How to Organize or Prioritize Patient Care

A common thread on nursing forums, especially among new nurses, is how to organize and prioritize patient care for a shift. No matter what type of setting you work in, this is essential to the successful completion of the daily tasks.

One of the first rules of prioritizing is to expect the unexpected. And the primary unwritten rule is NEVER to say how quiet it is! In expecting the unexpected, you will always have a Plan B in your back pocket and won’t be quite as affected as you would if you were expecting everything to flow according to the schedule.

Most days you will have to deal with something unexpected, if that is only a new admit who needs to take precedence now over the 3 dressing changes you were just getting ready to do.

Time management and organizational skills are essential for nurses and yet they are not often even discussed in nursing curriculum. Time management courses are available through college or university extension courses, adult education programs and online. If you seriously lack organizational or time management skills, you may benefit tremendously from one of theses classes.

At Home
Away from your job setting, use your critical thinking skills to consider the basics of your shift. Try to plan out a typical day. Take a piece of paper and divide it into two hour increments. Pencil in patient meal times, and the hours in which primary ADLs take place on your shift such as AM care or HS care.

Next consider medication schedules. For instance, will you likely have ac or pc medications to give? What about HS meds? When will your patients be most likely to go for tests, therapy or other events? When do most of the MDs make rounds? What time of day do you usually get bogged down with discharges or new admits? What part of visiting hours usually lets you slow down and catch up? Allow for these and now when looking at a specific assignment, pencil these in.

At Work
Arrive early for your shift to get settled and to get a feel for how the previous shift has gone. The tension and chaos or calm and quiet may flow over into at least the beginning of your shift. In learning to expect the unexpected, it’s important to get a feel for the pace at which things are going at any one time. If you need to hit the ground running, you need to be prepared for it, and not arrive running late.

Listen carefully during report or rounds to get a feel for:

• how busy everyone is going to be
• the general acuity level of the patients today
• who might have time to help you out if you get overwhelmed
• what treatments, assessments, or procedures may be taking place today that you could learn from if you have a chance

Look over your assignment and begin to plot items on your schedule. Look for

• time specific events
• patients who may require more of your time for teaching, hand holding, etc.
• new patients, diagnoses or treatments you need to look up
• things you want to put off until last or hope you don’t have to do
• things that can be delegated to an aide or LPN if necessary

Make rounds and quickly assess your patients for any additional information you need to help you set your schedule. Try to get the things you dislike out of the way first. This can include distasteful procedures, dealing with impossible patients, and anything you are uncomfortable with. The longer you put these things off, the more they will weigh you down during your shift. Get them out of the way and move forward. You’ll feel the load lift off your shoulders.

Schedule your meal break and other break times and try to stick to this. Meals and time away from patient care is important to your well being, your morale and your ability to provide quality patient care.

Make sure you leave time for charting at least three times during your shift and chart any PRN meds immediately. Review your schedule every two hours to make sure you’re on track and make adjustments for changes. If you’re getting behind, ask for help early on instead of waiting until near the end of the shift when everyone is pressed for time. Remember to thank those who help you out.

By Kathy Quan RN BSN. Kathy is the author of The Everything New Nurse Book and is the author/owner of TheNursingSite.com

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