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Introduction   

The difference between a smooth, productive work shift and a chaotic, stressful one can often be effective time management. This advanced nursing skill is essential for yielding productive workflows and high-quality patient outcomes. This course will provide learners with the definition and benefits of time management. We will also explore tactics to enhance time management skills. Throughout this course, reflective questions and unfolding case studies will provide conceptual application and personal reflection for improving your practice. Although this skill does not come naturally to most nurses entering the field, one can transition from novice to expert in no time with intentional practice and education.  

What is Time Management? 

Nurses must practice and develop time management skills to juggle their required work shift tasks. Time management is defined as a mental function of organizing events sequentially and allotting time for specific activities (5). Planning, organizing, prioritizing, and setting goals are essential to time management. 

Nurses must prioritize urgent and time-sensitive matters first and remain mindful of how long each task will take. Routine or supplementary activities should be reserved for periods of downtime. An example of poorly- managed time is spending 45 minutes helping a patient shower in the morning when other patients are waiting to receive their treatment or medications. Knowing when to delegate tasks to assistive personnel can create more time for focusing on other crucial matters. 

Proper guidance and training through orientation and mentorship can promote strong time management proficiency. After clinical rotations in an inpatient setting or orientation as a new graduate, you should be able to estimate timing for specific tasks like medication passes or dressing changes. In nursing, time management is considered a skill related to clinical competency; strong time management correlates with better patient care delivery and job performance (2). 

Unfolding Case Scenario 

Linda is a new graduate registered nurse in her eight-week orientation under the supervision of her preceptor, Maggy. Throughout the work shift, Maggy finds Linda stalled in patients’ rooms, frequently late for timed interventions and medications. Linda expresses that she feels stressed and behind in her work tasks, and the patients have multiple requests, which takes up much of her time. Maggy notices that Linda struggles with time management and needs to practice strategies to use her time efficiently. 

Why Nurses Need Time Management 

As mentioned before, time management and clinical competency go hand-in-hand. Clinical competency is acquiring knowledge and skills that help you successfully and proficiently achieve goals and perform tasks based on professional expectations (2). When you effectively use time management to your advantage, you provide efficient and quality patient care. Patients feel like their basic needs are met with attention and thus are more satisfied with their healthcare experience. 

Whether you are a nursing student balancing multiple classes and clinical rotations or a seasoned nurse with high-acuity patients, you quickly get overwhelmed if you aren’t focused and block out your time efficiently. Being organized and prudent with your time can make the difference between a productive and stressful work shift.  

Time management also decreases the anxiety and stress of nurses or nursing students (6). Often, nursing students feel they control their time and can be proactive and productive rather than struggling to meet work demands. 

Time Management Improvement Strategies 

Before Clocking In 

Being punctual to work lets you settle in and get organized instead of rushing and hitting the ground running (1). If you have a few minutes before shift change, log onto the computer and ready your desktop. Most electronic medical record charting software allows you to add your patients to a list and start to look up tasks and basic information. You will receive more details once the report begins, but this gives you the “big picture” view of the busiest times of your shift based on medication passes and interventions ordered. Spending five minutes before your shift starts to get organized can ease your anxiety and get you focused for the day. 

Case Scenario 

Linda arrives at her unit at 6:40 AM, giving her 20 minutes to review her patient assignment, read the off-going nurse’s note, and log in to the computer to see her master task list for the day. When shift change begins at 7 AM, she has a snapshot of her patient assignment and her busiest times. 

Report 

Without an organized way to take a handoff report, it will be difficult to understand the patient’s condition or plan of care. There are various report sheets on the internet or provided by your institution; use one that makes the most sense to you and helps act as a tool to aid in time management. In most hospitals, reports only last for 30 minutes, which is not enough time to know everything there is to know about your patients (3). 

What is the most essential information you need to know about your patients? You can look up details in their chart later. For example, when taking a report, I want to know the reason for their admission, orientation level, mobility, pain, vascular access, tubes/lines/drains, and any medications infusing. If the off-going nurse is saying details that are not pertinent, I kindly but firmly respond by asking for this information. 

During report, a bedside safety check can save you time in the long run by checking for potential errors and establishing patient rapport at the start of your shift. Imagine if you didn’t lay eyes on your patient until the first medication pass. The patient might feel neglected and press the call light frequently for small requests. By laying the groundwork at the beginning of your shift, you set yourself and your assistants up for success, saving time to allocate to more pressing matters. 

Case Scenario 

Linda brings an individualized report sheet organized by body systems, allowing her to collect information from head to toe. She deliberately refocused the report to answer her guided questions and stated that she could find more minor details about her patients later. Maggy observed Linda perform safety checks on her patients, checking potential fall risks or medication infusion errors at the start of her shift. 

Gathering Patient Information 

After the report, instead of jumping right into tasks, give yourself 20-30 minutes to look up your patients. This includes the patient’s vital signs, orders, medications, labs, and the most updated progress note. Why is this a beneficial time management strategy? It allows you to understand the big picture and plan for the patient’s treatment (3).  

Digging through the electronic chart can help answer questions about the patient that came up during the report or that you need to clarify with the doctor. Based on patient information, you can create a plan for the work shift that includes which patient to assess first and how to prioritize the to-do list of tasks and interventions. 

Case Scenario 

Linda looks at electronic medical charting and delegates answering call lights to her assistant so she can stay focused on learning more about her patients. From this exercise, she discovered that her patient had outdated orders and was missing a morning lab draw. She can immediately page the doctor with her concerns at the start of her shift. Linda sees that one of her patients’ wound dressings is overdue, so she makes a note to prioritize this dressing change early in her shift. 

Prioritization 

Prioritization is a fundamental building block for effective time management. Nurses must allocate more time to tasks according to their time sensitivity, understanding, or urgency (2). This may look like delaying routine medication administration to a stable patient and, instead, going to the patient whose clinical condition is deteriorating.  

At the beginning and throughout your shift, you should be asking yourself the following questions (1): 

• “What are your most important, time-sensitive tasks?” 

• “How long do you think each task will take?” 

• “What tasks must happen during your shift but can wait until later?” 

• “What tasks do not necessarily need to happen on your shift?” 

• “What can you delegate to free up time for more pressing tasks?” 

If you know that one task will be time-consuming and is not urgent, you could save that task for after you accomplish other assessments or interventions. For example, if you have a stable patient who will consume much of your time, you could save rounding on them until after seeing your other patients. Imagine if you visited their room first and couldn’t step away for 45 minutes to an hour. Your other patients would not get their needs met and would feel neglected and ignored. 

Case Scenario 

Linda learns during report that she has a chatty, anxious patient who requires a lot of time to complete tasks. After meeting this patient during the report and the safety check, she saved this patient’s medication pass last so she wouldn’t be delayed for her other patient’s needs. She notices that one patient is requesting a shower, but another patient is complaining of chest pain. She delegates the shower task to her assistant and immediately goes to her other patient. Maggy notices that Linda is more confident with how she uses her time and prioritizes urgent matters over routine tasks. 

Purposeful Rounding 

Rounding on your patients, especially at the beginning of your shift, can save you time and prevent you from falling behind on tasks. Instead of asking a patient, “Do you need anything?” utilize the 5 Ps each time you round: pain, potty, positioning, personal items, and privacy (4). Using the 5 Ps, you assess the patient’s basic needs each time you enter their room. This gives your patients peace of mind and decreases frequent call lights for small requests. By rounding every hour on your patients, you assess any changes in the patient’s baseline and potentially prevent complications from falls, neurological changes, or pressure injuries. 

Case Scenario 

Linda diligently rounds on her patients, checking for changes in their condition and utilizing the 5Ps. She notices her patient is slurring her words and immediately initiates a code stroke and rapid response. The patient received fast intervention and did not suffer devastating neurological deficits. Maggy was impressed with Linda’s purposeful and timely rounding, potentially saving the patient’s life and saving more treatment and interventions from secondary complications. 

Clustering Care 

To use your time efficiently, combining tasks or “clustering care” can decrease frequent trips back and forth from the patient’s room. While administrating medications, can you also assess the patient and assist them in going to the bathroom before you move on to your next patient?  

Avoid interruptions or distractions when focusing on a task (1). Being pulled in different directions disrupts your workflow and makes patient care suffer. The goal is to work smarter, not harder. 

Case Scenario: 

Linda plans to complete a medication pass, assessment, and dressing change while in the patient’s room before moving on to the next patient. This saves her time later for charting and routine tasks. While in a patient’s room, she asks if they need to use the bathroom or get to the chair for breakfast. This will save extra call lights for her and her assistant in the future. Maggy observes Linda’s clustering interventions and avoiding unnecessary trips.  

Delegation 

Attempting to accomplish all the necessary tasks alone will leave you overworked, rushed, and stressed. Delegation is a tool that nurses can use to improve their time management (1). Nurses can delegate hygiene-related tasks or vital signs to assistive personnel, freeing time for assessing and providing interventions. Become familiar with what is within a nurse’s scope of practice and the limitations of an assistive personnel’s scope of practice. 

Case Scenario  

Linda has been practicing asking her nursing assistant to take her patients to the bathroom or collect vital signs, blood sugars, and urine samples. If she is in a patient’s room and needs to move on to the next patient, she asks her assistant to finish any hygiene or mobility-related tasks.  

Charting 

Charting is an obligation in our profession, but it consumes time that could be better spent interacting with our patients. In nursing school or orientation, your preceptors may encourage you to chart in real time as you assess your patient. While charting in real time may not always be realistic, it can save you time later (3). If you do not want to chart at the computer in the patient’s room, try to chart the assessment right when you exit the room before moving on to the next patient. That way, all the details are still fresh in your mind, and you won’t be putting it off. Do not save charting until the end of your shift because something unexpected, like a patient emergency or new orders, always appears at the most inconvenient moment. Ask yourself, “What can I complete early in my shift to create a time buffer for later in case I face the unexpected?” 

Case Scenario 

While Linda does not prefer to chart in the patient’s room since her back would be to the patient for an extended period, she updates her charting outside the room before moving on to the next patient. By 11 AM, most of her charting is completed, and she doesn’t have to worry about it later in her shift. She now has more time to provide quality patient care during downtime.  

Conclusion

Many nurses struggle to manage their time effectively, leading to stressful and disorganized work shifts. Time management requires estimating the timing of tasks and planning the work shift around allocated time blocks. Poor time management increases anxiety, and patient outcomes can suffer as a result. Strategies like organizing patient information in report and prioritizing patients’ needs based on urgency can strengthen your time efficiency.  

During the unfolding case scenario, Maggy is impressed by Linda’s growth in time management skills and feels confident that she will perform her duties proficiently after orientation. Like Linda, with additional time management practice and education, you can become proactive and productive in your nursing practice. 

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