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ICU time management

Posted

Specializes in Float RN. Has 4 years experience.

Hi! I’m an ICU float now at new establishment. I am not happy about that ?but I am stuck here due to family dynamics etc.

??Each unit is run soooooo?different and so it pt population?, neuro vs ecmo, vs msicu vs CVICU. I’m having a hard time with time management. I’m night shift so baths are included. How do u balance 2 pt assignment? I like to get report eyeball pt (?A line, pumps at said rates) then Dayshift leaves I get into assessment and always find myself struggling with untwisting tubing n lines or finding something that needs sorting. Now I grab meds and by time given.... like when am I supposed to chart? I try to chart vs and I/o hourly. But this hospital wants assessment/skin/IV/adl charted Q2.?
I find myself being behind and not stopping to ever have time to read progress notes. I’m making myself ill from the stress. Any advice appreciated.?

Edited by Used2byoung

JBMmom, MSN

Specializes in Long term care; med-surg; critical care. Has 9 years experience.

My general approach sounds much like yours. I use the whiteboard in the room for many charting aspects, like hourly I/O, or other observations during assessment?and wrap it all up later in the shift. I'm also 7p-7a or 11p-7a and when I'm in at 7p I rarely get to charting before midnight because I'm in and out of my patient rooms. I try to get hex baths done by 10pm and usually the majority of HS meds are done by 11 so I can catch up on charting after that. I don't usually get to any notes until 2-3am, so if someone crashes I don't get to look through notes at all. Not ideal, I know that the "chart as you go" method works for many people, but I just never end up doing it that way. You'll get a better system when you've got more time under your belt. Good luck!

JadedCPN, BSN, RN

Specializes in Pediatrics, Pediatric Float, PICU, NICU. Has 15 years experience.

Floating in general is hard to adjust to because as you said, each unit is so different, the culture is different, even simple things like supply locations or room stock is different so that in itself is a learning curve - I still joke that I spent half of my day as a float nurse staring at the supply omnicell trying to find out where the unit I’m on keeps the tegaderm, or whatever simple thing I’m looking for.?

It’s been a while since I’ve worked ICU but I do remember clustering care was so important, as well as prioritizing based on acuity. As soon as I have “downtime,” I try to get any general shift requirements out of the way so I don’t have to worry about it the rest of the night - whether that’s a bath as soon as possible, dressing changes, etc. As you get your rhythm, charting as you go will come easier. Unless a patient is actively crashing or in pain or something urgent like that, I realized that I can take the extra 5 minutes to quickly chart my assessment and then go do what I need to do. As ICU nurses (I started in ICU as a new grad) we tend to be more OCD-ish when it comes to things like twisted lines or maybe a messy counter space...by all means if you have the time to clean it all up and make it pretty then of course do so, but don’t let this get you behind if it isn’t a necessity and isn’t impacting patient care. You’ll eventually find your groove but in the meantime give yourself some grace.?

RNperdiem, RN

Has 14 years experience.

A few things I have learned:

The first hour of two is focused on assessments, daily meds, turns and getting that stuff charted before rounds.?

Detangling lines, daily dressing changes, baths, getting OOB and other non-urgent tasks?can wait until I have the first round of charting done.

Sometimes the assessment will be incomplete to be filled in later, but vitals, I&Os, restraints and other required documentation needs to be done pronto.

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