Time Management & Setting Patient Care Priorities Key Concepts

Some basic time management strategies include

KEY CONCEPTS

outcome orientation (not delivery), an analysis of the cost of use of time, a focus upon priorities, and the ability to visualize the big picture.
Effective shift planning involves

KEY CONCEPTS

deciding what goals or outcomes they want to achieve. Identifying optimal outcomes (best possible objectives), as well as reasonable outcomes (realistic objectives given the resources at hand), and evaluating progress made toward these outcomes during and at the end of the shift are qualities that lead to effective planning during one’s shift. Often enough, nurses do not allow themselves permission to do less-than-optimal work, but sometimes, due to circumstances beyond their control (short staffed), achieving reasonable goals is the best that can be expected.
A definition of time management is

GENERAL TIME MANAGEMENT CONCEPTS

“a set of related common-sense tools that helps you use your time in the most effective and productive way possible” (Mind Tools, 2006). The Pareto principle concerns the concept that 20 percent of focused efforts results in 80 percent of outcome results. Shift planning deals with the organization and prioritization of patient care and tasks per shift. While the use of time management skills is a quality of effective leadership, it encompasses a variety of other attributes and qualities such as management skills, knowledge of leadership techniques, theory, and practice.
The Pareto principle is based upon

THE PARETO PRINCIPLE

the prioritization of work effort through such measures as managing one’s time effectively. The basic premise is that 80 percent of unfocused efforts results in 20 percent of outcome results or that 20 percent of focused efforts results in 80 percent of outcome results.
a student who does not study for an exam until the night before, thereby creating a “_____” that stimulates them to do the work.

THE PARETO PRINCIPLE

crisis; People continue to mismanage their time for other reasons: they do not know about time management, or they think they do not have time to plan or do not want to stop to plan.
It is important, when making long-term goals and outcomes, that

OUTCOME ORIENTATION

they remain flexible. The concept of flexibility should be built into any outcome orientation such as goal setting because, at times, the long-term goals may no longer be realistic or may need to be changed as circumstances change.
The activity log is a

TIME ANALYSIS

time management tool in which behaviors are logged consistently over a period of days to determine how time is spent. Nursing charts, shift action plans, and shift assignments are all good methods for organizing time and tasks.
Outcomes can be categorized in a variety of different groups. Reasonable (realistic) outcomes are

FORMULATE THE PLAN FOR THE SHIFT

those that can reasonably be expected to occur given limited resources and less-than-optimal circumstances. Unreasonable outcomes are those that are expected to occur under unreasonable circumstances. While many nurses decide they will settle only for optimal outcomes, it is wise to plan for the less-than-optimal circumstances and situations and to be more reasonable and realistic.
Prioritizing care is

FORMULATE THE PLAN FOR THE SHIFT

one means nurses have of organizing their patient care. Life-threatening or potentially life-threatening conditions (such as assessing the ABCs) are always the top priority, with patient safety second (availability of crash carts and equipment to help prevent patient falls or injury), followed by items relating to the plan of care (pain medication and patient positioning).
Improving the effectiveness of communication among caregivers (hospital goal # 2) was expanded in 2006 (hospital goal # 2E) to

UTILIZE SHIFT HANDOFF REPORT

“implement a standardized approach to ‘hand off’ communications, including an opportunity to ask and respond to questions,” which pertains directly to end-of-shift reports and the “handing off” of patients from one location (such as surgery or admission from another unit) to another.
Disadvantages of audiotaped end-of-shift reports are that

UTILIZE SHIFT HANDOFF REPORT

the information may be inaccurate due to the report’s being taped earlier in the shift and the quality of the report (equipment, diction, and clarity of the speaker) may not be easy to hear. The report’s being brief due to lack of interruptions from questions, patients being cared for by the outgoing shift, and the fact that the report is ready for the incoming shift when they arrive are all advantages of audiotaped reports.
Concerns that can be addressed in shift action plans include

TABLE 18-5 FACTORS TO CONSIDER IN PLANNING FOR A SHIFT

understanding the big picture (staffing issues, number of patients, environmental concerns), task completion due dates/times (time frame for accomplishment of tasks), understanding the priorities (emergency equipment checks, identification of patients at greatest risk for life-threatening complications), reasonable outcomes (those that are realistic to accomplish, not optimal outcomes), and resources (staff available to do work).
A number of factors would be considered when making the shift assignment. Some of these factors would include

TABLE 18-6 FACTORS CONSIDERED IN MAKING ASSIGNMENTS

the complexity of patient care; skill, education, and competency of staff members; attitude and dependability of the staff; the nurse practice acts; other responsibilities of the staff; and the need for continuity of care. Staff preferences would not be a major consideration.
Marquis and Huston (2005) identified five criteria that contributed to wasting time and hindered the outcomes being achieved:

EVALUATE OUTCOME ACHIEVEMENT

procrastination, inability to delegate, inability to say no, management by crisis and/or haste, and indecisiveness. Sullivan and Decker (2009) added interrupting telephone calls and socialization, and Reed and Pettigrew (2006) added complaining to this rather lengthy list.
Vacarro (2001) identified five potential “traps” of prioritizing that nurses need to be aware of and avoid. They are

AVOID PRIORITY TRAP

doing what hits first, taking the path of least resistance, responding to the squeaky wheel, relying on misguided inspiration (not judgment), and completing tasks by default.
Second priority activities

SECOND PRIORITY: ACTIVITIES ESSENTIAL TO SAFETY

pertain to the patient, and obtaining assistance during patient transfers is one way of providing safe care for the patient and the nurse. First priority activities are related to conditions that are potentially life-threatening to the patient such as having IV access and continuous monitoring of vital signs on critical patients. Third priority activities are related directly to the plan of care and include such items as medications, nutrition, and ambulation. The phrase “fourth priority” is not generally used in nursing.
Three major ways to create more time are

CREATE MORE PERSONAL TIME

delegating work to others, getting up 1 hour earlier (this can free up about 2 weeks per year of extra time), hiring someone else to do work (hiring people to do boring tasks), and eliminating chores that add no value (not those that have value).
There are numerous distractions available for invading one’s personal time. Two strategies for dealing with requests for assistance are to

CONTROL UNWANTED DISTRACTIONS

provide encouragement, but to send the requester back to finish the task; and to make a conscious decision about whether or not to respond to the request for assistance. It should be your choice whether to provide help or not.
White’s (2000) description of behaviors consistent with pursuers of excellence versus perfectionists listed the perfectionist behaviors as having to

TABLE 18-8 BEHAVIORS OF PERFECTIONISTS VS. PURSUERS OF EXCELLENCE

win to maintain high self-esteem, being devastated by failure (not learning from failure), valuing themselves for what they do (not for who they are), hating criticism (not welcoming criticism), getting depressed and giving up (not experiencing disappointment but keeping on going), only being able to live with being number one (not pleased with knowing they did their best) and remembering mistakes and dwelling on them (not correcting mistakes and learning from them).
Tips for personal time management when returning to school as offered by Flaherty (1998):

TABLE 18-9 PERSONAL TIME MANAGEMENT WHEN RETURNING TO SCHOOL

study on the run, be careful of sacrifices, be aware of the demands of school, focus on the outcome, develop computer skills, let your employer know you are interested in returning to school (not withholding this information), manage your time, and take a break if you find you need one (do not force yourself to continue if you need a break).
Who should the nurse Assess first:
a. The patient who needs assistance transferring from the bed to a wheelchair
b. The client with COPD who is having difficulty breathing
c. A client who is being discharged today
d. An elderly client who has requested medication for pain

FIRST PRIORITY: LIFE-THREATENING AND POTENTIALLY LIFE-THREATENING CONDITIONS

The nurse should assess the client with COPD first. This client is having difficulty breathing, which could be a life-threatening situation. Remember to follow the ABCs
Who would the nurse asses Second?
a. The client who needs assistance transferring from the bed to a wheelchair
b. The client with COPD who is having difficulty breathing
c. A client who is being discharged today
d. An elderly client who has requested medication for pain

SECOND PRIORITY: ACTIVITIES ESSENTIAL TO SAFETY

The client needing assistance with transferring from bed to wheelchair would be seen second
Who should the nurse Assess first?
a. Mr. Akerman whose wife is angry because his discharge papers have not been completed
b. Mrs. Samuels who needs to be taught how to use her new crutches
c. Mr. Donaldson who is complaining of chills and is having surgery today
d. Mrs. Smith who is scheduled for surgery tomorrow morning and needs to have her consent signed

FIRST PRIORITY: LIFE-THREATENING OR POTENTIALLY LIFE-THREATENING CONDITIONS

The client who should be assessed first is Mr. Donaldson. Because the client is scheduled for surgery, it is of utmost importance to determine the cause of his chills. The client’s condition could have a negative effect on his recovery from surgery.
Who should you see first?
a. An elderly client who needs help with transferring to the commode
b. A client admitted 2 hours earlier after receiving 2nd-degree burns on his face and torso
c. An obese client who needs assistance with changing position
d. A client who is 2 days post-op and has an IV that has infiltrated

FIRST PRIORITY: LIFE-THREATENING OR POTENTIALLY LIFE-THREATENING CONDITIONS

You should see the client admitted 2 hours earlier with burns to the face and torso. This type of burn injury has the potential for compromising the client’s ability to breath.
Who should receive first priority?
a. A client who complains of a sore throat and requests something to gargle with
b. A client with COPD who is resting quietly with 2 liters of O2 running
c. A client in respiratory isolation who requests a sleeping pill
d. A client with tubular necrosis and a urine output of only 15 mL for each of the past 2 hours

FIRST PRIORITY: LIFE-THREATENING OR POTENTIALLY LIFE-THREATENING CONDITIONS

The client with tubular necrosis who has only had a total of 15 mL of urine output in the last 2 hours should be seen first.