I’ve worked on both the floor and intensive care. In both units time management is absolutely essential. However, time management on the floor is very different from time management in critical care. I’m going to go through some tips to help you appropriately managing your time in a critical care setting. I know it can be scary at first, but it will get easier as you become more confident in yourself.
First of all, congratulations on landing a job in critical care! It’s so awesome! I am sure you feel like I felt. Like this:
TIMELINE
Here is my general timeline after I get report on my two patients. Typically, one is sicker than the other.
- After report, I double-check my orders. I make sure my monitor matches my ordered parameters (for example, if my order is to keep their systolic blood pressure 120-150, I make sure the monitor is set appropriately). I see if there’s anything I have to do (meds, labs, scans, etc.) at 0800. I print and interpret my telemetry strips. If my patients are on drips, I insure I have a full bag and one on deck. If not, I order one.
- I go see my sicker patient first. I get any 0800 meds/supplies, go in and do my assessment, turn, meds, oral care, and talk to them about the plan for the day. If time allows, I immediately chart my assessment at the bedside.
- Then, I go grab any 0800 and 0900 meds/supplies for my second (less sick) patient. I complete everything I listed above with this patient and immediately chart what I’ve done. I usually end up administering medications last because it’s barely 0800 by this time and I have to wait until then to give my 0900 meds. So sometimes I even chart my entire assessment first and then go back to administer meds.
- Then I head back into my first patient’s room with their 0900 meds. If they are a q2h neuro check then I complete it and chart it at this time.
- If my second patient is a q2h neuro check, I then complete that and chart it.
- Typically, if no one decompensates or needs to travel and if no doctors round.. I’m caught up by 0930.
However, it doesn’t happen too often like that. But it’s important to know your “this is what I do every day when time allows” routine.
NURSE EYE ROLL’S CRITICAL CARE POINTS OF ENLIGHTENMENT
1. Have a consistent routine. If you do this, then you won’t miss things. Rarely do things work perfectly, but you need to have a consistent, efficient and comprehensive routine that you stick to.. otherwise you could miss something important. Also, you can get behind early which screws up your entire day.
trying to collect yourself after your first code in critical care
2. Stay ahead. Always have your charting done, even if you think you have nothing pressing going on. Things change QUICKLY and severely in intensive care. You could all of a sudden get a coding admission and be in that room for hours and if you didn’t have your stable patient’s assessment charted from 2 hours ago, you’ll never remember it now! So if your meds are given at 0800 and your assessment isn’t charted, it is NOT time to go grab coffee. Chart everything first, turn, make sure there is absolutely nothing left for you to do before you have a break.
3. Anticipate and prepare. Once you’re there for a little while, you’ll be able to predict how patients respond to certain things. For example, if I have a patient with a history of CHF that needs 4 units of fresh frozen plasma, I know we’re going to need some Lasix at some point.. otherwise Mr. Smith is going to turn into Mr. Respiratory Distress. If we’re about to do a bedside tracheostomy placement, I know I’ll need to have a bolus primed and ready to go and a bag of Levophed hanging and programed because typically they become hypotensive with the procedural meds we administer. If you anticipate and prepare you won’t have to frantically grab supplies while your patient is decompensating.
4. Be meticulous. Most nurses in intensive care have Type-A personalities and are meticulous and detailed. If you don’t care about the details, you can miss something BIG and it would be your fault. Meticulous nurses save lives because they know everything about their patient. And not only that, they care about the details. Say goodbye to being task-oriented.. you are now big-picture oriented and you won’t be able to see and interpret the big picture if you don’t know the details off the top of your head. Additional, when things go downhill (because they will, and quickly!) you will know the important stuff off the top of your head for quick problem solving in the midst of chaos.
seeing that your patient is about to extubate himself. RESTRAINTS PLEASE!
5. Figure out what you think about death. I know this is odd to say, but I highly recommend soul searching to figure out what you personally believe happens after people die. Because you’re going to see it. A lot. It can be pretty gut-wrenching and it can hit close to home. Make sure you have a good emotional support system so when you do have a really sad day, you can go talk to someone you trust and love so that they can support you. Nurses that don’t become angry, sad, difficult to be around, and jaded. Moral distress is the #1 cause of caregiver burnout. If you can’t process that stuff, it’ll get to you eventually. PTSD in critical care nurses is real (check out this article about it); please take care of your heart and soul.
6. Develop rapport with your physicians. Things change very quickly in critical care. However, sometimes you just get a feeling about something.. and you need doctors that will listen to you and believe you. Take the time to get to know them and develop a trusting relationship with them.. it will pay off for the both of you.
7. When you come home, process your day with a loved one for no more than 10 minutes, then move on. It’s very easy to let your nurse life take over your entire life. Don’t let it. Yes, you’re a nurse, but that is one aspect of your life. Invest and grow the other areas of your life so that work doesn’t take over. It will help in dealing with rough work situations when you find fulfillment and purpose in other things. You will get burnt out if you don’t maintain a good work-life balance. And that includes unnecessarily going over situations that happened at work that you cannot change over and over again at home. Please save your sanity.. and your loved ones!
8. Take care of yourself on your days off. REST, work out, eat right and spend quality time with people that you love and that love you. Be intentional with your time. Our job is hard. It’s emotionally and physically draining. If you’re not taking care of yourself, it’ll make those days that you work that much harder. Your sanity and happiness won’t last long.
I know it seems like a lot but soon it will be second nature. And when you go home after you rocked your first shift in critical care, you’ll probably do this:
I know I did. Just ask my husband!
Stay tuned for Part I, coming out this Saturday. It’s about prioritization in critical care.
If you work/worked in critical care and have any advice or wisdom that will help newbies, please comment below!