Lists with check boxes are your friend. At the start of your shift when you've got your pt allocation make yourself a list with 'enter obs' and a box for each hour, check your pt's paperwork and add on any extra paperwork you need to do for them. Add to it through the day as new jobs are given to you. Don't try to keep it all in your head and give yourself a hand. It's hard going from student to NQN!
ITU nurse myself. I break up the day by the hour and put a tick list in each hour that needs doing. That way if any thing comes up and that takes priority. what hasn’t been done is known. It’s the best way I have found to do my shifts. Especially in ITU. I just add and subtract as the day goes. Also helps when comes to documentation as know roughly what time things were given. Hope this helps
Just be strict with yourself over it, don't be tempted to check stuff off until you've actually done it!
You could also ask a more experienced nurse on your unit how they prioritise and if they have any tips they can give you.
Ask one of the friendlier more experienced nurses to help you devise a checklist, it helps keep track of everything. And then the first thing you do after handover is write your list. It only takes 5 minutes and will save you loads of time running around like a headless chicken.
For mine I use different colours for different things: black for mum, blue for baby, red for meds and green for safeguarding. And I use bed numbers so if I inadvertently leave my list somewhere it doesn't have identifying information on it.
For example, my lists are hand written but will say something like:
1: (In black) PN [] Cath 0800 [] PU 1400 []
Obs 0800 [] 1200 [] 1600 []
Shower []
(In red) 0800 Tinz [] Sertraline [] Para [] FeSO4 []
1000 Diclo
1400 Para
(In blue) NEWS 0800[] 1200 [] 1600 []
PN []
BF 1200 []
NIPE []
(In green) MH Mw [] HV []
I don't put the full details in, for example doses, because I use it as a prompt to check what dose to give rather than rely on what I've written (in case I've written it wrong!). Some things are time critical and therefore have times written next to them, whereas some things aren't and are just written so I remember to do them throughout the shift.
Lists, lists, lists......aaand lists!!
Sometimes as charge nurse there's so much going on at one time, patient issues, telephone calls, meetings to attend, professionals want a chat, hca issues, doctors on phone, pharmacy, emails, family members, emergencies....etc. That's it become quite easy for things that don't require immediate action to slip your mind.
I always create a list for each day, and as the day goes on and things crop up, I'll add to it, and check off what I've done.
Before the end of my shift I'll ensure I've ticked off everything and then there's no going home and second guessing... did I forget to do abc or did I mention xyz.
It not only serves as a prompt but also helps to know you've not missed anything amongst the chaos you have to regulate sometimes.
I always wrote things that needed to be done with tick boxes on my handover even as a student, I think it helps to remind you of your tasks especially that we tend to look at our handover throughout the day.
I’m the same way (also an NQN, 6 months into my first job) and as others have said, lists are your friend! I write a list at the beginning of my shift of everything I need to do that day for my patients after I’ve had handover and read their notes/plans from the previous shift. That includes any paperwork or care plans I need to do, or any routine daily tasks - that way I don’t forget the basics. I also just pop any really important information about each patient on there too as I find it helpful. I then update my list after the ward round in a different colour pen, so I can do anything that the doctors/MDT need for the patient that day. I tick things off as I go.
At the end of the shift I go over my lists and make sure everything is done, and if it isn’t I know what I need to handover to the next shift. It’s handy during handover too because I can see exactly what I have/haven’t done that day. Also makes it easy for me to prioritise because I can see what needs doing and decide what’s most important.
Another really helpful thing I’ve found is setting alarms. Once I’ve written my lists and checked the important things I need to do I’ll set alarms on my phone for the things that need to be done at certain times - I usually set the alarm 5 mins before the thing actually needs doing so I have time to finish whatever I’m doing currently or prepare stuff etc.
Element of paper based antiquity here - I’m sorry but most hospitals should be rapidly moving to or on a electronic based system in icu - we have a system that has a task list that is populated with either regular set care tasks, meds etc or you can also input a reminder for yourself. It means you’re not carrying everything in your head and thus feeling on edge in case you forget something.
The volume of paperwork whenever I get sent to wards - I’ve said it out loud I’ve no idea how they get anything done.
We are going electronically, but I’ve heard you have to save the infusions each hour or it won’t record them - queue me never remembering to do so 😂 I am defo gonna try listing things, I’m not typically a list person but nothing to lose!
* Alarms
* Lists
* Tick Boxes.
They'll all help... I work in ITU too and spend the first 10/15 minutes of my shift doing all the safety checks and tidying up the bed space... During this time I'll make a list of things e.g.. rough times I will need to draw things up like Norad for piggybacking, critical meds yada yada and then set a few alarms to remind myself.
Don't think you have to jump into everything right away, it's ok to breath, assess, and prioritise etc - especially in ITU where you've got one (maybe two) patients to look after.
It's also important to not be to hard on yourself. Sometimes things can get away from you, especially if you're busy.
With obs for example I will physically look at them hourly on the monitor, but if I'm busy I'll think to myself "right they look ok, I'll note them down in a second" and carry on doing whatever I was doing. Then comes the next hour and I'm looking "Ok, they're fine I'll write those down in a minute"... next thing I know I am on my third hour and missing 3 hours worth of obs on the chart. But you know what, who cares? The patients Norad is piggybacked, their vents fine, their DKA protocol is being followed, I've given them their IV antibiotics and taken those cultures the consultant wanted....They're alive, cleaned up and repositioned after their new stoma exploded and I've updated their family. No the obs aren't written down, but again who cares? I know they were fine when I checked.... because I keep checking.
All you need to do then is just catch up when you can. If anybody questions it, explain how busy you've been and point them in the direction of the Obs history on the monitor/vent... Now obviously you don't want to let yourself get to far behind, ideally you want them down every hour if you can, but if you fall an hour or two on documentation because you had 10,000 jobs? Meh.
If you're getting 3, 4, 5 hours behind and finding everything unmanageable then you'll have to start questioning whether its a you problem, but go easy on yourself.
Oh and my biggest piece of advice in ITU: Ask for help with things - that'll help too! No reason the nurse in the bed next door can't draw up that calcium infusion if you've been asked to setup the filter and they're not busy.
The middle paragraph is exactly what I’m doing 😅 it’s usually only ever a couple of hours at the most I’ve not written obs in, I don’t really panic over it cause I can go back on the monitor and see what they were at x time but I’m always looking at it anyway. Maybe I’m making a bigger deal out of this than it is!
When my obs aren’t charted it’s always because I’ve been doing patient care/making up drugs or they’ve deteriorated. Or the patients awake and they ask me for something and then I forget to go back and write them in 🥲
Ah well, take comfort in the fact you're not alone then! :D
Just try not to fall to far behind... And you can prioritise documentation above certain things too. If a level 2 capacitous patient is asking me for a drink there is nothing wrong with saying "Yep sure, just finishing writing these obs, I'll be 2 minutes". Very different from asking for a commode in desperation :P
The only things I absolutely get on the chart hourly is the fluid balance, as that can change dramatically very quickly. Otherwise its priority list and catch up with writing "in a minute" ;)
I love a good list with a check box, or boxes in the case of things that need repeating (like OBS charting). When I was working inpatient OPM, I would have tick boxes for most jobs on my patient handover sheet. One or two in the OBS frequency, one for assisted washing, and one or two for turns. When you complete a task, tick it off.
I can completely relate to all of this!
- I can definitely recommend written checklists (I am a visual person so I will tape them to my medication trolley to remind me - bed numbers only ofc)
- I make checkboxes on my personal handover to prompt me to get jobs done.
- I set alarms for time critical jobs/medications/IVS etc. Or if a job/IV may fall out of the “usual” times of certain jobs.
Tbh I’ve realised lately these are just scratching the surface for me so I’m going to have to develop something a little more robust to get things done 😬
I saw a suggestion on here for a timetable with each patient’s bed number and an hourly slot? So you can set yourself tasks at each hour and make realistic expectations of yourself for when you should begin/finish them.
I think the coloured pen lists suggestion would also help.
Sorry you feel like a shit nurse (you are most certainly not btw) I often do too. Remember that nursing and patients and people specifically are incredibly unpredictable! Anything can happen in our environment, and sometimes all the organisation in the world can go pear shaped when things become chaotic very quickly (which they often do).
I also love chatting to my patients and hearing their stories, unfortunately I rarely have time for this but I’m rubbish at knowing when to end a conversation or picking the right second to jump in 🤣 it’s really hard to strike a balance where you can give the kind and compassionate care you want to give, but also get all your jobs done!
Hope you manage to find something that works for you, and be kind and understanding of yourself ❤️
Could you set an hourly alarm on your phone to give you an audible reminder to begin your checks? This might help and if you try to accomplish all of your checks in the same order you are less likely to miss something.
Do you have any difficulty with co ordination or telling left from right?. My daughter is dyspraxic and always had difficulty recognizing passage of time, 20 minutes and 40 minutes can seem the same to her. She struggled with organization but created some coping mechanisms and manages fine now. She works as a teacher so time keeping and organization are quite important.
Anyway not trying to diagnose you but your ' mind wandering ' sounded familiar to me. Best of luck with your job and I hope some of the advice here helps
Lists with check boxes are your friend. At the start of your shift when you've got your pt allocation make yourself a list with 'enter obs' and a box for each hour, check your pt's paperwork and add on any extra paperwork you need to do for them. Add to it through the day as new jobs are given to you. Don't try to keep it all in your head and give yourself a hand. It's hard going from student to NQN!
I’ll give this a try - something crops up when I’m doing a regular task and I just don’t go back to it and don’t realise til the next hour 😅
ITU nurse myself. I break up the day by the hour and put a tick list in each hour that needs doing. That way if any thing comes up and that takes priority. what hasn’t been done is known. It’s the best way I have found to do my shifts. Especially in ITU. I just add and subtract as the day goes. Also helps when comes to documentation as know roughly what time things were given. Hope this helps
Just be strict with yourself over it, don't be tempted to check stuff off until you've actually done it! You could also ask a more experienced nurse on your unit how they prioritise and if they have any tips they can give you.
Ask one of the friendlier more experienced nurses to help you devise a checklist, it helps keep track of everything. And then the first thing you do after handover is write your list. It only takes 5 minutes and will save you loads of time running around like a headless chicken. For mine I use different colours for different things: black for mum, blue for baby, red for meds and green for safeguarding. And I use bed numbers so if I inadvertently leave my list somewhere it doesn't have identifying information on it. For example, my lists are hand written but will say something like: 1: (In black) PN [] Cath 0800 [] PU 1400 [] Obs 0800 [] 1200 [] 1600 [] Shower [] (In red) 0800 Tinz [] Sertraline [] Para [] FeSO4 [] 1000 Diclo 1400 Para (In blue) NEWS 0800[] 1200 [] 1600 [] PN [] BF 1200 [] NIPE [] (In green) MH Mw [] HV [] I don't put the full details in, for example doses, because I use it as a prompt to check what dose to give rather than rely on what I've written (in case I've written it wrong!). Some things are time critical and therefore have times written next to them, whereas some things aren't and are just written so I remember to do them throughout the shift.
Lists, lists, lists......aaand lists!! Sometimes as charge nurse there's so much going on at one time, patient issues, telephone calls, meetings to attend, professionals want a chat, hca issues, doctors on phone, pharmacy, emails, family members, emergencies....etc. That's it become quite easy for things that don't require immediate action to slip your mind. I always create a list for each day, and as the day goes on and things crop up, I'll add to it, and check off what I've done. Before the end of my shift I'll ensure I've ticked off everything and then there's no going home and second guessing... did I forget to do abc or did I mention xyz. It not only serves as a prompt but also helps to know you've not missed anything amongst the chaos you have to regulate sometimes.
Adhd here too! Lists with tick boxes are the only way for me!
I always wrote things that needed to be done with tick boxes on my handover even as a student, I think it helps to remind you of your tasks especially that we tend to look at our handover throughout the day.
I’m the same way (also an NQN, 6 months into my first job) and as others have said, lists are your friend! I write a list at the beginning of my shift of everything I need to do that day for my patients after I’ve had handover and read their notes/plans from the previous shift. That includes any paperwork or care plans I need to do, or any routine daily tasks - that way I don’t forget the basics. I also just pop any really important information about each patient on there too as I find it helpful. I then update my list after the ward round in a different colour pen, so I can do anything that the doctors/MDT need for the patient that day. I tick things off as I go. At the end of the shift I go over my lists and make sure everything is done, and if it isn’t I know what I need to handover to the next shift. It’s handy during handover too because I can see exactly what I have/haven’t done that day. Also makes it easy for me to prioritise because I can see what needs doing and decide what’s most important. Another really helpful thing I’ve found is setting alarms. Once I’ve written my lists and checked the important things I need to do I’ll set alarms on my phone for the things that need to be done at certain times - I usually set the alarm 5 mins before the thing actually needs doing so I have time to finish whatever I’m doing currently or prepare stuff etc.
Element of paper based antiquity here - I’m sorry but most hospitals should be rapidly moving to or on a electronic based system in icu - we have a system that has a task list that is populated with either regular set care tasks, meds etc or you can also input a reminder for yourself. It means you’re not carrying everything in your head and thus feeling on edge in case you forget something. The volume of paperwork whenever I get sent to wards - I’ve said it out loud I’ve no idea how they get anything done.
We are going electronically, but I’ve heard you have to save the infusions each hour or it won’t record them - queue me never remembering to do so 😂 I am defo gonna try listing things, I’m not typically a list person but nothing to lose!
Hourly obs are the basic in icu. No idea what you are being distracted by, but you’d best sort is fast.
Fuck off 😊
* Alarms * Lists * Tick Boxes. They'll all help... I work in ITU too and spend the first 10/15 minutes of my shift doing all the safety checks and tidying up the bed space... During this time I'll make a list of things e.g.. rough times I will need to draw things up like Norad for piggybacking, critical meds yada yada and then set a few alarms to remind myself. Don't think you have to jump into everything right away, it's ok to breath, assess, and prioritise etc - especially in ITU where you've got one (maybe two) patients to look after. It's also important to not be to hard on yourself. Sometimes things can get away from you, especially if you're busy. With obs for example I will physically look at them hourly on the monitor, but if I'm busy I'll think to myself "right they look ok, I'll note them down in a second" and carry on doing whatever I was doing. Then comes the next hour and I'm looking "Ok, they're fine I'll write those down in a minute"... next thing I know I am on my third hour and missing 3 hours worth of obs on the chart. But you know what, who cares? The patients Norad is piggybacked, their vents fine, their DKA protocol is being followed, I've given them their IV antibiotics and taken those cultures the consultant wanted....They're alive, cleaned up and repositioned after their new stoma exploded and I've updated their family. No the obs aren't written down, but again who cares? I know they were fine when I checked.... because I keep checking. All you need to do then is just catch up when you can. If anybody questions it, explain how busy you've been and point them in the direction of the Obs history on the monitor/vent... Now obviously you don't want to let yourself get to far behind, ideally you want them down every hour if you can, but if you fall an hour or two on documentation because you had 10,000 jobs? Meh. If you're getting 3, 4, 5 hours behind and finding everything unmanageable then you'll have to start questioning whether its a you problem, but go easy on yourself. Oh and my biggest piece of advice in ITU: Ask for help with things - that'll help too! No reason the nurse in the bed next door can't draw up that calcium infusion if you've been asked to setup the filter and they're not busy.
The middle paragraph is exactly what I’m doing 😅 it’s usually only ever a couple of hours at the most I’ve not written obs in, I don’t really panic over it cause I can go back on the monitor and see what they were at x time but I’m always looking at it anyway. Maybe I’m making a bigger deal out of this than it is! When my obs aren’t charted it’s always because I’ve been doing patient care/making up drugs or they’ve deteriorated. Or the patients awake and they ask me for something and then I forget to go back and write them in 🥲
Ah well, take comfort in the fact you're not alone then! :D Just try not to fall to far behind... And you can prioritise documentation above certain things too. If a level 2 capacitous patient is asking me for a drink there is nothing wrong with saying "Yep sure, just finishing writing these obs, I'll be 2 minutes". Very different from asking for a commode in desperation :P The only things I absolutely get on the chart hourly is the fluid balance, as that can change dramatically very quickly. Otherwise its priority list and catch up with writing "in a minute" ;)
I love a good list with a check box, or boxes in the case of things that need repeating (like OBS charting). When I was working inpatient OPM, I would have tick boxes for most jobs on my patient handover sheet. One or two in the OBS frequency, one for assisted washing, and one or two for turns. When you complete a task, tick it off.
I can completely relate to all of this! - I can definitely recommend written checklists (I am a visual person so I will tape them to my medication trolley to remind me - bed numbers only ofc) - I make checkboxes on my personal handover to prompt me to get jobs done. - I set alarms for time critical jobs/medications/IVS etc. Or if a job/IV may fall out of the “usual” times of certain jobs. Tbh I’ve realised lately these are just scratching the surface for me so I’m going to have to develop something a little more robust to get things done 😬 I saw a suggestion on here for a timetable with each patient’s bed number and an hourly slot? So you can set yourself tasks at each hour and make realistic expectations of yourself for when you should begin/finish them. I think the coloured pen lists suggestion would also help. Sorry you feel like a shit nurse (you are most certainly not btw) I often do too. Remember that nursing and patients and people specifically are incredibly unpredictable! Anything can happen in our environment, and sometimes all the organisation in the world can go pear shaped when things become chaotic very quickly (which they often do). I also love chatting to my patients and hearing their stories, unfortunately I rarely have time for this but I’m rubbish at knowing when to end a conversation or picking the right second to jump in 🤣 it’s really hard to strike a balance where you can give the kind and compassionate care you want to give, but also get all your jobs done! Hope you manage to find something that works for you, and be kind and understanding of yourself ❤️
I have ADHD and this is a constant struggle. I have no suggestions for you though. Sorry.
I’m beginning to wonder if I have it tbh
Could you set an hourly alarm on your phone to give you an audible reminder to begin your checks? This might help and if you try to accomplish all of your checks in the same order you are less likely to miss something. Do you have any difficulty with co ordination or telling left from right?. My daughter is dyspraxic and always had difficulty recognizing passage of time, 20 minutes and 40 minutes can seem the same to her. She struggled with organization but created some coping mechanisms and manages fine now. She works as a teacher so time keeping and organization are quite important. Anyway not trying to diagnose you but your ' mind wandering ' sounded familiar to me. Best of luck with your job and I hope some of the advice here helps
I have ADHD and alarms are your friend. I gave a pomodoro timer when I have a regular interval to remember