Seneca the Younger, a Roman philosopher from the first century noted, “It’s not that we have little time, but that we waste a good deal of it.” While some nurses would balk at that statement (me included at times), it’s sometimes not about the time we have, but what we do with it that determines how successful a shift is.
A very brief history of time
The concept of time is one that humans have tried to understand and master for millennia. From primitive stone structures hundreds of years ago that marked time by displaying shadows on the ground, to the masterful Swiss engineering that people now spend thousands of dollars for, we have tried to bend time to our will so that we can know how much of it we have left in a day as we rush to accomplish various tasks. Paracelsus, the 16th century Swiss doctor and alchemist said, “Time is a brisk wind, for each hour it brings something new…but who can understand and measure its sharp breath, its mystery and its design?”
The constant pursuit of mastering time and facing new challenges each hour are concepts that are certainly not foreign to nurses. For many nurses, the ever-present challenge of racing the clock while assessing patients, giving medications, responding to call lights, answering complex questions, addressing family concerns, and of course charting everything that is done, is a daily battle against time to do all these things and more within the confines of an 8 or 12-hour shift.
The arduous and perpetual ticking of the clock can feel unforgiving and relentless as nurses rush against it to complete all the aforementioned demands in an effort to get out on time each shift. This feeling is likely one that has been felt by all novice nurses, but even the most experienced nurse has probably had a shift where the added burden of a higher acuity, increased census, or lower staffing has caused time to feel in short supply.
Seneca the Younger certainly never worked a 12-hour shift on a busy med/surg unit before making his statement of absolutes regarding the sensation of not feeling there is enough time. But it’s probably safe to assume that every nurse has felt at some point that time is an unforgiveable foe, constantly pressing against deadlines and responsibilities.
Time as a tool
While the concept of time has been acknowledged as a challenging burden that nurses constantly work against, it must also be recognized as a ubiquitous tool that is regularly used by nurses just as much as a stethoscope or pen. We use time for capturing data, from its basic use for counting respirations or heartbeats, to its minute calculations for interpreting ECG strips. Time is a helpful assessment tool for determining the effectiveness of pain medications, as it is only with the passing of time that one can determine if an intervention is effective. Using root cause analysis and failure mode and effects analysis enables nurses to travel back in time or into the future respectively to assess what went wrong in an event or break down a process to prognosticate what likely can go wrong to improve upon a process.
While time cannot be sped up or slowed down, it can be used in many ways as an ally in nursing. Time can be used to establish trust with a patient or family by saying you will return to a room within an established timeframe and ensuring you do so. Certainly, there will be periods that this will be disrupted, but most of the time, consistently stating when you will return and acting upon it will generate positive relationships between the nurse and patient and/or family that can facilitate better care.
Make friends with time
Following the words of Seneca the Younger to make good use of the time that is available, busy nurses would benefit to learn about the practices of cognitive stacking, routinization, and the CURE hierarchy as discussed in Cognitive stacking: Strategies for the busy RN, by Kohtz, Gowda, and Guede.
Cognitive stacking is an internal process by which the nurse begins planning the day before even starting the shift. The nurse should create a mental queue with prioritized tasks that must be completed. Due to nursing tasks being nonlinear and the fact that a nurse receives on average over five interruptions per hour, this is a dynamic process that is ever-changing.
Routinization is simply repeating what works in your routine in a systematic process so that the consistency helps with time management. The key is to be cognizant of the sequencing of activities in your routine and how long each one will take you to complete. Every shift is a mini Plan-Do-Study-Act cycle in which you as the nurse can tweak your routine to maximize the efficiency of your time.
There are several acronyms floating in the nursing realm regarding how to prioritize nursing care, and we all likely started with the ABCs of airway, breathing, and circulation. The CURE acronym stands for critical, urgent, routine, and extras, and is an additional tool that may help to prioritize your care and manage your time.
Critical—This highest priority is for patients requiring immediate intervention to prevent decline. Examples are chest pain, respiratory distress, and sudden change in level of consciousness.
Urgent—The next priority is for situations with a high potential for harm or patient discomfort if the problem is not resolved. Examples are administering a PRN analgesic, responding to a bed alarm, and clarifying a medical provider’s medication order before administering it.
Routine—The third priority, which makes up the bulk of the routine, consists of standard daily nursing activities that include performing assessments and administering medications.
Extras—These are any extra activities that promote patient comfort such as providing a heated blanket or getting a drink and make up the final priority in the hierarchy.
More friend than foe
There is no denying that no matter what tools nurses may have at their disposal, on some days, they simply won’t feel there is enough time in a shift to get everything done. This should, ideally, be the exception though and not the norm. Using these tips and making a conscientious effort to plan the day can help start and end each shift on a positive note and make time more friend than foe. In the hopeful words of the 19th century English novelist, Arnold Bennett:
“The chief beauty about time is that you cannot waste it in advance. The next year, the next day, the next hour are lying ready for you, as perfect, as unspoiled, as if you had never wasted or misapplied a single moment in all your life.”
Jon Templeman is a staff nurse at Our Hospice of South Central Indiana Inpatient Facility in Columbus, Indiana.
Kohtz C, Gowda C, Guede P. Cognitive stacking: Strategies for the busy RN. Nurs 2017. 2017;47(1):18-20.