One of the main challenges of new nurses is time management. In a hospital or nursing home setting, you often have coworkers to rescue you in a pinch in case you are overwhelmed; besides having nearby coworkers, most orientation programs and nursing schools focus on time management skills in a facility setting. Yet what about time management as a visiting nurse — in home health, home hospice, or both?

Let me share my wisdom and experience in time management in the field of visiting nurses to hopefully help you have more time for life compared to work — a better work-life balance.

While my Tips for New Hospice Registered Nurse Case Managers article covered some time management tips, please allow me to expand on the critical areas of time management:

First, let me hit the most significant time saver to help you, your patient, your family, and your work team. That's your commitment to the evidence-based best practice of as close to real-time as possible by ensuring you are within the visit. Buy yourself a Bluetooth keyboard (mine's heading towards being four years old; a backlit version is available from the same company), carry it with your tablet (not necessary if you have a laptop, of course), and use it to document within the visit itself.

Documenting within the visit saves you time charting outside of regular working hours (or extending working hours). It helps your coworkers have very accurate information that was charted in close to real-time, and for the same reasons, accuracy helps your patient and the family.

Now, while I addressed the charting first — mainly because this is where I see the most resistance among my fellow nurses, the desire to avoid charting in the home — you start by saving time at the very start of your workday.

Come up with a battle plan of whom you will see in what order, with the understanding that a patient may have a crisis or the office may send you in a different direction. Even if that happens, having a battle plan for the day gives you a structure to work off. I recommend charting your approximate arrival times using Waze's planned drive feature. Once you put in where you are at the start of the day, you can build your list by putting in the second visit, including drive time based on where you will be coming from and so on.

While the above is a generic web-based image, when I plan out my entire day, I'll have anywhere from six to nine stops, with the times based on estimated in-visit time plus drive time to the next visit.

So it might look something like the following:

08:00 AM — Office

08:30 AM — First patient visit

09:30 AM — Second patient visit

11:00 AM — Third patient visit

And so on.

As you plan this out, please consider the patient you will see next. If you've not seen them before, try to block out a larger block of time for that patient based on your agency's max expected time in a visit (our minimum expected time is 30 minutes, the average is 45 minutes, and max expected is 60 minutes with the understanding if a patient needs more they get more). If you've seen them before, what will you do during your visit? How long does each step take? Will you need to make phone calls for medication refills? Provider calls? Etc? Include that in your time estimate.

If it helps, I have a general script I follow for each visit that I adjust (often on the fly) based on the patient and family's needs. The typical script goes as follows:

“Hello ______. How are you doing today?” (explore as necessary to see if there are any to three complaints that we can manage during today's visit)” If there isn't much tangible, “how have you been since I last saw you?” (again, I'm trying to determine if there's anything new to manage; a maximum of three items/areas). If the is effective and the patient is stable, I do my head-to-toe assessment (documenting as I go), followed by my skin inspection and (documenting when I complete it). I then check if they need any refills. If I need to call a provider, I make the calls during the visit. Then, I contact the pharmacy for any new orders and refills. Then comes education along with questions and answers (Q&A) at the end of the visit, documenting as I go so that everything is documented and completed at the end of the visit.

Now, as an additional time-saver, when I call families at the start of the day to provide a ballpark of my arrival time, I may hear from them that such medication or treatment isn't working or is only partially working. If your provider has a secure way to text them, then as you are heading to the patient, you can reach out with either recommendation (best case) or recommendations and seek their input, letting them know you will be onsite within x minutes.

An example of this might look like the following:

“Hello, doctor _____. RE: Smith, John, a 72-year-old male on service for _______ who also has dementia FAST 6D. Over the past two weeks, the patient has had increased and falls due to getting out of bed to go to the bathroom, taking off his o2, and then desatting to 70%. The have tried 50 mg of Trazodone in one to two tabs, then three tabs, then four tablets without success over the past four weeks. We did a trial of 1 mg Risperdal at bedtime, but after three days, we had to stop due to urticaria. The report that 0.5 ml of Haldol wears off around the 4-hour mark, and there appears to be some resistance to full effect. May I have an order to increase the Haoldol to 1.0 ml q4h PRN and ? What else would you suggest? Thank you.”

In the case of the above, the provider gave the order along with an order to trial Zyprexa (Olanzapine) at bedtime. All of this was done via secure text, so when I arrived onsite, I could just flow into the visit, saving an approximately 15-minute minimum of time by having this done along the way.

My last time management tip is to keep your nursing bag organized. Be sure to have the most used items — your stethoscope, a touchless thermometer, an automatic blood pressure cuff, a manual blood pressure cuff, a pulse oximeter, and a tape measure in an area where you can quickly access them. I keep most of my items in a one-gallon Ziplock bag with the manual blood pressure cuff in its bag right next to the ziplock bag.

In summary:

  1. Organize your nursing bag.
  2. List your patients for the day (this may be in a list on your tablet; don't create duplicate work).
  3. Review your battle plan for each patient, understanding that things may change when you get onsite. For new patients, plan the maximum time your agency allows (if there's no such thing, go with an hour until you get a feel for how long new patients take for a visit).
  4. Chart your day — I strongly recommend using the Waze planned drive feature.
  5. Consider texting providers when you are en route to the patient for whom you may be texting.
  6. Follow a generalized script for your visit.
  7. Document the visit and make all related phone calls during the visit.

Hopefully, you learned at least one new tip from this article and can improve your work-life balance!

Resources

Numerous articles with tips for nurses

How Home Health Nurses Plan Their Work Schedules: A Qualitative Descriptive Study

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