Never Get Behind Again: The Secret To Getting Sh*t done

5/12/2018

How many of y’all often feel like there is just too much going on at work?

Do you struggle with keeping up on the routine tasks when there is a lot of other stuff happening? Do you find yourself overwhelmed with the amount of work?

At the risk of making myself sound stupid, it took me a long time realize the importance of having a routine around routine-work.

In my free guide for new ICU nurses (which you can download here) I talk about why its important to get these routines down. It basically boils down to this: the ICU can be a mad house at times, but we are still expected to meet certain requirements that involve a lot of routine work. Not only that, but our patients need us to do the routine stuff (the turns, the baths, the accuracy of our charting, etc).

If it feels impossible to handle all the routine stuff AND the surprise punches the ICU likes to throw at us, I am here to tell you it is possible! It takes a little bit of work, but with these habits in place, you’ll be handling it all like a champ in no time!

(A word to the wise: These are only suggestions- you will have to find what works for YOU. That is the beauty of it. Experiment and see what clicks with you. Once you find that click, stay loyal to it. The more clicks you find, the quicker, more efficient, more reliable your work will become. Heck, you might even find yourself with some down-time! Imagine that!)

Let’s take a look at some ways to make routines around routine-work.

Developing Routines Around Routine Work

The Beginning of your shift:
The goal: To get a good understanding of your patient’s story, all their data, tasks you will have to do for them, goals for your day, and setting up your work for the shift.

When you get report, get as much information as will be useful to you. Do not use this time to be social. This is a time where you are taking on responsibility for someone’s life.
Look over the chart- Take note of the orders, make sure they match what you heard in report. Read the recent note and gain a good understanding of the patient’s story. Look around the chart to give yourself the confidence that you understand what is happening with the patient before you start getting busy.

I/O’s:
The goal: to chart accurately and timely.

Why this is important: keeping track of your hourly I/O’s will give you insight into what the patient’s body is doing. It will help you prevent potential complications, and help you pick up when something isn’t right.

Get in the habit of tipping the Foley meter at the top of the hour. Chart it immediately, if possible.
Have a back-up system for when you tip it at a different time (for whatever reason). For example, if you tipped it at 0900, and then got busy and did not tip it until 1030, there are different ways you can compensate. You could wait until 11 and divide the amount in 2 (for 2 hours). Although harder to remember, you could chart that you tipped it at 1030 and then from there on out chart on the half hour. Or you might decide altogether to just chart when you tip it, whenever that might be, and let the data speak for itself. The trick is to always have the same back-up system. You should primarily aim for on-the-hour.
At the end of the shift when I empty the bag, I always have a number I stop at on the container. I always stop filling the container at 800 ml, that way I just keep track of how many times I filled up the container, plus any remaining amount. I am a visual person, so it is hard for me to remember a number I calculated in my head. For example, instead of having to remember that I dumped 1350 ml, I remember that I emptied it once (800 ml) and the second time I filled it, I had 550 ml. When I sit down and chart, all I have to do is add 800 +550. This might work for some, and not for others.

Q2H Turns:
The goal: to consistently get your patients turned every 2 hours

Most ICU nurses use the even numbers on the clock to turn their patients (turns at 0800, 1000, 1200, etc).
If you do that, you will be able to plan ahead when doing other tasks. If you know you will have to turn patient B at 1400, do what you need to do to get Patient A settled before then so that you can free up your time and mind to get Patient B turned.
Cluster your care. Turning can be a big pain in the butt. But if you use that time to get your hourly care on that patient, you can knock it out in the first part of the hour. In the above example, Patient B has to be turned at 1400. They might also have a med due at 1500 as well as oral care, tipping back the foley, a blood glucose check and hanging a new bag for their drip. I would personally do all that the first half of the hour.
So that you don’t forget an important step during the actual turning process, I would recommend a routine so you do it without much thought. You know that it is important to do oral care and suctioning before laying flat, or that the patient should be restrained after you are done repositioning. Create a routine around these things so you never accidentally forget.

Assessments:
The goal: to do a thorough head-to-toe assessment in a timely fashion

Do your head-to-toe assessment in a systematic way that makes sense to you. My nursing instructors would kill me if they knew I did my neuro assessment last. But for me, that is just the way I do it! HOWEVER you do it, always do it in the same way. What mostly matters is that you do it, period.
Immediately chart your findings. Those who know me know that I am a huge advocate for real-time charting. When you finish your assessments, chart it. Some people prefer to only chart the abnormal findings and then go back later to fill in the rest. I always say that if you can, do the entire charting. Why? You don’t know what will happen in the future, or if you will have the time.

Patient Hygiene:
The goal: to keep the patient clean, groomed and feeling fresh.

Side Rant: A lot of this type of work often falls to the wayside but it is really important for patients and their families. Not only does good hygiene lead to decrease in complications, it is important for the patient’s self-image/confidence and it is also comforting to patients and families.

The truth about hygiene work is that even though it feels trivial, it also only takes a few minutes to complete. The payoff is great, so it is worth the effort.

Have an extra 2 minutes? If the patient is not intubated, make oral care with a toothbrush and toothpaste part of your morning/nighttime routine with them.
Have an extra 3 minutes? comb their hair/beard and wipe down their face. Get all the crusty stuff off their eyes and mouths.
Have an extra 5 minutes? put some lotion on them. Recall what its like to have super dry skin- it is itchy AF. Lotion it!
Have an extra 30 min? Get that bed bath in. If you are really pressed for time, do a quick wipe-down and sheet change during one of your turns.
Have an extra minute? Empty the trash, or de-clutter the counter tops. Environmental hygiene can boost a patient’s moral.

The End of Your Shift:
The goal: to wrap up loose ends, finalize your charting for the shift and prepare the patient/room for the next shift.

The room: empty the trash/laundry bin (if its your job), clean the surfaces, get rid of excess materials, etc. Restock any items that are frequently used.
The Patient: empty drains, do your last reposition, make sure they have everything they need including pain medication or objects they use (so that they don’t call during report or so the on coming nurse can have some time to get situated).
Your Charting: chart anything you might have missed. Look over your day’s charting and make sure it was accurate and that you didn’t miss anything. Chart hospital requirements (such as care plans, nursing notes, etc).

via GIPHY

That was a lot to cover!

Take-Away:
A lot of routine work comes down to having a system in place to get it done. The system could involve the timing of when you do it, the sequence of how you do it, or just about any other quirks that will remind you to get it done.

The important thing here is to create this system for yourself. If you don’t, you will undoubtedly make your work more stressful than it has to be.

I am curious:
what weird quirk or effective methods do you use to systematize your routine work?
Comment below and share!

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