call back or have whomever answers the phone call back my reasoning for this is you just met this patient and you're also meeting five other patients and it's really hard to give a good update when you are just meeting your patients for the first time so unless a patient's family member can't talk at any other time i really reserve shift change when i'm getting report and shortly thereafter to get to know the patient and get a picture of what's going on before i talk to patient family members about specifics because i need to get my mind around what's going on not just on their loved one but the five other loved ones i have to take care of so i think that's you know an important thing to do and it's not rude to say hey can you call back in about an hour yeah well while i kind of get situated here and then i'll give you a much better update and i and i always actually tell family members to call whenever you need to but if you can avoid calling around shift change that would be ideal because you're either talking to a nurse that's been awake and up for 14 hours taking care of patients or you're meeting or you're talking to someone who just learned their name five minutes ago so if they can if you can not take non-urgent calls at the beginning of the shift that's helpful next one pay attention when you're looking you got report you're trying to figure out which patient to see first because you've got four five six seven eight maybe even nine patients take a look what's going to dictate if let's say everybody's stable right the nclex and everything kind of teaches you what do you do when someone's unstable which one's unstable let's just say everybody's stable because that's what happens most of the time the way i figure out which patient i'm going to see first is i figure out who has time-sensitive medications the most common one is insulin so if someone's got insulin due before their meal like a longer-acting insulin or if they've got insulin do with their meal i'm kind of paying attention to that if i have a patient that has a medication due at 7 7 30 i'm probably going to see them first and the patient that only has nine o'clock meds their last another way that i kind of determine which patient i see first is also which patient is has the most going on like do i have typically when you're getting um your patients a lot of times one patient has a lot more going on than the others to kind of balance out the work so you know maybe i see okay i've got three patients that can swallow pills on their own and another one that i have to crush all of their meds give them down tube feeding i have to hang two iv meds and give an iv push med and i have to assess them and i have to turn them that's going to take a lot longer than my other ones so i'm going to save the heaviest and i say heaviest meaning in tasks save that for last because i would rather be late on one person's meds than four and i have one person that i can peek in hey i just want you to know i'm going to go peek in on all my other patients and then i will be in here with you in an hour this guy knows i'm going to be in here he knows hopefully not to hit the call light for something because i'm going to be here in an hour and then i can go touch base with my other four patients so they're not all mad because i was in a room with one other guy for an hour if that makes sense i found that that was an easier better way to go through my day um and then everyone sees your face if that makes sense so and then when this is my when i get when i go into the patient room i try to consolidate trips so if i'm going into a patient room hopefully i'm going in to assess them or turn them and give a med i'm doing i'm rarely am i going in a room to do just one thing so like if i have nine o'clock meds and 10 o'clock meds i'm not going in at 8 45 and 9 45. i'm going in at 9 30 and bringing the nine in the 10 o'clock in at the same time so doing trying to consolidate trips is a big thing and then what i do especially when i'm doing that big typical 9 a.m or 9 p.m med pass i'll walk in the room i'll first i will assess them then i will give them their medications and while they're taking their medications i will chart the assessment i'll start charting the abnormals first that way if i have to go do something else at least i have that taken care of but if they're going slow and chatty and i've got a little time i'm going to quickly chart that whole assessment so in that five minute trip into the room i've got an assessment charted and meds given and the patient is you know i'm having a conversation with the patient boom boom boom got them all done um let's see do not make the mistake of waiting until you see everyone and then sitting down to chart you will not have time to chart for 30 minutes and uninterrupted like that just does not exist chart as you go save your non-emergent and urgent questions for when the doctor rounds you know if you get in a report that you're not sure if we're going to transition from iv cardiosome to oral cartism today but you know this physician typically rounds around 10 am don't stop what you're doing at 8 o'clock and page them wait for them to round and address those non-urgent issues um big thing is when you're giving medications don't go do something else that's one of the big things um that you just can't you know give a patient a cup of meds and then run out the door you know or or something like that and i think those are my my big time savers for the floor oh and my other one too is maximize time with cnas so if you see a cna is get ready to do a bath or if you if your cna is getting ready to go in there i like to consolidate okay they're good then i can have them help me turn and i'm going to take a look at their back and i'm going to you know consolidating those kinds of trips um because it's a i think a lot of people like to say oh okay i want to do all my blood sugars and then i want to go through and do all my turns and then i want no no no no that is so inefficient go in and do blood sugar turn um you know zero their art line and recalibrate like do like do as much in one room at a time as possible and don't go do one thing in each room and then go back like that's very inefficient i think i talked i'm sorry i talked so fast but that's like no i think i think no i think that's good and i think a lot of those tips so we're going to go into time management for the icu a lot of those tips can be carried over except instead of having five and six patients you have two one thing that has helped with time management is bedside reporting because i can tell you what like i'm in there i'm introducing myself we do report and i can see immediate issues that are going on with the patient like i need to bring some more iv fluids um i typically don't do my thorough head to toe assessment but whatever problem pertinent problem is going on with the patient at that time i assess that while i'm in there so at least i can get a peace of mind of of you know right like if it's a stroke patient or a neuro patient i'll do a quick neuro assessment i won't listen to heart lungs etc yet but um or if it's um a patient who's had um i don't know uh um bowel resect um resection i'll take a quick look at you know the you know surgical site and ng tube and you know or if someone's in with sepsis i'll make sure that i've got you know my blood pressure stable and i've got my pressers or whatever's going on with them or i've got plenty in the in the bag i personally i use a work list that's set up in our electronic medical record that helps me to kind of figure out okay because a lot of times in the icu you have meds due constantly 8 9 10 midnight 2 4 6 so you're constantly giving meds and some of those meds are given so frequently that you can't really say okay you know um i'll give my um nine o'clock med with my eight o'clock med pass because they just had that medication at six o'clock like you really have to be more on point with the time that your medications are due um so um the the bedside reporting helps just kind of get a brief idea of of you introduce yourself to the patient and family um and then after i get report i kind of have an idea after looking with the work at the work list kind of what my schedule is because a lot of times you have frequent labs to draw or things like that um and then i kind of look at who's the sicker patient um prioritizing based on who's sicker or who has the most work that needs to be done right at that point who has the most stuff that needs to be assessed um and sometimes if i have a really simple patient and a really complicated patient i've gotten through bedside reporting i've at least laid eyes on my sick patient and my not so sick patient i'll go back and check on my not so sick patient first get their needs met and out of the way first because i know i'm going to spend more time in that sicker patient's room you know people you know you say oh you know you should go see you know see who's sicker first but i know i'm going to be in that room for a long period of time that patient is stable right now they don't need anything for the next 15-20 minutes i'm gonna i'm gonna get my other patient taken care of um which is similar to like that floor mentality like i'm gonna do the ones that don't need me quite as much so i can kind of be in that other room for longer right right um also too um i kind of like to go through the beginning of my shift to family's presence and i'll say hey you know my name's elizabeth i'm going to be the nurse tonight you know these are some things that we're kind of planning our goal is you know to you know unfortunately i'll be checking on you know waking up this patient every couple of hours we'll do a ct scan in the morning to check whatever problem there is or our golden knight is to maintain their blood pressure continue the medications or wean the medications to keep you know whatever blood pressure going i kind of do a brief overview of kind of what the plan is we do blood work in the morning or we'll do blood work at 10 o'clock and then again at 6 a.m um so they kind of know what the plan is going to be um you know i you try to stay ahead and on top of things um as best you can um it's usually the charting that i get behind on the most but i do my best to stay on top of charting because you never know what's going to roll through that door later on in the night and you never know what's going to happen if you have you know kind of not a not so good feeling about one of your patients you should anticipate and prepare for what's going on like what for what you think so if i have a patient um who let's say um is having some respiratory issues just for example they've come in they've had this surgery um and you know their oxygen requirements are going up and they're having more work of breathing um i kind of think in the back of my mind like what do i have in the room to i kind of have everything ready to set up in case we need to intubate or um or a couple others or you know if um discuss with respiratory respiratory kind of beginning in the shift like you know this person looked to see if you have a blood gas do or a chest x-ray do that kind of thing um so um um no kind of anticipate anticipate for problems yeah and i think a couple other good examples are like let's say you've got a patient that has a history of chf but they need maybe some ffp for whatever reason fresh frozen plasma you know maybe we're probably going to need some lasix at some point because otherwise you know mr smith is gonna probably turn into mr respiratory distress you know so you gotta make sure that you're kind of thinking about the be kind of forward thinking and that stuff is kind of hard to come by at the beginning but even because you're so task focused it's hard to get that big picture and anticipate that stuff and that that piece will come in but you got to make sure you're kind of anticipating stuff another example is you know we do bedside tracheostomy placements a lot and you give pretty um hefty doses of you know sedation and you gotta you know one thing a lot of people do is have um leave a fed or some sort of vase oppressive med nearby or a bolus just in case the the patient becomes hypotensive because it that happens frequently and you don't want to like frantically grab supplies when it's like well i think we could have been a little prepared for that right like you know so just something to keep in mind and if you if you know um like if you know um you're going into the supply room to get stuff and you know your shift in your shift you're responsible for changing out the suction tubing and all that stuff go ahead and get that stuff bring it in the room so it's kind of in there to save you another trip later um you know i it anticipating for things is um that's like you said it's it's you're focused more on tasks but that's part of the critical care aspect um and you know what this is a 24-hour job and so honestly if you're so dang on busy in one shift and you need to do a dressing change and it didn't get done you know pass it along you know it's it's not a big deal prioritizing is key with time management so if you have a super sick patient and you've been in the room all night and this this this and this is going on so some of the smaller lesser most critical problems are not or issues aren't dealt with i don't wanna say problems but tasks that need to be done aren't done you know the next shift will hopefully maybe get a chance to do it so yeah what is what does um kim say continuity of care or continuous care right it's not real we would love to have our patients all packaged perfectly to the next nurse but it doesn't always happen and we need to you know not beat ourselves up it's not a bad nurse if we didn't get every little thing done and you know it's it's i still sometimes will carry around a clipboard with a blank sheet of paper and write down the tasks that i know each patient needs i know like i said we have a work list in the electronic electronic medical record but sometimes i create my own task list to know so i can check things off as i go sometimes that just makes me feel more accomplished so with that hopefully we've addressed some time management tips with you and hopefully this has been helpful yeah i think this is a challenge and time management takes a little time to figure out you got to develop your style um and and making sure too if you're getting precepted paying attention to that person's time management style and adapting what you like and forgetting what you don't like because not everybody does it quite exactly the same but it's it's important that you figure this out and don't just like you know think you're gonna just do one task at a time many times you have to really have a plan of attack so yeah so thank you guys for um listening to the fresh rn podcast go to freshrn.com podcast for some show notes i've got some links to some good articles about time management and kind of like a typed up kind of version of what we talked about for you know that you can take a look at hopefully this is helpful for you and your first experiences with time management at the bedside check out freshrn.com for some additional resources and gear and all that fun stuff uh thanks nurses stay fresh

Channel: Kati Kleber, MSN RN

Views: 21,409

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Id: eBN1HeeuTMQ

Length: 18min 58sec (1138 seconds)

Published: Mon Sep 28 2020