How To Manage Your Time: Nursing For Day Shifts
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What is a typical day shift like for nurses? How do you manage your time well enough to be able to leave on time? Unfortunately, there is no definite answer to this. We first have to look at the nursing day as a whole, not just one aspect of it. We have to consider what we can do to make the day go by easier and to do this effectively, it might be easier for nurses to figure out what we can "get out of the way" rather than focusing on completing a certain task.
*please note: some of my tips are according to my facility. Please acknowledge your facility's policy prior to adhering to what is recommended by this article.
Understanding workload and a typical day
But first... lets understand workload. Workload is the amount of work done by someone on a daily or shift basis. Workload can be broken up into the following
Frees up Workload:
Dialysis patients
Patients going to surgery
Patients going off to do a procedure
Add-on to Workload:
Type of patients
Alcohol withdrawal
Delirium/confused
Elopement risk
Bipolar/Schizo
Pain-seekers
Hospice
Condition of your patients
Vital Signs (VS) unstable
Actively dying (under hospice)
Agitated (or angry family)
Labs unstable (electrolyte replacement, blood transfusions, uncontrolled blood sugar)
Specific patient scenarios:
Transporting a patient down to surgery
Difficult admissiondischarge
Expected Workload:
Admissions
Discharges
Transfers
Medication Administration
Assessments
Multi-Disciplinary Rounding (MDR)
Documentation
Tending to needs of the family
Answering/making phone calls from everyone
Adhering to orders
Nursing interventions
Fixing "cleaning-up" orders
Assisting with ADLs
CNA duties (when they are not available)
Tele strips
A Typical Day Shift (Ideal)
Schedule:
0600 - 0700:
Look up your patients (including vitals and trends)
0700 - 0800:
Get report.
Give report to your clinical technicians (CT).
Start pulling up insulins and give along with your 0800 meds
0800 - 0900:
Start giving your meds. As you're giving your meds, start doing your assessments.
Document your assessments.
Sometimes, I will not start 1000 meds until I have finished documenting the assessments I have done already.
0900 - 1100:
Start 1000 meds.
It is important to round with your doctors so that you will know what the plan of care is for your patient.
Finish documenting.
Help your CTs with activities of daily living. During this period, you will be able to do your skin assessment.
1100 - 1200:
Start your insulins and 1200 meds.
Get everything done to make it to mid-shift huddle.
12:00 - 1300:
Look at your vitals.
Finish up with 1200 meds or documentation.
Make it to huddle and give your charge nurse report.
1300 - 1400:
Go eat.
Once you're done, start giving your 1400 meds.
Start charting careplans and tele-strips.
1400 - 1600:
Be available for your patients (tend to their needs)
Look at your 1500 vitals (the last set of vitals for your shift): make sure they are stable.
By 1600, your charting should be done.
1600 - 1800:
Start looking at your blood sugars for your last insulin coverage.
At 1700, start giving your 1800 meds.
Look at your IV bags: replace them if they're about to be empty
Start letting your patients know that we will be giving report soon.
Tend to their needs now so that nursing report is uninterrupted.
1900 - 1930:
Start giving report
Leave
Tips on managing your time:
Come in early and look up your patients. People might think I'm crazy for coming in an hour before my shift, but looking your patients before you start is so helpful. I come in an hour early, look at everything for my patient, and get report. When I get report, everything is just a reinforcement and all of the information sticks better.
Get organized. I have stated this multiple times throughout my other articles. Get all of your materials together. The best practice is to have your stethoscope around your neck, your preferred assessment sheets, and your favorite pens all prepped for the day
Here are some of the stuff that I have that you all may be interested in having as well:
Get charting done as early as you can. In that way, you can focus most, if not all, of your energy into nursing.
Real-time charting. What does this mean? This means you are charting as you go. Once you’re done performing your assessment, start charting it. You won’t have to spend the last minutes of your day charting or trying to remember what to chart.
Clean up your orders at the beginning of your shift. Cleaning up your orders can be a pain. Sometimes you come into a shift and you see duplicate orders or orders that you feel like were unnecessary. Doing this early on clears up confusion and decreases errors.
Tag team with a buddy. The buddy system has been out and about in nursing practice for a long time. People think it’s minuscule... but if used appropriately, it can be quite effective. Your “buddy” is that one person during your shift that covers your patients during your break, signs you off for your high risk meds, and other nursing tasks. Of course, you will do it for the other person as well.
Rounding with your MDs. It would be best to round with your docs to be updated with the plan of care. During this time, I like to address and clarify nursing orders. I also like to get orders as early as I can so that I don’t have to page them last minute.
Anticipate the expected. Consider the following scenarios:
If you know your patient is going to dialysis, call the dialysis unit in the morning and get a time on when they're going. In that way, you can manage your time around that time
If you have a patient who's getting pain medicine every 2 hours and has been getting it consistently with no plans of weaning off at this time, get ahead of their pain. Don't wait until the patient calls you during your lunch.
If the patient is going down for surgery and has an order for telemetry, ask the doctors if the patient can transport off monitor. If not, tell the receiving unit if they can assign a RN transport.
If the patient has been nothing by mouth (NPO) all day for a surgery, order them a lunch or dinner tray any way. In that way, if the surgery gets pushed back or cancelled and the patient gets that diet order again, you're already prepared.
I can keep going... I'll stop here. You get the drift, right? Try to get ahead if you can predict the future.
Tag team with your certified nursing assistant (CNA). This is pretty much one of the most important aspects of effective teamwork. Teaming up with your CNA increases your productivity. You can tag team those patients with their activities of daily living, ambulation, heavy patients, etc. The more you get them involved in understanding the plan of care for the day, the better. They can even anticipate the expected with you.
Get your supplies together. Put some flushes, line caps, and alcohol pads in your pockets. Start your day.
Disclosure: There are some affiliate links above, but they're are all products I highly recommend. I would not put anything on this page that I haven't verified and/or personally used.
