Time Management

Nursing is a demanding and stressful profession.  It is important to be organized, but you have to remain flexible.  It would be nice if every shift flowed smoothly, allowing you to visit each patient in order, completing your assessments, documentation and med pass, but that is not a realistic expectation.  You have to expect the unexpected to happen at the worst possible moment and critical thinking and time management skills will help you shift gears and focus on those events without losing your stride.

Here are the most important tips to remember:

1. Arrive early and scope out your assignment.  Get your ducks in a row before you take the helm.  Expect that the nurse you are relieving did everything she was supposed to do and, if she didn't, ask her why.  Don't enable people to leave things for you.  You have enough to do.
2. Get report quickly and have a positive attitude.  Pay attention to the facts you need to know and don't let it turn into a negetivity-laced anti-pep-rally.  Getting a late start will put you behind for the entire shift and listening to complaints will affect the attitude you carry with you on your first round.
3. Give report to your tech.  A good tech can make or break your shift.  By the time you hit the floor, your tech should have been able to make a round.  This way, you will not walk in to empty water pitchers, snack requests or emergent bathroom needs.  Delegate when necessary and pitch in when able.  No one should be sitting around while someone else is in the weeds.
4. Prioritize your To-Do List.  Start with your sickest patient or your least desirable task.  That way you will not be filled with dread as you see your other patients.  Delegate when you need to.  If you are in the middle of an assessment or patient education and your tech asks you to help with a bath or linen change, ask them to get another tech to help.  It's okay.  Don't delegate learning experiences.  If you've never dropped an NG tube or pulled a central line, don't ask someone to do it for you, make time to do it yourself.  These are skills you need.
5. Chart as you go.  Take a minute to document as you complete tasks so you won't forget critical information.  Use your flowsheet to the best capacity and don't write a book of narrative charting in your notes.  Don't save all of your charting and think you're going to have hours to sit and complete it.  That is invariably when a patient will "crump out" or you will get a new admission.  Charting as you go allows you to remain flexible to step up when a patient needs you.
6. Make that final round.  After a busy shift, you may have to force yourself, but making that final sweep in the last half-hour of your shift will make shift-change that much smoother.  Tell your tech you expect her to do it as well.  Without a final round, it can be 2-3 hours between times patients see staff members.  It is no wonder they have a laundry list of requests or complaints when someone finally does show up.

Remember, this is the life we have chosen for ourselves.  It isn't always pretty, but time management and critical thinking are a nurse's best tools to help her stay sane and take the best care of her patients.