Basics of Organization

Basics of Organization

Did you miss out on Nursing Organization 101 in college? Don’t woory you're not alone. Accomplishing many routine tasks in a chaotic, disruptive environment can be frustrating and detrimental to the spirit of a new nurse. An efficient system of organization must be developed quickly for doctors, patients, family members, and other team members all rely on a nurse’s ability to coordinate care. Whether taking report, giving report, charting, or trying to prioritize tasks, the whirlwind of information must be organized to ensure a smoother shift.

Relate your experiences to the graduate nurse concerning organization and keeping information together.

1.    Many nurse have a "brain" or "cheat sheet" which contains pertinent patient information creatively organized on a sheet of paper. Tell me how did you develop your "brain" ?

2.   In a hospital or similar setting, the report at shift change can be a difficult time for both the nurses coming on and for nurses trying to get off. Name some common courtesies that are good for ongoing and offgoing nurses to practice during report time. 

3.   What is the advice would give to a new nurse about preparing for shift report? 

4.   Charting is like a chewy candy, do you do it Now or Later?

5.    What's your take on charting and how do keep yourself on track?  

6.   Most nurses must know job specific information such as paging doctors after hours, telephone extensions, diagnostic test protocols, and usual lab turn-around time, how did you know and keep up with all this information on your job?  

7.   How do you prioritize and manage your tasks in a busy environment?

8.   How do you prevent yourself from feeling overwhelmed and avoid emotional overload?

Comments

[Aimee Dinwoodie]

1. When I first stared I created a sheet for all of the information on each pt and filled it out in shift report and added to it as new orders were given throughout the day and highlighted the important things. I had an area that I could wrote down medication times so I could look and see easily who had what due when. Things liek that. I should find that sheet and post a copy of it on here. Anyhow- now that I'm in the ED, I keep a piece of paper on it and I jot down notes on what I need to do if I'm having a moment.

2. LISTEN to what the other nurse is saying. Ask questions. I don't want to be blamed for something that you didn't ask about or hear("Well, day/night shift didn't tell me anything about that.")If you see an order for something, ask if it was done, ask what the lab results were... Also, pass on tasks that need to be done. It's okay to say "Hey, bed 15 needs a new bag of IV fluids."

3. Take a moment before you give report and think of what's important to pass on to the next shift. Abnormal labs, the pt's vital sign trends, things that are necessary to know before taking care of the pt. I wan tto know if my pt's BP has been 86/40 since they arrived and that it's not a new development. I want to know that the pt is MRSA positive or that they have right sided weakness from an old CVA.

4. Always try to chart when things are fresh on your mind, when you steadily maintain your charting throughout the day it'll be a less overwhelming task at the end of the day. If it's not possible to keep up with your charting keep good noted with times and details.

5. I try to chart at least once an hour on each pt. I'm in an ED environment so I try not to get behind by delegating tasks that can be delegated or asking a fellow nurse for help if I notice that they're caught up. When I worked on the floor I would do my morning medications and assessments, making notes as I went, and then I would sit down and chart my main assessment before starting dressing changes and noon meds. I also on the floor charted every 4 hours on my pt's at the least and every 1-2 optimally.

6. I make good friends with the unit secretary. :o)

7. I make lists of most critical tasks. Or I take my most critical pt and focus on stabalizing them before moving to the next less critical pt.

8. Usually by getting off the unit for a few minutes, or taking time to eat or drink something.

[LCC]

1. Each nurse can show you their "brain" or "cheat sheet" which contains patient information creatively organized in a certain way. Tell me how did you formulate your "brain" (system of recording and organizing patient information)? At first I took report putting info all over and every where. After a few embarrassing moments where I couldn't find anything on my paper I borrowed several coworkers old shift reports and created a hybrid version of them all.

2. In a hospital or similar setting, the changing of shifts can be a painful time for nurses coming on and for nurses trying to get off.
Name some things you dislike that the other nurse does when your trying to give report and get out of work. Why must they flip through the chart as I am talking! Also when I'm giving report it's me and you time, don't turn around and start talking about your bad date last night to another co-worker. Give me 5 min. of your time and you have the whole shift to chat about that stuff.

Name some things you dislike that the other nurse does when your trying to receive report and get your shift started. Give me the basics and none of the "Ms. X was once a ballet dancer and we talked about abc. She's really sweet and has two girls who can xyz." I have only so much time for report so make every minute count.

What's one piece of advice you would give to a new nurse about shift report. If you don't know, say you don't know, if you didn't do it, say you didn't do it. and the number one thing is KNOW WHAT DIDN'T GET DONE AND COMMUNICATE IT TO THE NEXT SHIFT. Very immportant! Don't assume they'll find out that the abx weren't started or that the daily dsg change wasn't done. JUST TELL THEM!

3. Charting is like a chewy candy, do you do it now or later? What's your take on charting and how do keep yourself on track? I try, try, try to chart my assessment as soon as it happens.

What's your game plan if you fall behind? If I see things are coming up and charting will have to come later, I jot down on my report sheet brain teasers of every patients assessment.

4. Most nurses must know job specific information such as paging doctors after hours, telephone extensions, diagnostic test protocols, and usual lab turn around time, how is one to know and keep up with all this information?
I used to keep a clipboard with all that info on the face of it but now I have just remembered it all, I use it so much! That clipboard was helpful though initially. If it's something new, I look on the units important number directory or I call the helpful operator, 0!

5. Prioritizing. How do you prioritize needs, whether patient needs or doctors?
Common sense. Basically though, I list out what needs to be done and sometimes I go in order down the list, other times I'll group the patients activities together, and then there are those times when I'm all over the place on that list.

The call bell is binging, the phone is ringing, a family member is at the desk asking for the water pitcher to be refilled, and a doctor is asking you to find results to this mornings labs. What do you do?
I tell the family member to wait for a second, tell the doctor I'll investigate the labs in a moment and will call him if he leaves, the person calling on the phone will call back if I don't answer the phone soon enough, so I then answer the call bell, patient's first.

When things get chaotic, everyone needs you 'right now' and you start to turn circles, what do you do?
Stop, and go into the breakroom for 5 minutes and sit. Or go take that bathroom break I've been neglecting for the past 5 hours.

6.How do you prevent yourself from feeling overwhelmed and avoid emotional overload?
Taking that break and knowing the crazy shift won't last forever. It will end sometime.