Time Management Tips for New Nurses

One of the biggest challenges for a new nurse is to learn to navigate through a busy shift. There’s so much to do: patient assessments, passing medications, doing treatments, preparing for procedures and discharges…and that’s without the inevitable urgent events that can happen at any moment. How can so much be squeezed into 8 or 12 hours?

Time management is essential from your first day on the job. In a recent ANA webinar, Misti Ludwig, DNP, RN-BC, offered some ways for an early career nurse to get organized. Her tips can make sure you don’t just survive, but thrive, during the first few months. Some are temporary to help you get launched, others will become habits that will last throughout your career.

1. 1

   Prepare for your shift

   • Get to work 20-30 minutes early. While you’re learning the ropes, this is a temporary tip that will help you feel organized and ready for whatever comes your way. You can’t clock in, but you’ll gain so much by planning your day. Review your patients’ charts: how are they doing, any new orders, lab results, scheduled procedures, or anything else that will be useful to know. You’ll get some of this later during shift report, but for now, get as much as you need to be familiar with the patients and the charting system. After awhile, you won’t need to do this anymore — but it’s valuable in the beginning.
   • Find a reporting tool that works for YOU. Sometimes called “nurse brain sheets,” you can find templates online. Depending on your unit, there are specialized reporting sheets, such as for telemetry, pediatrics, ICU, etc. Use one for each patient. Ask another nurse to share theirs or make your own with Microsoft Word or Apple Pages. The important thing is to always have the same information in the same place for easy reference. Ludwig suggests using a four-color ballpoint pen to color-code everything: Green for the information you get from the patient’s chart; Blue for what you get at shift report; Red for what happens during your shift, including labs and vital signs; and Black for any orders during the shift. You can locate information quickly, especially if there’s an urgent event.
   • Plan your day! Lay out your timeline by writing when meds are due on the back of each patient’s reporting sheet. Do the same for when lab results are expected, as well as any scheduled procedures or treatments. Don’t worry about which meds, procedures, or treatments — for now, just the times. Combine all of them on the back of the last patient’s reporting sheet — now you have a Master Timeline for the shift. You can now plan when to do things for each patient. If you’re waiting for a lab result before administering a medication, you can calculate when the result will be available and work around it, while passing meds for other patients. Using the Master Timeline as a checklist can keep you on task, without your having to memorize the day’s schedule.
   • Organize your pockets. There are days when every second counts. One of the biggest time savers is knowing where to find things in a hurry. Keep your pens and highlighters in the dominant hand scrub pocket. Store alcohol wipes and bandage scissors in the other scrub pocket. If you can get scrub pants with pockets, always keep the same items in the same pockets. Whatever works for you, stick with it. The same goes for your nursing bag or organizer. Keep it tidy, with everything in its same place. Once a week, take time to declutter and restock.
2. 2

   Anticipate the shift

   • Every shift is different, but you can start by looking at your patients and figuring out what each will need: medications, labs, procedures, etc. As you gain experience, you’ll find this easier, but in the beginning, try to plot out everything you’ll need.
   • Example #1: This patient had a Vancomycin peak and trough level lab drawn. When the results are ready and have been reviewed, you will hang the next bag of Vancomycin. By combining the assessment with the medication administration, you will save time.
   • Example #2: This patient is receiving Kayexalate to treat hyperkalemia. You know that the patient may experience nausea and diarrhea after a dose. Tell your team members what to expect, so everyone is prepared to answer the patient’s call light quickly.
   • Example #3: This patient was admitted for ongoing chest pain and a myocardial infarction has been ruled out. You expect that the cardiologist is going to order a cardiac catherization. The cardiologist usually makes rounds about 0800, so you plan to be available to prep the patient for the procedure.
   • Look at your patient’s reporting sheet. Are they scheduled for physical therapy, a breathing treatment, or discharge? You can arrange your shift around events you know will take place. This keeps your day on track and allows for unexpected situations.
3. 3

   Prioritize your patients

   • Category 1: Patients with a recent change of condition. A patient with an acute change should be seen and assessed first. This includes a patient with a chronic condition, such as COPD, who has developed sudden shortness-of-breath. Any patient experiencing a deterioration belongs in Category 1; to not see them first could cause harm, including falls.
   • Category 2: Urgent patient issues require attention after you’ve checked the patients in Category 1. These include patients who need preps before scheduled. procedures or surgery. Time-sensitive medications belong here, too. An example: Vancomycin peak and trough administration.
   • Category 3: Things to do during the shift. This category includes passing routine medications, treatments, processing orders for discharge, and patient education for discharge.
   • Category 4: Nursing actions that advances the plan of care for patients. These are important, but not urgent activities. Some examples are patient education, referrals for patients with chronic conditions, and assessments, such as ambulation and self-care.
4. 4

   Delegate and explain what you need

   • Know your team members and what they can do. If you aren’t already familiar with their scopes of practice — as well as what your facility allows — take time to do so now. Knowing what you can hand off is important.
   • Delegate early in the shift so your team members can plan, too. Explain clearly what you’re asking. Don’t assume they know. For example, if you’re asking an unlicensed assistive personnel (UAP, such as a CNA or PCT) to report an abnormal blood pressure for a patient, explain what is abnormal for that particular patient. If another patient is on strict I&O, make sure the UAP understands what that means. This will save time and frustration for both you and the UAP (or LPN).
   • UAP/CNA/PCT: Generally, you can delegate these tasks:
     1. Vital signs, I&O, empty Foley catheter
     2. Activities of Daily Living: Bathe, toilet, ambulate, meals, positioning
   • LPN/LVN: Generally, you can delegate these tasks:
     1. Administer routine patient medications
     2. Continue assessments after RN has initiated
     3. Insert a Foley catheter
     4. Possible IV maintenance
     5. Any CNA tasks
   • Charge Nurse: In an emergent situation, you can ask your Charge Nurse for help. Medication administration is a good activity to delegate; it maintains the schedule for other patients while you attend to a patient’s emergency.
5. 5

   Take care of yourself

   • In a poll conducted during the ANA Webinar, about 35% of the nurses reported that they never take a break during their shift. About 56% said they are sometimes able to get a few breaks. Only 3% said they always took their breaks.
   • As a new nurse, allowing yourself to take a break may seem impossible. You may worry that you appear selfish or unconcerned about your patients. There may be days when a break is truly impossible, but it’s important to find time to sit for even a few minutes.
   • Pack your favorite foods and snacks. When you know you have something good to eat, you’ll look forward to your breaks and be more likely to take them.
   • Neglecting to care for yourself — both professionally and privately — can lead to illness. It can also lead to burnout, which is especially harmful to new nurses. You worked hard to become a nurse and now you’re discovering that the work itself can be hard, physically and emotionally.
   • Join the Healthy Nurse, Healthy Nation Initiative Grand Challenge, sponsored by ANA Enterprise. Nurses tend to be less healthy than the average citizen, mostly because we put others before ourselves. The challenge addresses five areas: Physical, Nutrition, Rest, Quality of Life, and Safety. Register, do a quick assessment, pick a challenge, and join! It’s an easy way to stay accountable as you pursue your health goals.

No matter where you are in your nursing career, there are always ways to become more organized. There’s a steep learning curve in the beginning, but when you adopt good planning practices, you’ll find that you’re more productive and focused. No matter what the shift brings, you’re in a better spot to handle it. In the end, you’re also more satisfied with how you were able to provide excellent patient care.

If you haven’t already joined the American Nurses Association, consider doing it now. You will have access to free webinars, special discounts — and be part of the organization that works on your behalf.

About the Author

Winona Suzanne Ball

Nursing Adviser, RN | MHS, Governors State University, IL
Full member of the American Nurses Association. Learn more