Time Management Challenges

The Nursing Transition from Graduate to Registered Nurse

The nursing transition from a graduate to a registered nurse (RN) is termed as a challenging and stressing. Ekstrom et al. (2015) suggest that the case of graduate nurses give a good example of challenges and difficulties experienced during the transition. Increased complexity further complicates the problem in the nursing healthcare system, advanced technology and patient acuity (Ratta, 2016). The primary challenge is time management, an important professional challenge affecting the way nursing graduates feel, work and impact on patient quality of care outcome.

Purpose Statement

The aim of the essay is focusing on time management challenges by providing peer-reviewed literature information supporting the transition challenge. Lastly, as a graduate care provider, I will propose approaches for successful time management and promote self-care.

Sourcing Peer-Reviewed Data

The essay will incorporate an anecdote containing a short interview to discuss time management issues with a new graduate. The interviewed has only been in the medical ward environment for two months. “During the beginning of the morning shift, I received handover followed by allocation to four patients. It was challenging to handle the four patients and end up struggling to meet the care goals. My first client had received insulin infusion, nil by the mouth waiting for surgery. The hospital infusion protocol affirms that the Blood Glucose Levels must be monitored every hour. My second patient required regular toileting whereas the third client needed pressure area care after every two hours. The last client had a Patient Control Analgesia together with ketamine infusion that needed PCA check and vital observation hourly.”

Challenges in Time Management

The interviewed person responded to the challenging experience while managing time requiring nurse prioritization. “The day was busy. Early morning, before breakfast, the 2nd, 3rd, and 4th patient were in the bathroom and their medications administered. At 11:00 am, I checked the vital signs of the 3rd client and noticed that he showed Modified Early Warning Score range of 4. I did not have an idea of what to next, and the first suggestion was calling the Medical Emergency Team (MET) but still challenged on the right approach to take it.

At the same time, the 2nd client buzzed and wanted to relieve himself. As I catered for the patient, I realized that I had not checked the BFL of my first client and was in frenzy as I tried to check the insulin infusing past the hourly observation and checking PCA when needed.” Generally, the interviewed person failed to check the 3rd patient’s vital observations and call the MET despite the MEWS protocol.

“The handover made feel like I was not competent because I left many things unturned and had no clear explanation why I failed to intensify the vitals of the patient and calling the MET.” the interviewed was frustrated because his main concern was doing the job and not focusing on patient quality care. “As a new student in the ward, it was challenging to request for assistance because I did not know my colleagues. I was guilty of not seeking assistance, fearing that I would be judged for being lack and incompetent resulting in the death of the patient; coroner’s case resulted.

Factors Affecting Time Management

Several factors affect time management have been proposed by Liaw, Palham, Wai-Chi Chan, Wang & Lim (2014) with a good example of poor planning resulting in difficulties while managing and delivery to the allocated patients. Anytime planning phase is absent; the graduate nurse is challenged in managing time (Litchfield and Chater, 2007). Litchfield and Chater (2007) further suggest the students become distressed because they cannot handle everything at a time.

Prioritization was another problem due to inability in setting priorities resulting in skill difficulties (Ekstrom & Idvall, 2015). Lack of knowledge to prioritize important things was a problem (Kramer et al., 2012). The primary problem was catering clients’ needs by prioritizing and organizing nursing care provision (Kapburg & Fischbein, 2000). The graduate nurse tries to work as a team and be everywhere (Kapburg et al., 2000).

A task-focused graduate creates time management issues because they focus on getting all care done (Burger et al., 2010). The timely manner in completing the task is a big challenge apart from focusing on patients’ health (O’Kane, 2011; Giallonardo, Wong & Iwasiw, 2010). The case of routine bed-making and showing is a good example suggested by Suzuki, Tagaya, Ota, Nagasawa, Matsuura & Sato (2010). The reason is that graduate nurses main focus is the task compared to professionals whose main goal is patient-centered responses (Nelson, Lasater & Stock, 2016). Ekstrom et al., (2015) argues that time management was a challenge because the graduate did not have practical knowledge and experience of the routine and organization. Lack of knowledge in the routine, where to find and how to do things resulted in slow responses (Catherine et al., 2007). The outcome is poor care prioritization and lack of proper order to do things as supposed. Unfamiliarity with hospital nursing care organization led to delegating difficulty for the graduate care provider because they were afraid of being bossy or lazy while delegating roles to others (Ekstrom et al., 2015).

Lack of knowledge and experience regarding the clinical condition of the client was another factor that led to failure in catering to the four patients. Catherine et al. (2007) propose that lack of knowledge in the medical condition of the various patients make the graduate nurses feel incompetent in time management because they spent significant time searching for information and learning the procedures to cater to patient needs. The graduate nurses lack clinical skills and knowledge of identifying deteriorating health or serious illnesses (Kapburg et al., 2000). According to Clare and Vanloon (2013), graduate nurses are not prepared or experienced to manage normal patient work, particularly in complex patients. The lack of skills and knowledge make the graduates unaware of when they need assistance and the person they could request for help, and the intervention to undertake (Blackberry and Jackson, 2016).

The inexperienced graduates sometimes have high self-confidence and expectations that make them try to cope with the assigned workload as individuals. The nurse graduates work hard with the aim of proving themselves as being competent as professional nurses (Ratta, 2016). According to Mooney’s (2007) study on graduate nurse experience based on a feeling of frustration and guilt while asking for assistance, the reason behind the failure is their perception that they have the right skills to manage their work. They feel that their nurse colleagues might view them as lazy and incompetent in the nursing environment (Mooney, 2007).

Approaches for Successful Time Management

Time management improvement approach is essential in creating a competent care provider who can attend several patients in a short time without errors (Blair, 2014). There are various approaches I can take as a graduate nurse related to peer-reviewed literature while solving issues related to time management. The first strategy is being knowledgeable about the client and the routine work in the care environment I work. Knowledge about nursing organizational operations makes things simple to delegate and prioritize assigned work (Ekstrom et al., 2015). Secondly, the knowledge about the client will assist me to manage my time effectively. Every night should be aware of the patient responses by considering the psychological, social, and physical well-being of the client during care provision (Burger et al., 2010). The expectations and routines allow the graduate nurse to prioritize and predict the work and eventually saving considerable time.

The third approach to take is planning as an essential element used in time management. The purpose is setting daily goals and the time someone thinks is right in doing certain things, allocating time and ticking every completed event at the same time confirming that all things are present (Chase et al., 2013). Every nurse requires a worksheet fitting an individual’s style and easily modified to fit the assigned task (Blevin and Millen, 2016). Some consideration should be done at the beginning of every shift by recording all information that will assist the care provider in organizing the daily routine for further information collection (Belvin et al., 2016). My role as a graduate nurse is to make sure that I use the shift planner for guidance and a reminder of all my requirements to be done and completed at the specified time. The purpose of the goal is to guide me in case I happen to leave any task undone. The worksheet is also used when reminding the care provider about patient medication, assessment, treatment by not depending entirely on the memory (Burger et al., 2010). For example, when medication provision fails, the nurse may write it down and underline followed by providing the medication in the right manner (Burger et al., 2010). It is important to develop a detailed worksheet containing a particular organization of such patients for an effective time management approach.

The other strategy is work prioritization regarding daily demands to allow differentiation of urgent or important things and adjusting tasks’ performance to save time (Said, 2014). The schedule of high-priority tasks is important on a daily basis and leaving gaps for less significant duties. I will achieve such by arranging the tasks according to priority and working first on the most sensitive duties while the less follows. Nurses need to consider multiple factors when creating such priorities, stacking the priorities for easy shifts for effective nursing care completion achieved by using time effectively (Witternberg and Moriarity, 2015).

Additionally, graduate nurses need to identify their daily plans; tasks need be completed and identify care priorities (Nielsen, Lasater & Stock, 2016). The case of the medical round is a good example where nurses are needed to move from one room to the next in a discerning way based on client demand apart from their room number order (Nielsen, Lasater & Stock, 2016). Medication was administered at the right time to make sure that clients requiring crushed drug were placed as the last priority during the medication round for effective administration of others (Jennings et al., 2011).

Blevins & Miller (2010) propose that efficiency in time management requires care providers to apply clinical judgment in understanding what to delegate safely and promote nursing collaboration. Nursing requires collaboration, and the team is expected to provide effective time management to promote quality care outcomes (Blevins and Miller, 2010). The care providers require better a sense regarding the time to delegate and work as individuals (Burger et al., 2010). Once the nurse fails to complete the assigned job, he or she must immediately delegate or look for assistance from a clinical development officer or colleagues (Burger et al., 2010). Therefore, teamwork brings knowledge to the priority system, care urgency, and the right time to ask for assistance (Blackery et al., 2016). As a graduate, my focus would be on the client with the MEWs rata of 4 followed by a delegation of the PCA task check, monitoring BGL, and observing hourly changes.

Ratta (2016) suggests that new graduate nurses should be able to realize and recognize the preceptor, nurse colleagues, and clinical development managers as individuals they must always depend on for help. The preceptor directs care by guiding priority actions; manage individual time and specific instructions when caring for various clients in complicated scenarios (Ratta, 2016). For example, anytime a care provider is catering for a patient with deteriorating health and is not sure of the right approach to take, the best way is seeking assistance by calling the clinical development manager of the preceptor for guidance.

Lastly, graduate nurses must learn to multitask to assist in developing cognitive skills and prioritize several demands (Burger et al., 2016). According to Chang et al. (2016), multitasking involves conducting various activities at the same time apart from sequencing. Jennings et al. (2011) suggest that medication provision should not be a single entity but coordination of broad and large tasks useful in managing competing demands and maximizing time efficiency. During medication provision, nurses must engage in various care activities such as checking vital signs, reading parameters from medical equipment, change the dressing, patient-family interaction, and documenting patient assessment (Jennings et al., 2011).

Conclusion

Literature sources suggest that several elements affect time management. Task orientation, prioritization and planning, unfamiliarity with routine work, lack of clinical judgment, experience, and knowledge, and high self-expectations are good examples of poor time management (Waterworth, 2003). Various approaches can be applied to provide successful time management. The strategies include planning, clinical judgment, prioritization, ability to delegate tasks, knowing the client’s clinical condition, and routine work organization. Lastly, it is important to focus on the patient and not the provided task to improve time management. Such achievement would make me more efficient, able to meet the needs, and work smart apart from hard to meet the requirements of all my patients.

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