Time Management (5)

I PASS THE BATON

I - Introduction: introduce yourself P - Patient Name: identifiers, age, sex, location A - Assessment: "The problem", procedure so far in the process S - Situation: current status/circumstances, uncertainty, recent changes S - Safety concerns: critical lab values/reports; threats, pitfalls, and alerts B - Background: co-morbidities, previous episodes, current meds, family A - Actions: what are the actions to be taken and brief rational T - Timing: level of urgency, explicit timing, prioritization of actions O - Ownership: who is responsible (person/team) including patient/family N - Next: what happens next? Anticipated changes? Contingencies

Personal Time Management

Managing time is difficult if a person is unsure of his or her priorities for time mangement, including personal short-term, intermediate, and long-term goals.

Delegating to Others

Many studies have demonstrated that approximately 50% of nursing time is spent on non-nursing activities like cleaning, running errands, clerical duties, and stocking supplies. Delegation of non-nursing tasks can provide the nurse with additional time to dedicate to clients care.

Prioritizing - Urgent but Not Important

Today is the deadline to submit a quality assurance report about decubitus ulcers; the study results demonstrate that staff practice is consistent with standards and the decubitus ulcer rate is decreasing

Delgation

Transfers responsibility while remaining accountable for outcomes

Contingency Planning

anticipated problems, results, procedures, and what to do about them; be specific

"Read back"

to verify a shared mental model

Pareto Principle

-20% of focused effort results in 80% of outcome results -Efficient time management requires that a shift be changed from doing unfocused activities that require 80% of time for achieving 20% of desired results to doing planned and focused activities that use only 20% of time or input to achieve 80% of desired outcomes. (Ex: cleaning the house when company says they are 5 mins away so you clean the house in less time that would have take you much longer without the pressure)

Creating a Time-Efficient Work Environment

-Gather all supplies needed before starting an activity -Group activities that are in the same location -Use time estimates -Document nursing interventions as soon as possible after they are completed -Always strive to end the work day on time

Costs of procrastination

-Health: weakened immune system, GI problems, stress, anxiety -Destroys teamwork & relationship with others -Monetary costs -Low self-esteem

Daily Planning Actions to Utilize Time

-Identify key priorities to be accomplished that day -Determine the expected level of achievement of a prioritized task -Assess the staff assigned to work with you -Review the short- and long-term plans of the unit -Plan ahead for meetings -Allow time to assess progress of goal attainment -Take regular breaks -*Think of worst case scenario & how you will prevent that for your patient (interventions) -*Document interventions & teachings to patient/family -**Always anticipate complication

Organizational Factors

-Job enlargement (combining positions): organizational structure that can affect time demands -Flatter organizational structure: positions combined with managers having more staff to supervise -Shared governance: students participating in the course, leading the course

Procrastination Solutions

-Know thyself -Do worst task first -Break large tasks down into smaller tasks -Reward yourself for completing smaller tasks -Go public/ask for help -Use post-it notes or other means to keep self on task

5 Rights of Delegation

-Right Task -Right Circumstance -Right Person -Right Direction -Right Supervision

Types of Procrastination

-Thrill/Arousal: works best under fire -Avoid -Decisional: doesn't know which fence to be on

Dealing with interruptions

-Urgent or positive interruption: requires you to reroute thinking of day (code, personal emergency) -Time waster: technology (social media), socializing (visitors), interruptions, paperwork overload, a poor filing system

Methods of Handoff Report

-Verbally -Handwritten notes -Bedside (can be combination; some verbal & some bedside) -Telephone -Audiotape -Non-verbally using electronic reports, computer printouts, and memory

Personal Characteristics of Time Wasting

-does not understand time planning -cannot distinguish what is important form what is not -underestimates time and effort needed to accomplish tasks -makes too many rules or procedures or approvals -anxiety about planning robs energy -does not look at the standard of work necessary

Prioritizing Your Care

-identify the busiest times on the unit (morning med time) -do not schedule a dressing change when medications need to be given -plan on preparing meds at least 30-45 mins before the hour they are due -do not procrastinate; start early -similar teaching for multiple clients; do group teaching if appropriate -ask seasoned nurses about their time management tips

Charge Nurse - What to consider when making assignments

-priority of patient needs -geography of nursing unit -complexity of patient needs -other responsibilities of staff -need for continuity of care -agency organizational system -state laws, state nurses practice act -need for fair work distribution among staff -need for lunch/break -need for isolation -need to protect staff and patients from injury -needs of other units in hospital, number of staff -skill, education, and competency of staff (RN, LVN, UAP) -hospital policy and procedure -patient care standards -environmental concerns -accreditation regulations -desired patient outcomes

How should nurses prioritize their time?

-understand the big picture -decide on optimal desired outcomes -do first things first: 1st: Life threatening? 2nd: essential to safety? 3rd: includes comfort, healing, and teaching?

Three Categories of Prioritization

1. "Don't do" - things that will take care of themselves 2. "Do later" - needs to think on it 3. "Do now" - done right here, right now

Three Cyclic Steps

1. Allow time for planning and establishing priorities 2. Complete the highest priority task whenever possible 3. Try to finish one task before beginning another

The SMART Approach to Studying

1. Set specific, clear goals to be accomplished 2. Record your progress as measurable progress maintains your interest 3. Identify the steps needed to accomplish your goals 4. Be realistic about your time constraints and set goals that can be accomplished within these constraints 5. Set a time frame and plan for this

Bran's 12 Habits to Master Time Management

1. Strive to be authentic 2. Favor trusting relationships 3. Maintain lifestyle that gives you maximum energy 4. Organize day by your biorhythms 5. Set very few priorities and stick to them 6. Turn down things inconsistent with your priorities 7. Set aside time for focused effort 8. Always look for ways of doing things better and faster 9. Build solid processes 10. Spot trouble ahead and solve problems immediately 11. Break goals into small units of work and think only about one unit at a time 12. Finish what is important and stop doing what is no longer worthwhile

Two Mistakes of Time Management

1. Underestimate how long it is going to take 2. Not allowing adequate time for planning

Prioritization

A - requires action as soon as possible B - necessary, but can wait for now C - can wait until you get to it or until it can be discarded D - can be immediately discarded or delegated to someone else

Prioritizing - Urgent and Important

A patient's condition becomes life threatening and you have other patients who need your care

Good time-management skills

Allow an individual to spend time on things that matter. You do not manage time, you manage yourself, others, and work.

Procrastination

Putting off something until a future time, postponing, or delaying needlessly. Not a character flaw, but a set of behaviors that develop over a period of time and that an be changed. The dread of doing a task uses more time and energy than doing the task itself.

SBAR

S - Situation: introduce yourself and the patient and briefly state the issue that you want to discuss (generally the patient's condition) B - Background: describe the background or context (patient's diagnosis, admission date, medical diagnosis, and treatment to date) A - Assessment: summarize the patient's condition and state what you think the problem is R - Recommendation: identify any new treatments or changes ordered and provide opinions or recommendations for further action

MOT: Memorandum of Transfer

Used when moving from one facility to another facility

Handoffs

Verbal exchange of information during transitions in care across the continuum

Prioritizing - Important but Not Urgent

You are the clinical preceptor for a nurse student who needs to debrief about how he communicated with the case manager about a patient's discharge plans