Again, when we're talking
about whom do we see first.
Go to that most critical patient on
some of those points we talked about.
Once we've done that,
at about 8 o'clock or so
or about an hour in,
we're able to gather all our information,
we've seen them, we've decided
who we're going to go see first.
Once we've done this, we're going
to address our patients with again,
that full head to
This is the time to do that.
We're going to do this
because we're going to get
the full clinical
picture of our patient,
addressing all these pieces.
when you do a head to toe assessment.
As you know, as a nurse,
they may have looked okay
on the focus assessment,
or the general survey.
But maybe you find something
that needs to be addressed
on the head to toe assessment.
So it's important to do one of
these on each of your patients.
We also got to think
about in planning our day,
we have to see our
So just know the standard is what we
call hourly rounding with our patients.
Here's a good guideline,
we call it the 4 P's
on what we do when we go see
your patient at least every hour.
Now before we get too far into
this, I want to let you know.
Typically, we get to alternate that with
another staff member like a nurse's aide
or a trained
assistant, for example,
but just know someone should see
that patient at least every hour.
Now when we do this,
we address again the 4 P's.
One's called pain, potty,
positioning and possessions.
So we always want to keep on
top of the patient's pain,
especially if they're a post
op patient or a post surgical.
We also need to address
their toileting needs.
Now guys, let's take a
minute on the potty piece.
Please don't say
this to your patient,
there are adult
If you're in the children's
area, that may be fine.
Just make sure it's appropriate
to your patient population.
The reason why
this is important.
If I walk into my patient's room and
their level of their bed is really high
and they could fall out
that's an issue, right?
We want to make sure
they're in a safe position.
Also keep their
Believe it or not, there's many
falls that happened in the hospital
because the patient's trying to get
to their cell phone that's ringing
on their bedside table that's pushed
on the other side of the room.
So please keep this in mind and
the four P's when you round.
So these are also great
indicators just to help support,
maybe anticipate any of the needs the
patient will have during the shift.
Now once we've gone through all
though, thought about our rounding,
we need to try to
cluster our care.
Oh man, guys, I had such a problem
doing this when I was in nursing school.
I would go pull my meds
from the medicine system
and I'd walk to
the patient's room,
then I forget the
then I have to turn back
around, go back to the med room,
I grab my medication cup,
then I went back to the room.
I wasted so much time
and that is so difficult
in organizing a shift
when you're a new nurse.
So please take a moment and
think about what you need to do
and anticipate needs and what
we call cluster our care.
So let's like take a look at these
checklists and talk about a few of those.
you have to give meds during the pay,
the facilities policy time window.
What I mean by that?
Typically daily meds
at most facilities
are given at o900 in military
time, or 9 o'clock.
Most hospitals policy says you can
give an hour before at 8 o'clock
or an hour after at 10.
So this is really actually helpful to
help plan your day throughout your shift.
Also providing personal care as
a nurse's great to your patients.
But sometimes that
we get really busy and
have a lot of tasks
and a lot of responsibilities
at the beginning of the shift.
So we need to appropriately delegate
and we'll talk about that a few later.
Also, for some of you, outlining a
written plan for the day is most helpful.
So you will just have to adjust the
what's going to work best for you.
Now just know we talked
about this earlier as well.
Sometimes there are certain
treatments that are time sensitive,
such as some medications have to
be given early in the morning.
Sometimes there's critical labs
that have to be addressed right now
or maybe your patients immediately
go into surgery, so consider this.
Also, educating your patient on
maybe those unexpected procedures,
also is going to take some time
and again making sure we
allow our patient to rest.
Now we talked about delegation.
This is a huge time saver
and honestly a little difficult
for a new nurse to do.
So let's take a look
at this graphic.
So let's start here at
the top where it says,
is the patient need a priority
at this time? Yes or no?
So we need to consider this.
So when we say no,
this may be something we delay
until we are at a time when we
have more time to address that need
it's not a priority.
Now if it is,
can we delegate this safely?
This may be delegated to maybe a nursing
assistant or unlicensed personnel.
If it can't, well,
we may have to deal with it at that point,
and work around the guidelines
of our shift and our timeframes.
But if it can,
and it can be done safely
then it's a great idea to do so.
This is going to make
working much more efficient
with our team to give
safe and efficient care.
Now, when we talk about delegation
guys, this is a topic in itself.
As you see here on the screen,
there are certain things that RN's,
nurses can do,
and assistant personnel can do.
So that's going to matter
in how you delegate.
So just know a few key
things to point out.
If you're a supervising RN,
just know that the licensed practical
nurse cannot do initial teaching,
or maybe do initial
assessment or evaluation.
Also just know things such
as blood glucose, maybe,
oh, activities of daily living
like toileting and bathing,
can be delegated to the
and that's going to help
you save a lot of time.