Carla is a new grad nearing the end of her orientation. At her scheduled end of orientation meeting, her manager says she has concerns about taking her off orientation due to her time management and critical thinking skills. Carla is being given two weeks to improve her performance.
Carla’s stomach drops. She can’t believe what she is hearing. What is she hearing, actually? Is this code for getting fired? Should she quit? Who would hire her after this?
Carla goes home and begins to feel angry. Yes, she finds the job hard, but believes she’s basically doing OK. She hasn’t made any medication errors. Time management? What does that mean, exactly? Of course she’s slow, she has to look up meds, and then there’s all the interruptions. Her preceptor hadn’t told her she wasn’t doing well, although lately she’d been impatient when Carla asked questions.
Here are seven essential time management tips for nurses
A shift rarely unfolds in a pre-planned, linear fashion. Patients’ conditions change in a heartbeat and unanticipated admits show up at the same time as a Rapid Response. Meanwhile call lights are going off and you haven’t gone to the bathroom, much less had lunch.
When confronted with multiple tasks and demands, how do you decide what to do first? Remember you can only choose one, and that means not choosing others. Be clear on your rationale and be able to speak to it. Your rationale should be based on patient safety, and time-sensitive activities.
Let’s say Patient A just returned from surgery, Patient B’s IV is infiltrated and puffy, and Patient C needs assistance to the bathroom.
Seeing your post-op patient right away is a priority because of the three patients, Patient A is the least stable. At the same time, an actively infiltrating IV needs attention.
- Turn off the IV infusion and tell Patient B you will be back soon to remove the IV. This is immediate, quick, and temporarily takes care of the problem.
- Assess Patient A. This is your priority.
- Call your nursing assistant and ask her to please ambulate Patient C to the bathroom.
As another example, let’s say you have both a wound care dressing and an antibiotic due at 1400. Hang the antibiotic first because it’s time-sensitive. A dressing change can be re-scheduled without harm.
Delegating is crucial to success. Always help with patient care when you are able, but if you are regularly spending time turning, cleaning, feeding, etc. and are not completing your RN tasks on time, then you must learn to delegate. Your nursing assistant cannot respond to IV alarms, pass meds for you, or assess your patients- but she can assist the patient to the bathroom.
Be careful you are not unconsciously gravitating to comfortable tasks as a way of avoiding new RN skills.
Have a “What’s the worst that can happen mindset?”. Always anticipate what could go wrong so you’ll be prepared.
- When starting an IV, anticipate you may not get it at the first stick. By anticipating what might go wrong, you take two catheters into the room. This saves you a trip back to the supply room. What other supplies might you need?
- The monitor tech tells you to immediately check on a patient because the leads are off. What’s the worst that could happen? You could find the patient pulseless and unresponsive. Running down the hall, you rehearse what you’ll do. Call a code, stay in the room, initiate basic life support. When you get there, your patient is talking on the phone. Good! But you were ready to respond if the worst had happened.
- You survey the empty room where your patient will be returning from surgery. Make sure there is an emesis basin or bag in the room. Is the SCD pump in the room and ready? Is there a water pitcher in the room? Planning is better than catching up.
Stay in Control
If you have a hard time getting out of your patients’ rooms due to lengthy conversations, you will get behind. Don’t be unwittingly hijacked. You must recognize when this is happening and learn the skill of tactfully extricating yourself. Watch what your preceptor does or says to exit the room while still meeting the patient’s needs.
Always tell a patient when you will return and keep your promise. Remember to under promise and over deliver.
Make every attempt to document in real time. You may think you don’t have time, but it saves time in the long run. A sure way to invoke craziness at the end of your shift is to relax and put off documentation early in your shift.
At the end of the shift, ask your preceptor for feedback. “Can you give me feedback on my performance today?” “Is there something I could have done differently?” This keeps your preceptor accountable and keeps you from being blindsided.
Stay in regular contact with your manager as well and ask for feedback. “What exactly do you need to see in two weeks?” Ask for measurable goals. “Time management” is vague but “no overtime” is specific. “Critical thinking” is broad, but “recognizes change in patient’s condition” is measurable.
Start a journal and write down the day’s events. Reflect on what happened.
If the shift went poorly, reflect on exactly when things changed. What was happening? What could you have done differently if the day were repeated? Could you have asked for help before the tipping point?
Keep journaling and read entries from earlier weeks to see how far you’ve come.
By focusing on these tips, you will be well on your way to meeting your time management goals.
Article By: Beth Hawkes