In Through the Looking-Glass, and What Alice Found There by Lewis Carroll, the Red Queen told Alice, “Now, here…it takes all the running you can do, to keep in the same place. If you want to get somewhere else, you must run at least twice as fast as that.”
With nursing growing ever more complex and demanding, perhaps you sometimes feel like Alice, who ran as fast as she could but stayed in the same place. Nursing isn’t the task-oriented profession it once was. Today’s nurses must think while acting, intervene in emergencies, and advocate for patients—all while educating those around them. A typical 12-hour shift can tax the organizational skills of even the most seasoned nurse.
This article helps you make the most of your nursing minutes. It discusses common barriers to effective time management and gives advice on overcoming them.
Barrier #1: The seemingly constant med pass
Some days, you may feel as if the only thing you’ve done is administer medications. While polypharmacy in the elderly is well-documented, nearly all patients with acute conditions receive medications as part of their care.
Having a plan is one of the most basic skills you can use to manage your time effectively. Ever wonder why the second or third day of caring for the same patients seems more organized than the first? It’s because, intentionally or not, you formulated a plan. You predicted how your shift would play out based on what you knew about the patient assignment. If you plan things right, you can achieve this same level of organization on day one.
The plan for the day should start during shift change when you receive report. As your colleague explains your patients’ diagnoses, behaviors, procedures, and so on, start to formulate a plan. Then jot down the plan in concrete form. For example, you might plan to develop concept maps, checklists, or a timeline in which you assign tasks to time slots. You can then insert medication administration into any of these formats, and assign it the approximate amount of time needed. Review your patients’ medication records; note not only what medications they’re receiving but how many and, based on past experience, how long it will take you to prepare and administer them.
As the reporting nurse outlines specific situations and tasks awaiting resolution during your upcoming shift, give those items priority and assign them potential time slots in your plan. It helps if you prioritize the most difficult and time-consuming tasks and accomplish them as early as possible. Procrastinating the tasks you dislike may cause you subconsciously to slow your pace, which affects the efficiency of your plan. Throughout the shift, revisit your plan and make changes as needed.
Make multitasking a no-no
When it comes to medications, steer clear of multitasking. Although some people claim multitasking is the hallmark of organizational skill, current research suggests this fragmented approach can impair patient safety. Instead, designate a quiet zone around the medication preparation area, and concentrate on one task at a time when preparing and administering a drug.
At the bedside, explain to the patient and family that medication administration, especially by the I.V. route, requires your concentration. Assure them you’ll be happy to answer all their questions after you’ve finished preparing and giving the drug. With fewer interruptions, you’ll be able to complete your med pass faster and more safely while saving valuable minutes. (Keep this in mind when a colleague is preparing drugs. Don’t ask her about her new promotion or her Friday dinner plans while she’s concentrating on preparing or giving a medication.)
Don’t leave empty handed
As one of my colleagues reminds us, never leave the “kitchen” empty-handed. (As a former waitress, she knows the benefits of planning ahead before making a move.) Before leaving the medication preparation area, ask yourself, “What else will I need? Does the patient’s I.V. tubing need to be changed?” If so, grab the tubing now, along with a date-and-time label. Do you have all the extra supplies you’ll need? If you don’t, you’ll end up wasting time looking for them during medication administration.
Barrier # 2: The sinking ship
Imagine you’ve already been assigned to five patients when the charge nurse calls to tell you another is on the way and will arrive within the hour. It’s 11 AM, you haven’t started your morning charting, and already you have that sinking feeling you’ll never get out on time. Your ship is taking on water and listing portside.
What should you do? Ask for help. Knowing where to turn for help can make all the difference. Patricia Benner, who did extensive research involving expert nurses and their habits, observed: “Expert nurses often noted how they are aware of the rest of the staff, the total picture of patient needs, and the resources available to them.” In essence, she’s saying, “Alice, get your head out of the rabbit hole! Look up and see who around you is available to help.”
By keeping their finger on the pulse of the unit, expert nurses always know who’s available to give assistance. Are the two nurses chitchatting next to you willing to help? Is the charge nurse free, or is she tied up with an emergency? Can the patient care assistant (PCA) help enter vital signs for you? Can you delegate some other tasks to the PCA?
The Golden Rule applies here: Nurses who are good time managers know that although they’re the ones asking for help today, tomorrow they’ll be asked to help others. They store up good will with colleagues by helping out when they’re not busy, knowing full well they’ll need to call in that favor the next time their own shift goes astray. Teamwork is the backbone of any unit that manages time effectively.
Don’t be afraid to delegate
Nurses aren’t always great at delegating. Some of us think we’re the only ones who can get things done the right way. If you’re among them, keep in mind that in the long run, it doesn’t matter that you weren’t personally responsible for every bit of care delivered to a patient. In the end, what matters is that it was done, and done correctly.
Good delegators invest energy up front to find out who’s great at what, and then stroke these individuals’ egos when asking for help. “Wendi, everyone knows you’re the best at inserting an orogastric tube in a ventilated patient. Would you mind demonstrating your expertise in that area while I start the I.V.?” I’ve found that shameless schmoozing goes a long way toward securing my full cooperation, and it works like a charm on my colleagues.
Barrier #3: Documentation
Just when you think the powers-that-be can’t come up with one more category of data for you to chart, they do. Thanks to the advent of pay for performance, documentation has never been scrutinized more closely or seemed so overwhelming.
I teach time management to new graduate nurses, and one of the most successful strategies I’ve seen new nurses use is to document as early in the shift as possible. The first physical assessment is particularly crucial. For effective time management and accuracy, document the most time-consuming chore as early in your shift as you can. If you can document all of your first assessments within the first 2 hours of your shift, you can adapt better to any unforeseen events you’ll encounter throughout the day.
Making brief notes about abnormal findings during your assessment can improve your documentation accuracy. At the end of the shift, when you’re exhausted, you may have trouble accurately recalling in which lobe you heard abnormal breath sounds. Your charting will be faster and more accurate if you use your notes when you sit down to document.
If your unit has whiteboards in patient rooms, use these as documentation tools—for jotting down drugs given during a procedure, blood glucose levels, or intake and output amounts. Later, when it’s time to record these facts, you won’t have to waste time searching for them.
Barrier #4: Tag, you’re it!
Let’s face it: Nurses work long hours. When you’re near the end of your shift, your main focus is to give report and get home (so you can come back tomorrow and do it all again). Making a few tweaks to shift change can make report go smoother and faster, helping you get out on time and headed home for a well-deserved rest.
Both the receiving nurse and the reporting nurse have important roles in report. When you’re receiving report, be sure to practice active listening. Some receiving nurses ask the reporting nurse questions before she can get to the topic. But when you derail the reporter’s train of thought, it takes her time to get back on track. The appropriate time to ask questions is at the end of report—if your question has gone unanswered. Nothing is more aggravating than for the receiving nurse to ask a question about something the report just told her. Active listening is harder than you might think; it takes practice and energy.
When you’re giving report, save everyone time by painting a picture. Benner observed that some reports are “retroactive descriptions of how the past shift went, which are seldom really predictive of how the next shift is going to be. But some nurses have the ability to present the report in terms of situations most likely to develop and the problems awaiting resolution in the next 8 to 10 hours.” So when giving report, don’t waste time painting a picture of what your shift looked like. Instead, paint a picture of the probable future—what the receiving nurse’s shift might look like and problems awaiting resolution in the next 12 hours. When you frame your report in this manner, you’re helping to jump-start her plan for the day.
“Time is precious.” It’s a cliché, but it’s so true. With practice, these tips can help you organize your day, giving you more time to spend where you belong—at the bedside. They might even yield the ultimate payoff—time to have a relaxed conversation with your patients.
Wendi L. Froedge is an RN IV clinical educator in critical care services at Houston Methodist Willowbrook Hospital in Houston, Texas.
Benner P. From Novice to Expert: Excellence and Power in Clinical Nursing. Commemorative ed. Saddle River, NJ: Prentice Hall; 2000.
Carroll L. Through the Looking-Glass, and What Alice Found There. London: Macmillan and Co; 1872.
Westbrook JI, Coiera E, Dunsmuir WT, et al. The impact of interruptions on clinical task completion. Qual Saf Health Care. 2010;19(4):284-9.