8AM–9AM: More Prioritization, Patient Rounds, Delegation (Nursing)

by Samantha Rhea, MSN, RN

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    00:01 Again, when we're talking about whom do we see first.

    00:04 Go to that most critical patient on some of those points we talked about.

    00:08 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.

    00:19 Once we've done this, we're going to address our patients with again, that full head to toe assessment.

    00:23 This is the time to do that.

    00:25 We're going to do this because we're going to get the full clinical picture of our patient, addressing all these pieces.

    00:32 So occasionally, when you do a head to toe assessment.

    00:35 As you know, as a nurse, they may have looked okay on the focus assessment, or the general survey.

    00:42 But maybe you find something that needs to be addressed on the head to toe assessment.

    00:47 So it's important to do one of these on each of your patients.

    00:52 We also got to think about in planning our day, we have to see our patients, right? So just know the standard is what we call hourly rounding with our patients.

    01:02 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.

    01:10 Now before we get too far into this, I want to let you know.

    01:13 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.

    01:26 Now when we do this, we address again the 4 P's.

    01:29 One's called pain, potty, positioning and possessions.

    01:34 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.

    01:40 We also need to address their toileting needs.

    01:43 Now guys, let's take a minute on the potty piece.

    01:45 Please don't say this to your patient, there are adult patients possibly.

    01:49 If you're in the children's area, that may be fine.

    01:53 Just make sure it's appropriate to your patient population.

    01:56 Also positioning.

    01:58 The reason why this is important.

    01:59 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.

    02:09 Also keep their possessions close.

    02:12 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.

    02:21 So please keep this in mind and the four P's when you round.

    02:25 So these are also great indicators just to help support, maybe anticipate any of the needs the patient will have during the shift.

    02:34 Now once we've gone through all though, thought about our rounding, we need to try to cluster our care.

    02:40 Oh man, guys, I had such a problem doing this when I was in nursing school.

    02:45 I would go pull my meds from the medicine system and I'd walk to the patient's room, then I forget the medication cup, 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.

    02:58 I wasted so much time and that is so difficult in organizing a shift when you're a new nurse.

    03:05 So please take a moment and think about what you need to do and anticipate needs and what we call cluster our care.

    03:12 So let's like take a look at these checklists and talk about a few of those.

    03:16 So typically, you have to give meds during the pay, excuse me, the facilities policy time window.

    03:24 What I mean by that? Typically daily meds at most facilities are given at o900 in military time, or 9 o'clock.

    03:33 Most hospitals policy says you can give an hour before at 8 o'clock or an hour after at 10.

    03:40 So this is really actually helpful to help plan your day throughout your shift.

    03:46 Also providing personal care as a nurse's great to your patients.

    03:50 But sometimes that mid-morning hustle, we get really busy and have a lot of tasks and a lot of responsibilities at the beginning of the shift.

    03:59 So we need to appropriately delegate and we'll talk about that a few later.

    04:03 Also, for some of you, outlining a written plan for the day is most helpful.

    04:08 So you will just have to adjust the what's going to work best for you.

    04:13 Now just know we talked about this earlier as well.

    04:16 Sometimes there are certain treatments that are time sensitive, such as some medications have to be given early in the morning.

    04:23 Sometimes there's critical labs that have to be addressed right now or maybe your patients immediately go into surgery, so consider this.

    04:31 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.

    04:40 Now we talked about delegation.

    04:42 This is a huge time saver and honestly a little difficult for a new nurse to do.

    04:49 So let's take a look at this graphic.

    04:51 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.

    05:00 So when we say no, okay, this may be something we delay until we are at a time when we have more time to address that need because again, it's not a priority.

    05:12 Now if it is, can we delegate this safely? This may be delegated to maybe a nursing assistant or unlicensed personnel.

    05:20 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.

    05:28 But if it can, and it can be done safely and appropriately, then it's a great idea to do so.

    05:36 This is going to make working much more efficient with our team to give safe and efficient care.

    05:43 Now, when we talk about delegation guys, this is a topic in itself.

    05:47 As you see here on the screen, there are certain things that RN's, licensed practical nurses can do, and assistant personnel can do.

    05:55 So that's going to matter in how you delegate.

    05:58 So just know a few key things to point out.

    06:01 If you're a supervising RN, just know that the licensed practical nurse cannot do initial teaching, or maybe do initial assessment or evaluation.

    06:13 Also just know things such as blood glucose, maybe, oh, activities of daily living like toileting and bathing, can be delegated to the unlicensed personnel and that's going to help you save a lot of time.

    About the Lecture

    The lecture 8AM–9AM: More Prioritization, Patient Rounds, Delegation (Nursing) by Samantha Rhea, MSN, RN is from the course How to Organize a Nursing Shift.

    Included Quiz Questions

    1. Assesses the client’s pain level.
    2. Asks if the client needs to use the toilet.
    3. Makes sure the client is in a comfortable and safe position.
    4. Makes sure the client’s possessions are close to them.
    5. Conducts a full head to toe assessment of the client.
    1. The nurse makes sure to give all scheduled 9 AM medications in the approved time frame.
    2. The nurse writes a rough outline for the day before initiating client care.
    3. The nurse makes sure not to give any scheduled 9 AM medications after 9:15 AM.
    4. The nurse gives every client a full bedbath, by themselves, at the start of their shift.
    1. Transferring a client from bed to chair.
    2. Checking a client’s blood glucose level.
    3. Taking the vital signs of a new client.
    4. Conducting a head-to-toe assessment on a postoperative client.
    5. Performing complex wound care.

    Author of lecture 8AM–9AM: More Prioritization, Patient Rounds, Delegation (Nursing)

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN

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