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New graduate nurse time management

Author(s): By Robin Hackett, MSN, RN, NPD-BC, and Veronica Bigott, MSN, ACNS-BC, RN-BC, NPD-BC

A game-based approach accelerates time management skills. 

Takeaways:

  • Time management is an essential skill for nurses, especially new graduates.
  • Using a novel board game, Nurse Life, nurses better understand how integrating time management strategies into clinical practice contributes to optimizing patient care.

Nurses are bound to time. It guides their entire day as they manage multiple patients and tasks, constantly prioritizing and reprioritizing. From medication administration and patient testing to time-outs before a procedure, time management is critical to ensuring proper care delivery, recognizing a patient’s changing condition, and optimizing workflows.

New graduate nurses join the profession with a strong theoretical foundation and an opportunity to enhance their clinical knowledge and skills. Organizations can support these novices by providing new graduate residency programs that include time management skills to help bridge the gap between theory and clinical practice.

A novel approach

Throughout the residency program at Advocate Aurora Health, new graduates are encouraged to apply time management strategies to connect meaning with nursing activities. These strategies align with expectations established by the American Nurses Credentialing Center Practice Transition Accreditation Program. (See Time management strategies.)

Time management strategies

Before nurses in the new graduate nurse residency program play the Nurse Life game, they meet in small groups to learn a variety of time management strategies and brainstorm how to apply them to clinical practice. Each strategy is reinforced while the new graduates play the game.

  • A, B, C, D approach (to-do lists). This strategy identifies items that Absolutely must get done, items that are Better completed sooner than later, items that Can wait until later, and items that can be Delegated. Making this type of to-do list helps nurses prioritize what needs to be done.
  • Be proactive. Being proactive means taking the opportunity to complete low-priority tasks when time is available, which provides a time buffer in case unforeseen events occur. For example, a patient is scheduled to be discharged later in the day, but the nurse takes advantage of time available earlier in the shift to begin completing essential discharge components.
  • Bedside shift report. The bedside shift report improves communication among caregivers, patients, and families. The nurse going off duty can share the plan of care, and the oncoming nurse can perform a quick visual assessment and prioritize care for the upcoming shift.
  • Clustering care. New graduate nurses should be prepared to complete more than one task while in a patient room. Clustering care while performing purposeful hourly rounding is encouraged. For example, a nurse uses time during a patient assessment to deliver a fresh pitcher of water, answer care plan questions, and provide patient education.
  • Delegation. Effective time management requires new graduate nurses to understand how delegation impacts daily practice. They must know their state’s nurse practice act, which defines what can be delegated, and use critical thinking to determine when it’s appropriate.
  • Prioritization and reprioritization. Nurses must be able to determine which patients or care activities should be provided first, second, and third. The A, B, C, D approach and bedside shift report aid prioritization.
  • Purposeful hourly rounding. This strategy allows the nurse to proactively address a patient’s needs and should be used in conjunction with clustering care.
  • Seek assistance. As new graduate nurses navigate task completion, they should become familiar with key team members and available resources and ask for help when they need it.

Expiration: 3/1/24

Recognizing that new graduate nurses gravitate toward task completion, we created Nurse Life, a customizable board game, and integrated it into our systemwide new graduate nurse residency program. The game includes a variety of nursing activities and time-management techniques to enhance new graduates’ understanding that completing nursing tasks is a piece of a puzzle that fits into a larger picture and to demonstrate how time management strategies can op­timize patient care.

The game

New graduates are divided into small groups of four to five players and one charge nurse. Each group has a Nurse Life game board, spinner, game pieces, and timecards that equal 720 minutes (equivalent to a 12-hour shift). The charge nurse is responsible for managing the “time bank” and is an active player. The time bank consists of index cards worth 15, 30, and 60 minutes. Before the game starts, the charge nurse distributes the timecards to each player, including themselves. As the game progresses, the charge nurse adds or deducts time accordingly.

The game board includes a variety of nursing activity circles with completion times and blue time management strategy circles. When a nurse lands on an activity circle, the charge nurse deducts the designated time from their total. When the nurse passes a blue time management strategy circle, the charge nurse awards 30 minutes. Nurses are given 15 minutes to play the game. The nurse with the most time accumulated at the end is declared the winner. (See A game with a purpose.)

A game with purpose

The Nurse Life board game reinforces time management strategies and helps nurses place individual completed nursing tasks into the larger context of optimized patient care. Players lose time when they land on individual tasks and gain time when they pass the blue time management strategy circles.

Game Board_Nurse-Life Time Mgmt_20x15

The authors encourage others to adapt this game for their own use (download a PDF). 

Debriefing

Throughout the game, new graduates are encouraged to think critically about how tasks fit into a larger picture and how essential they are to comprehensive care. After completing the game, the small groups reconvene into the larger group for reflective debriefing. Using peer support, the new grad­u­ates discuss their current time management strategies, including best practices and areas for development. A conversation led by the facilitator (a nurse educator who’s a member of the nursing professional development education team) encourages re-evaluating current practices and opportunities for incorporating newly learned time management strategies into clinical practice. The discussion fosters an understanding of which clinical tasks require a greater expenditure of time and how time management strategies can improve patient outcomes, enhance care delivery, and allow for meaningful connections with patients.

Evaluation

At the end of each residency program session, nurses complete a voluntary electronic evaluation, rating content using a Likert scale. In March 2020, feedback from 434 participants indicated that 97% (421) strongly agreed or agreed that time management strategies can be applied and incorporated into daily practice. These findings demonstrate that the board game approach positively contributes to new nurses’ understanding of the importance of integrating the time management strategies learned in the course into clinical practice.

Keep playing

The Nurse Life board game, combined with reflection and peer support, encourages new graduate nurses to explore the connections between nursing activities and time management strategies. Although the game was designed for use with new graduates, it can be customized for use in a variety of onboarding and ongoing staff development opportunities.      AN

Robin Hackett and Veronica Bigott are system nursing professional development specialists at Advocate Aurora Health in Downers Grove, Illinois.

References

Benner P. From novice to expert. Am J Nurs. 1982;82(3):402-7.

Blevins S, Millen EA. Foundation for new graduate nurse success. Medsurg Nurs. 2016;25(3):194-5. doi:10.1097/NND.0000000000000226

Leis SJ, Anderson A. Time management strategies for new nurses. Am J Nurs. 2020;120(12):63-6. doi:10.1097/01.NAJ.0000724260.01363.a3

Nayak SG. Time management in nursing—Hour of need. Int J Caring Sci. 2018;11(3):1997-2000.

Pabst PK. Don’t shortcut patient safety. Nurs Made Incred Easy. 2013;(11)6:6-9. doi:10.1097/01.NME.0000430830.75944.46

Said NB. Time management in nursing work. Int J Caring Sci. 2014;7(3):746-9.

Texas Health and Human Services. Time management module. hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/QMP/TimeManagementModule.pdf

 

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