The ICU is dynamic and things change constantly and quickly. Patient conditions and staffing change significantly in an instant. No two shifts will be the same. However, it is important to know what your routine would be if you are adequately staffed, have an appropriate assignment, and nothing happens that changes your plan (which happens q3years, I know!)
Remember, these are suggestions. Time management is not the same for everyone. Adapt as you see fit. As long as tasks are complete and needs are met, you’re good to go. This is a starting off point.
Assumptions: this is day shift, you have two patients, and a CNA is working with you
- Maximize this time
- Look at orders (what needs to be done immediately, sooner, later)
- Look at meds (make sure none are overdue, look at what is due 0900 and before and if you need to get it from pharmacy/is it very time sensitive)
- While they’re talking, look at all of your lines
- What needs to be changed, when?
- How much is left of your fluids/drips? Do you need to get new ones sooner rather than later?
- Mentally plan your day
- When will you change your lines, do you have any procedures/scans/tests?
- Learn to give and receive report efficiently
- 30 min is MAX for report
- Speak concisely when giving report, don’t ask questions until the end when receiving report
- It’s not a time to catch up with buds – it is precious time
- When you’re done – LEAVE! Don’t linger!
- Complete meds, a turn, assessment, and chart all at once
- Spending slightly more time in a room and completing more tasks at once is much faster than one task at a time with each patient. You’ll be constantly chasing your tail. It’s better to complete tasks slightly early or slightly late than everything is late.
- If an MD is rounding and completing an assessment, complete one then as well and save yourself another trip
- Be proactive with educating patients/families while in the room to cut down on questions/call bells just to answer questions
- Move quickly at the beginning to get everything done. Beginning of shifts are busiest between meds and getting that first assessment charted
- Even if you are ahead or don’t have anything pressing going on, move fast to get these things done. You never know what’s about to happen.
When the chaos ensues…
- Immediately think: “who needs me most right now?”
- Stop and breathe. Ask a coworker for help prioritizing if you don’t know.
- Everyone may try to make you think that what they are worried about/asking about is a priority, but only YOU know the needs of both of your patients. Be unapologetic about this, even if someone is mad. You can’t make everyone happy when patients are unstable/have immediate needs.
- Delegate to your coworkers the task-oriented things, not the things that require you to provide information about your patient that would take too long to explain
- If you are pressed for time, chart the ABNORMAL things only and go back and fill in the “chart this same basic thing on everyone” stuff later. So if their assessment was normal except for their lungs and their peripheral pulses, just chart those things in real time and then go back later. It is really, really easy to forget this stuff.
- If you don’t have time to chart anything at all, at least chart “reassessment” or at least one thing at that time so you have a time stamp.
- Learn shortcuts. The faster you can chart, the more efficient you will be. The less time spent charting, the better. This doesn’t mean chart LESS, this means chart more EFFICIENTLY. Focus on less clicks, learn the shortcuts, read the updates or tips and tricks sent out by IT via email.
- If deemed appropriate, copy and paste your assessment and change what needs to be changed (saves a LOT of time)
Sample morning of time management
- Before report: print telemetry strips
- 0645-0700: Report on patient #1, quick intro, and “I’ll be back shortly after I get report on my other patient.. do you need anything before I come back?” Check to see if you need to bring any replacement drips/fluid when you return.
- 0700-0715: Report on Patient #2
- 0715-0730: With patient #2, introduce, educate, assess, chart (only a few things.. stuff you would easily forget), give any meds (typically minimal at this time), level your lines check your alarm settings, see if you need to replace any fluids/drips. Before leaving the room, check to see your 0800/0900 meds for patient #1 and get those on your way back to #1’s room. Be quick and efficient.
- 0730-0800: Back to patient #1 and educate, assess, chart, turn, level lines, check alarms. Once 0800 hits, scan and administer all 0800 and 0900 meds and replace fluids/drips. Before leaving the room, check #2’s chart to see what you need to bring in to that room for 0800/0900.
- 0800-0830: Back to #2 and medicate, turn, finish charting
- 0830-0845: At nursing station, interpret/chart tele strips and double check orders/chart to make sure you haven’t forgotten anything
If nothing happens, which is rare, you’ll be done with everything at 0900. It is essential to be as caught up as possible constantly because you never know who is going to be unstable and what’s coming through the door.
What are your ICU time management tips?