Nursing has many components involved. That is why time management in nursing is crucial. It is literally the glue that holds the skills we have learned to become a nurse together. You need to be good at such a large array of things that it can become overwhelming at times.
After you receive report on your patients, you will be building your to-do list.
They key to managing the to-do list is to have a clear hierarchy of tasks that can be flexible as things change and to be comfortable with delegation in nursing.
Start with the ABCs
- Is the airway patent?
- Rate, depth, pattern and sounds of breathing
- Heart rate, BP, perfusion, beating of the heart (What is their EKG?)
This is actually the easiest part of prioritizing. You will need to adjust any plan you put into motion if an ABC becomes compromised.
As for the other tasks, which I will call non-urgent tasks, you can plan these tasks to make your day go more smoothly and efficiently.
So everyone’s urgent needs are taken care of. There are just non-urgent tasks to complete. Check out our post on stable patient prioritization.
You can separate the tasks into categories that help you decide what to do first. I generally separate them into the following categories:
- Things that require action before they can happen
- Things that are time sensitive
- Things that other people can do
- Patient schedules/appointments
- How many items a patient needs to have done
Then I try to get a timeline together of when certain things must be accomplished and work from there, filling in the gaps and grouping activities if possible.
Tips to working smarter, not harder
A key thing to think about when prioritizing in nursing is how to get the most amount of things done in the most safe and efficient way. Usually, this requires you to work smarter, not harder. I mean when I say this to combine tasks if possible, anticipate certain tasks, set yourself up for success.
For example, there are a few tasks that I do on almost every patient, and then there are tasks that I do every time per patient complaint or need.
Almost every patient will:
- Get hooked up to the monitor (if available) for continuous vital signs.
- Give a urine sample if they go to the bathroom.
- Side note: If your patient will need a urine sample because they are complaining of burning upon urination let say, then it is helpful to have that be the first thing you do with that patient. Go into the room and before hooking them up to the monitor, take them to the bathroom and get that urine sample.
- Get an update of what is next before you leave the room. (Trust me, this will save you time in the long run)
Specific patients needs:
- If getting an IV:
- Draw the rainbow (all the tubes) and hold them.
- If they need blood work:
- Put in an IV so you can potentially draw more blood if needed, or give medication if needed. (It saves the patient pokes)
- If they complain of Chest Pain/Shortness of Breath:
- Get an EKG, start an IV, draw blood, and place them on the monitor.
- If they are febrile or have a suspected source of infection (cellulitis for example):
- Draw a set of blood cultures and hold them just in case.
Imagine that the patient really has to use the bathroom so you take them to the bathroom and then get them hooked back up to the monitor, warm blankets applied and lights dimmed. All of a sudden the doctor orders a urinalysis… If you had just gotten that a few minutes ago when the patient was going you wouldn’t have to wait to get it, have this looming task over your head that might be awhile before you can accomplish it.
Or let’s imagine a scenario where your patient says they are in 10/10 pain and you ask the doctor for pain medication and the doctor asks you for the last BP… if you had the patient hooked up to the monitor you would have a recent BP.
Speaking of talking to the doctor….
Before you talk to an MD
Before running to the doctor, save yourself some steps by gathering some information first:
- If a vital sign is abnormal:
- LOOK at the patient- symptomatic or not?
- Double check it: do it manually
- Check trending vitals
- If the patient needs a medication:
- Check the chart, is it ordered?
- What was the last set of vitals?
- What are the patient’s allergies?
- Have they ever had the medication before?
- If it is a home med, is the medication in the chart correct? (Use the 5 rights of medication administration)
- If it is a pain medication, when was the last dose? What is their pain score?
- If there is a change in patient condition:
- Does the change involve the ABCs?-If so, assess for life threatening issues and call for help. Have someone else get the doctor, do not leave the patient.
- If patient is stable:
- Get a full set of vitals
- Check to make sure there aren’t orders in for you to address the situation
- Ex: patient has a fever and Tylenol is ordered PRN for fever.
- Check to make sure there are nursing protocols you can initiate without a doctor.
- Get lab results (most current and trending)
- Assess the patient for symptoms
- Ex: Patient has a low HR-Are they dizzy-do they feel SOB?
- I cannot stress this enough: LOOK AT THE PATIENT!-Do not treat numbers for the love of god. If their BP is too low…think: are they symptomatic?-do they usually have low BP?- Have you double checked it?- Have you checked manually?
Delegation in Nursing
This can be a tough thing for people to do effectively. Just because there are tasks that can be delegated, does not mean it should be delegated. At the same time, just because you can do everything doesn’t make it efficient for you to do so.
When choosing to delegate, think about the following:
- Is this something you could do while in the patient’s room?
- If yes, don’t delegate
- Is this task time sensitive?
- If yes, delegate
- Is the person you are asking busy?
- If yes, don’t delegate
- Is the person qualified to do the task?
- If yes, delegate
When planning out the tasks that need to be covered, try to consider these time saving tips. They will help you be more efficient and make sure that everything that needs to get done, gets done. For more tips on how to manage your time in nursing check out Everything You Need to Know About Nursing Time Management