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Time Management: Keeping Track of Your Tasks & Managing Patient Care

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Time Management: Keeping Track of Your Tasks & Managing Patient Care

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Staying organized is essential when starting as a new nurse.  Time management is the key to providing safe, efficient patient care. There are various tools out there to assist RNs on the unit, including this table, which can be customized to fit the needs of the user.  A time management log can help analyze activities that need completion during the shift, providing an easy way to check off tasks once finished.

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Nurses in management roles are responsible for running the unit according to policy and principle.  Nurse managers perform staffing and delegation tasks, organize the unit, and enforce protocol. Nurses in leadership roles motivate other nurses toward a common goal.

Discussion Questions:
Can a nurse be a leader without being a manager?  What might it look like for a nurse to be in a management position without effective leadership?

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EFFECTIVE LEADERSHIP

According to the official journal of the ANA, there are nine qualities that make a nurse an effective leader:

1) Commit to excellence
2) Measure the important things (general examples: service, growth, finances. Specific examples?)
3) Build a culture around service
4) Create and develop leaders
5) Focus on employee satisfaction
6) Build individual accountability
7) Align behaviors with goals/values
8) Communicate on all levels
9) Recognize and reward success

Guyton, Nate. Nine Principles of Successful Nursing Leadership. American Nurse Today, 6 Sept. 2017, www.americannursetoday.com/nine-principles-of-successful-nursing-leadership/.

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Tsai, Yafang. “Relationship between Organizational Culture, Leadership Behavior and Job Satisfaction.” BMC Health Services Research, vol. 11, no. 1, 2011, doi:10.1186/1472-6963-11-98.

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What makes a great leader? These TED Talks offer surprising, nuanced approaches on how to inspire and empower others to do their very best.

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We've discussed management and leadership within the vacuum of the nursing team. How can we apply this to the management of client care?  How can the aspects of leadership we've discussed have a positive impact on patient outcome?

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- Facilitate analyzing of time management for individuals, team
- Help set benchmarks (example: Emergency Department sets goal of average patient stay <90 min)
- Aid in root cause analysis to improve unit function and prevent poor patient outcomes in the future

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Hendrich, Ann, et al. A 36-Hospital Time and Motion Study: How Do Medical-Surgical Nurses Spend Their Time? The Permanente Journal, 2008, www.ncbi.nlm.nih.gov/pmc/articles/PMC3037121/.

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There are many barriers nurses face when trying to maintain an effective workflow on the unit. By keeping a few things in mind, and working a few steps ahead, time can be managed more efficiently.

Ineffective multitasking is a culprit for wasting time.  This includes ensuring all supplies are gathered before entering a patient room, and by making an attempt to cluster activities when tolerated by the patient.

Charting in real time can also help save time.  It may seem difficult to stop and document after every task's completion, but it will save hours of charting at the end of a shift, while ensuring patient safety.

Discussion question:  What are some negative outcomes of waiting to document until the end of a shift?

Being proactive in communicating with physicians and pharmacy can also help maintain the workflow.  Check for needed medications before you need to give them, call the doctors ahead of time if you know you need something. Give yourself the extra time to get in touch with pharmacy over a missing medication, or a doctor when you know you will be needing an order in the near future.

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Traditional vs Contemporary Models of Client Care

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Traditional vs Contemporary Models of Client Care

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Team Nursing: Involves a team leader/team members to provide various aspects of care to a group of patients. For example, medications might be given by a nurse, while baths are given by a nursing assistant, and all tasks are supervised by a manager. Fragmentation of care is a concern with this model.

Functional Nursing: Divides specific nursing tasks to individuals. For example, one nurse may administer medications for patients, while another nurse may assist patients with ADLs, and another may assist with scheduling tests/procedures.

Primary Nursing: All nursing care for a patient is managed by one nurse for a 24-hr period. Includes scheduling of activities, tests, and procedures.  Often seen with critical patients, potential a 1:1 ratio.

Patient Focused: Allows the patient to play a large role in determining the path of their healthcare.  Also allows for unlicensed assistants to perform more tasks than traditionally, such as perform blood draws.

Discussion Question: Which of these models do you find most appealing?  Which ones seem least effective?  Why?

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Right Task

Right Circumstances

Right Person

Right Direction/Communication

Right Supervision/Evaluation

Barriers to delegation:

Unclear explanation of delegation of task, failure to communicate effectively

Performing task on the wrong patient, at the wrong time, and/or under the wrong circumstances

Improper documentation of delegated task

Failing to supervise a task that requires supervision

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1.  A patient with a pulmonary embolus is receiving anticoagulation with IV heparin. What instructions would you give the nursing assistant who will help the patient with activities of daily living? Select all that apply.

A.  Use a lift sheet when moving and positioning the patient in bed
B.  Use an electric razor when shaving the patient each day
C.  Use a soft-bristled toothbrush or tooth sponge for oral care
D.  Use a rectal thermometer to obtain a more accurate body temperature
E.  Be sure the patient's footwear has a firm sole when the patient ambulates

2.  A patient with chronic obstructive pulmonary disease (COPD). Which intervention for airway management should you delegate to a nursing assistant (PCT)?

A.  Assisting the patient to sit up on the side of the bed
B.  Instructing the patient to cough effectively
C.  Teaching the patient to use incentive spirometry
D.  Auscultation of breath sounds every 4 hours

3.  After the respiratory therapist performs suctioning on a patient who is intubated, the nursing assistant measures vital signs for the patient. Which vital sign value should the nursing assistant report to the RN immediately?

A.  Heart rate of 98 beats/min
B.  Respiratory rate of 24 breaths/min
C.  Blood pressure of 168/90 mm Hg
D.  Tympanic temperature of 101.4 F (38.6 C)

3.  The charge nurse is making assignments for the next shift. Which patient should be assigned to the fairly new nurse (6 months experience) pulled from the surgical unit to the medical unit?

A.  A 58-year old on airborne precautions for tuberculosis (TB)
B.  A 68-year old just returned from bronchoscopy and biopsy
C.  A 72-year old who needs teaching about the use of incentive spirometry
D.  A 69-year old with COPD who is ventilator dependent

4.  Which intervention for a patient with a pulmonary embolus could be delegated to the LPN on your patient care team?

A.  Evaluating the patient's complaint of chest pain
B.  Monitoring laboratory values for changes in oxygenation
C.  Assessing for symptoms of respiratory failure
D.  Auscultating the lungs for crackles

5.  Which intervention for a patient with a pulmonary embolus could be delegated to the LPN on your patient care team?

A.  Evaluating the patient's complaint of chest pain
B.  Monitoring laboratory values for changes in oxygenation
C.  Assessing for symptoms of respiratory failure
D.  Auscultating the lungs for crackles

6.  The director of a medical-surgical unit notices that nurses are frustrated with the overcrowded, disorganized supply room. She holds a meeting to discuss possible solutions with the team. This is an example of:

A) Autocratic Leadership
B) Laissez-Faire Leadership
C) Democratic Leadership
D) Tea Party Leadership

7) Which of the following are principles of effective leadership (select all that apply)

A) Commitment to budget
B) Fair and equal punishment
C) Build a culture around service
D) Communicate on all levels
E) Create and develop leaders

8) Which of the following statements is the best description of the importance of organizational culture?

A) Organizational culture plays a role in employee satisfaction by creating a positive environment that fosters teamwork and enhanced patient outcomes.
B) Organizational culture ensures a democratic working environment.
C) Organizational culture ensures that the policies and procedures of the workplace are clear and easy to follow.
D) Organizational culture helps keep organizations on track in terms of budgeting and finances.

9) Which of the following scenarios empowers leadership

A) A bulletin board displaying efforts the unit makes to prevent CAUTIs
B) A clipboard kept in the break room listing current press-ganey results
C) An email from the unit director about a recent rise in tardiness
D) A weekly newsletter including staff spotlights and notes of thanks

Which of the following is an example of leadership?

A) Raising expectations
B) Having subordinates
C) Maintaining status quo
D) Giving Directions