*Original post released on 4/1/2023
It goes without saying that nurses, especially in this day and age, need to be efficient and stay on top of their duties during their shifts. Ever since COVID hit, there has been less staff, more patients, and more duties to take on because of less staff in other healthcare professions (such as phlebotomy, physical therapy, respiratory therapy, etc.). In units like ICU, demands placed on nurses have become even greater still. Staying on top of your nursing duties can help ensure more accurate charting, allow you to adapt more easily to changes throughout the shift (with admissions, transfers, discharges), can help prevent mistakes or omission of important information, and affords you flexibility to address changes in condition as they occur. Let’s discuss some of the methods you can implement from the very beginning of your shift to help you stay on top of all of your duties!
The shift always begins with change of shift report. Meet your off-going nurse and get report from them at the patient’s bedside so you can get a glimpse of how your patient looks and their overall status. While you are in the room, make sure to check all lines, drains, wounds, pumps, and methods of oxygen delivery. Have your off-going nurse help you turn them to check their backside, reposition the patient for comfort, and turn if necessary. This keeps all nursing staff accountable for patient care as well. Then, once you’re finished, chart a nursing note about who gave you report, their current hemodynamic state, what’s running on your pumps, any drains and their status, and any pending orders/studies.
Once you’ve taken report on your assigned patients and seen them in-person, now it’s time to do some recon! What I mean by this is to devote 5 to 10 minutes of your time per patient to review their med schedule, recent lab and study results, new or pending orders, and any interventions that need to be completed (Ex: wound care, bed baths, foley care, line changes, dressing changes, etc.). Keep track of those in a note or notebook kept on your person so you can have them handy for reference, communication with other health care professionals (HCPs), and as reminders of tasks still to be completed. This act of reconnaissance helps you set the framework for the rest of your entire shift.
Next up during your shift is likely to be med pass. My advice at this time is to attempt to cluster as much care as possible with your med pass. Gather all of the necessary medications and supplies before going to see and care for your patient again. Clustering care with your first med pass not only saves you time and makes tackling your nursing duties more efficient, but it also gives your patient more time to rest and recover from interventions that we and other HCPs are doing for them. My next piece of advice is to perform your assessments while doing med pass and those care interventions. Make mental notes from an ongoing assessment you’re performing, keeping in mind each body system, during every interaction with them. If necessary, jot down notes on a piece of paper or small pocket notebook for charting more accurately at a later time.
Now let’s move on to charting. If you’ve stuck with this routine so far, you’ll have performed most of your care interventions, assessed your patients, and passed their meds…leaving charting as the major remaining task. If you’re lucky to be efficient enough, only two to three hours may have passed so far and you’re already pretty much done with required tasks. This leaves the remainder of your shift for charting and dealing with any unexpected situations that may arise later on. Take this time to do your full length charting for each patient. If necessary, document quick notes as able when you know you won’t be able to chart your full assessment. Notes can include changes in vitals or status, communications with other HCPs or family, critical lab results, new orders, changes in level of care, etc. Notes will help you keep track of those major events if charting gets delayed or interrupted. Try to chart any notes in real time or as close to real time as possible. Again, keep paper or a small notebook in your pocket for notetaking.
Now that you’ve completed the majority of (if not all of) your nursing interventions and charted your full assessments, you can take the rest of your shift in stride. This can help reduce anxiety, allow you to provide more comprehensive and attentive care for your patients, and reduce stress in general during your twelve hour shift. Hustle those first few hours, and I can assure you it will help set you up for a better second half of the shift. You’ve got this! Until next time, happy studying!