Time managementTime managementLecturer – Olena Bidovanets

Nurses manage care for individual clients, families, and communities in hospitals, outpatient settings, clinics, health departments, home health agencies, long-term care facilities, and rehabilitation centers as well as in other specialized healthcare organizations. The strategies they use to organize care are drawn from leadership and management theories.

The approaches to leadership and management reflect the dynamic state of health-care delivery as nurse managers and leaders strive to empower nurses to provide care that produces optimal outcomes. Management and leadership have evolved and continue to evolve from a hierarchical structure based in early management theory to a more flattened and inclusive approach that incorporates concepts from the physical and social sciences.

Managers have traditionally been responsible for the control of resources required to accomplish organizational goals. These responsibilities include budgeting, staffing, and maintaining the functions of the organization while simultaneously balancing fiduciary responsibility for the resources of the organization. Rowland and Rowland (1997) define management as a five-step process:

1. Planning2. Organizing3. Directing4. Coordinating5. Controlling

The manager is employed by an organization and given the responsibility to accomplish specified goals for the organization. Managers are expected to teach workers the best way to perform the job; match the employee to the job; provide motivational incentives to workers; see that time, energy, and materials are used efficiently, and ensure that the organization fulfills its objectives.

At the same time, managers seek to enhance efficiency, develop resources required to reach the goals of the organization’s strategic plan, and manage across boundaries in the organization (Huber, 2000).

Newly graduated staff nurses assume responsibility for leading a team of direct care providers and, therefore, need to know how to manage a patient care team effectively. This team often includes nursing assistants, patient care technicians, licensed vocational/practical nurses, and other registered nurses.

Nursing is a demanding job and it can often feel as though there are not enough hours in the day to complete all of your tasks. Unlike other jobs, priorities can change rapidly - when a patient is in urgent need of your attention, your to-do list can change rapidly. The hectic pace of the job is one of the reasons that many nurses get burned out and stressed out.

Using time management techniques designed with nurses in mind is one way to make your life a little easier, as well as getting more done! Time management strategies can be broken down into five strategies:

1. Plan your day out in advance. Many nurses say that while planning is a good idea, their days are too unpredictable to plan. However, nurses who do plan their day will find that they get more done with less stress. It is difficult to plan your day because your environment can change rapidly, and much of your day is spent responding to the needs of patients.

However, if you plan out the tasks you have to get done in a day they can become more manageable. Make a list of everything you must get done today. Then, make a note of how long it will take and rank the jobs in order of importance.

Start looking at tasks and seeing when you will have time in your day to get one or two items done, and when you have a few minutes, complete a task that you can get done in that time. You will also feel better knowing that you are not forgetting anything!

2. Focus on the most important activities first. When you make the list above, also focus on the items with the highest priority. Remember, you may not be able to get everything done but by completing the most important tasks, you will be less stressed.

Also, keep in mind that if nothing is going on right now, you should be working on one of your tasks because due to the unpredictable nature of your job, you can’t be sure that you will have time later. As you complete tasks, check them off on your list. It will give you a sense of accomplishment and make your stress level drop.

3. Don’t let interruptions disrupt your day. Nurses have to deal with many interruptions, many of which can’t be helped. However, there are many interruptions that are not so important. Interruptions like long non-work related chats with other staff members, checking non-work email, or other non-essential tasks can get you off track quickly

. Make time to relax, visit and do things to lower your stress, but don’t let those things become more important than your work.

4. Keep yourself and your workspace organized. Being organized saves time. If you have a desk, spend a few minutes at the end of the day to put papers where they belong so that you can find them when you need them. At the beginning of the day, make sure all equipment is clean and ready for use. This will lower your stress level and make your day easier.

5. Learn to delegate tasks. Remember that you can’t do it all, nor should you have to. When you need help, ask. If someone asks you to do something that you don’t have time, it’s OK to say no. Remember, time management is about making your day easier and more productive! (Catherine Bynes )

As a nurse, you will have many people competing for your time and attention. Things change quickly in healthcare environments, so it is important to be flexible. Determining priorities, which things must be done right away and which can wait, is critical in maintaining your equilibrium.

Work out a system where you get the most important things done first and you know how much there is left to do. You also need to work out what could be delegated to others.

The ABCD system is an excellent way to organise and prioritise your tasks:

A: Absolutely must get doneTasks that must be done at a certain time.You will be interrupted to do a particular task if it is not done soon.Others need it done to do their job.Waiting will cause a patient or his or her family avoidable distress.A risk or hazard is presentMost documentation and paperwork.

B: Better sooner than laterCan wait, but not too longMust be done today or on this shiftWill save time and resources if done soon.

C: Can wait until laterThings that do not have any time frame attached.Getting things that will be needed later in the day.Some paperwork.

D: Do not worry about itThese are tasks that are beneficial, but if left undone will not affect patients or their care.These things should get done, but no one will be hurt if they are not.

When you write down tasks or things your patient needs, rate them A, B, C or D. Get all the As done as soon as possible, or at their scheduled times. Sometimes you can combine tasks without costing extra time. For example, while toileting patients (A), you might wash them as well (B). Make sure that tasks which could cause interruptions or delay other people are done first whenever possible.

As new tasks arise, decide where to put them on your list. Tasks will sometimes change in priority. If a patient vomits on the sheets, for example, changing the linen goes from a C to an A. Some tasks can be avoided simply by being considerate and cleaning up after yourself.

It is often difficult for nursing students to delegate tasks, but it is an essential skill. To delegate safely and appropriately, you have to consider a number of points:

What tasks must a nurse do by law and what must be done because it is trust policy?

If a particular task is delegated and things go pear-shaped, how bad could it be?

Does the person to whom you are delegating have the knowledge and skill to complete the delegated tasks?

What is best for the patient?Are you being lazy by delegating?Will it be done in time if delegated?

Communication is key. Make certain that the other person understands exactly what you need and when you need it done. Delegation and time management are essential for developing professional nursing practice. With practice you will find they get easier and make your working day go more smoothly. They also give you the time you need to give the best possible care. (Bethann Siviter is district nurse team leader, past chair of the Association of Nursing Students and former student member of RCN council)

“All of us spend time doing ridiculous things that are a complete waste of time simply to avoid going out of our comfort zone” – Dr. Stephen Covey

What is really Urgent?What is really Urgent?Understanding what is really

urgent in your work requires careful consideration and it will be different in different roles. Stephen Covey in his Seven Habits of Highly Effective People presented a model with four quadrants.

The goal here is to put first things first by identifying different levels of urgency. - even if the activity is something unpleasant. All of our time can be divided into one of these four quadrants. The matrix below is an example of the model with typical leadership activities/responsibilities placed in each of the four quadrants.

Categorizing our work requires honesty. We may enjoy socializing or talking with professional colleagues but is it really category 2 or do we engage in so much of it that it is category 4.

Using To-Do ListsUsing To-Do Lists Using to-do lists can be quite helpful in making

sure that goals get accomplished. The challenge with these lists is that sometimes they become so long that the lists themselves seem overwhelming. Leo Babauta, author of the blog Zen Habits, provides some good advice about this. He suggests that we establish no more than 4 goals to achieve for the week – which he describes as Big Rocks. Each day of the week we should establish what our 1-3 most important tasks are and then be sure to complete those. Babauta also advises that it is easier to complete tasks if we can focus on one task at a time and learn to say NO to commitments that are not essential, don’t contribute to your goals or add value to your life.

He suggests that we establish no more than 4 goals to achieve for the week – which he describes as Big Rocks. Each day of the week we should establish what our 1-3 most important tasks are and then be sure to complete those. Babauta also advises that it is easier to complete tasks if we can focus on one task at a time and learn to say NO to commitments that are not essential, don’t contribute to your goals or add value to your life.

Avoiding InterruptionsAvoiding InterruptionsInterruptions to our work flow are

routine especially in health care settings but are they really acceptable? Increasingly in clinical practice, it is recognized that they can present risks to patient safety.

Hall, Pedersen and Fairley in recent research conducted in Canadian hospitals found that workplace interruptions are a significant issue on nursing units. Interestingly, the majority of the interruptions came from unexpected interactions with other health care team members most often communication related to patient care issues.

Most of the interruptions observed could have had a negative effect on patient safety versus improving patients care.

Researchers have found that it can take between 10 and 20 minutes to get back on track after an interruption so they also need to be viewed as significant time wasters. In clinical environments, we have seen the introduction of interruption-free zones in medication rooms. Some good tips to avoid interruptions and reduce distractions in your environment include the following:

Develop an awareness of the negative issues with interruptions.

Abstain from being the cause of an interruption….ask Is this a good time for You?

If you need a distraction free zone – close the door and put a sign on it.

If you have only five minutes to talk – say that up front so the conversation can be focused.

If you need to finish a task you have started, say so let the person know when you will be free.

Let your phone go to voice mail, turn off your email, text messages or other communication devices when you are trying to focus.

(By Rose O. Sherman, EdD, RN, FAAN)