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Something that took me a while to master was the best way to start my shift after getting report. I felt like as soon as I got report, I was somehow behind. Seriously. I was.
I started out working on a floor with four to six patients and, of those, I had two to three discharges and potentially two to three admits/transfers. So basically the second the night RN would finish report, the patient would say, “Can I go home now?” and have a list of things I needed to immediately do.
TIME OUT. THAT CAN WAIT.
Every nurse’s workflow and time management are different. But when you’re new, you have no idea what your options even are, let alone the best way to go about things. You ultimately do what your preceptor does because you don’t have time to improvise at this point! This is what worked for me.
So let’s say I’m walking around, getting report on my five patients. I tell them ALL who I am, that I’ll be back with meds and to do my assessment, and if there’s anything going on today (for example, going to get an MRI). This lets them know I’ll be back so don’t ask me for anything right now in a polite, I still care about you but have a lot to do way.
Now make a quick exit because you have a lot to do. Don’t linger—you have plenty of time to be a caring nurse, but as soon as you get report is not the time. (I’m not mean, I promise!)
Then I run back to the nurses’ station (hopefully before anyone needs anything) and see who has 0730 or 0800 meds or breakfast insulin and say what’s up to my techs. (“HEY TECHS—I love you. Hi, how are you doing today? Gah, that Starbucks [thing] looks delicious. The guy in room 73 is crazy, and the family of 82 are douche bags, just so you know. GO TEAM!”) Those patients get assessed first. Also, if during your report with the night shift you can tell some patients talk a lot, do them last because they’ll delay you like crazy.
NOTE: If any family members call to check in at this time, tell the secretary to get a number from them and you will call them back when you are done with your meds and assessments. They will call. You will get behind. That can wait. It is not a priority.
Go in and do your assessment first, then meds. You can leave the room if they want to take time working on taking their vitamin D and Colace, and get to your next patient. (Don’t tell your professor I said that.) If you’re lucky enough to have a computer in the room, chart your assessment while they’re taking their meds. This is important in the beginning because you’re not going to be able to chart a full assessment in two minutes like you will in one or two months from now. You’ll get bothered a lot more at the nurses’ station rather than the patient’s room, so chart in the room at the beginning if you don’t want interruptions. Don’t feel like you’re annoying your patient by charting in there. You’re in charge. You’re the nurse. Get your charting done however you need to.
Some RNs do all of their assessments after they’ve seen all of their patients, but I’ve mixed things up and forgotten some information, which makes me have to go back to the room and check again (how did their lungs sound again?). And it’s also difficult to find 30 to 45 minutes to sit down and chart without interruptions during that busy time.
It’s always important to see who has blood sugar checks, who has their breakfast and who needs insulin coverage. That should be your medication priority (generally speaking). I always got excited when I didn’t have a patient who needed insulin (cough-never-cough-cough). Insulin is time-sensitive and you’ll be surprised how many patients “forget” to tell you they’ve eaten 45 minutes ago, despite being a diabetic for 12 years. Ugh.
Question: It’s 0738 and you have a patient with a 0730 Synthroid due who is asleep and doesn’t want to eat until 1000, and a patient with a blood sugar of 203 with 4 units scheduled Novolog, also needing 5 units of sliding scale, due at 0830, who just got their breakfast tray. What the hell do you do?
Answer: You assess your diabetic nom-ing patient and give them their insulin plus any other meds FIRST, chart on them and move on to another patient because your sleeping Synthroid patient can wait!
Helpful tip: If it’s too early for all their 0900 meds, ask the patient, “Do you want your morning meds with your breakfast? Is that what you do at home?” And if they say yes, BOOM! You have all your a.m. meds done with them and chart “patient request” as your reason for early administration. I love it when that happens because you always have to go in twice with your insulin patients…0730 insulin and you can’t go give their 0900 meds til 0830, forcing you to give meds twice. And it’s honestly better to do what they do at home, rather than go by those designated pharmacy times. So, win-win.
So basically go down the line of your patients, assessing/giving meds to the least complicated/busy ones first, working to your heaviest/one with most meds last—all while paying attention to time-sensitive meds (mainly insulin, if you’re working on the floor).
Delegation is also important at this busy time. If you’re giving meds/assessing and they want to do something that will take more than three to seven minutes, get the tech to do it when you’re done. It sounds mean, but you honestly do not have time. You should spend approximately 15 minutes with each patient between charting and meds. If you do 20 to 25 with each, you’ll be late on your meds. I used to do this because I felt bad. I was in with everyone for 30 to 45 minutes each, doing all their morning care. It doesn’t work! Delegate in a non-jerky way.
This timeline, without interruptions (yeah right), should get you done with all charting/meds by 1000-1015.
Learning how to be a great nurse at the bedside while maintaining your sanity at home is no easy task. Becoming Nursey: From Code Blues to Code Browns, How to Take Care of Your Patients and Yourself talks about how to realistically live as a nurse, both at home and at the bedside…with a little humor and some shenanigans along the way. Get ready: It’s about to get real, real nursey. You can get your own copy at at NurseEyeRoll.com (PDF), Amazon(paperback) or Goodreads (ebook).