Time
Management
Tools
Chapter 18 of Nursing
Leadership and
Management
Introduction
Time Management

Time management is
“a set of related
common-sense skills
that helps you use
your time in the most
effective and
productive way
possible” (Kelly, p.
427).
Importance


Time management is
important for nurses on
the job and nurses in
their daily lives.
Time management
facilitates the
prioritization of care,
deciding on
appropriate outcomes
and the performance
of the most important
interventions first.
Overview
 The
Pareto Principle
 ABC
 Maslow’ Hierarchy
 End of Shift Reports
 Shift Action Plan
 Triangle Hierarchy
 Prioritization
and Delegation Exercise
The Pareto Principle “is a strategy
for balancing life and work through
prioritization of effort” (Kelly, 427).
"Lose an hour in the morning and
you will be all day hunting for it"
Richard Watley (1864)
The Pareto Principle
 “States
that 20% of focused efforts results
in 80% of outcome results, or conversely
that 80% of unfocused efforts result in 20%
of outcome results” p. 427.
 Example: Reading textbooks while logged
into Facebook vs. reading textbooks and
focusing on what you are reading.
 Planning
your time leads to more
productivity.
 When you are frenzied and unorganized,
you will be less productive.
 Example: gathering items for a task like a
wound change. If you are going back
and forth from the supply room, you
waste time. If you gather your supplies
before you start, you will save time.
If you can achieve more
with focused effort why
don’t more people do
so?
• They might not know
how.
• They might enjoy the
attention.
• They believe they are
so busy they do not
have time to plan.
• They love the state of
crisis.
Incorporating the Pareto
Principle into Practice





Establish objectives
Prioritize
Eliminate tasks-delegate
Plan your time!
Work smarter, rather than making work
harder!
McLauchlan, C. (1997). Time Management.
Journal of Emergency Medicine, 14(5),
345-346
Conclusion
 The
Pareto Principle can be applied to
many situations at work and in daily life.
 There are times when you would want to
use different strategies, especially in a life
threatening condition.
ABC’s of
Prioritizationa guide to
determining
life-threatening
conditions
A- Airway
B- Breathing
C- Circulation
First priority: Life-threatening or
potentially life-threatening
conditions





Vital signs or level of consciousness have
potential for respiratory or circulatory collapse
Risk to themselves or others
Can occur at any time during a shift
Not always able to anticipate
Need to monitor at risk patients to prevent
adverse reactions
Secondary priority: limb-threatening and sightthreatening
ABC’s to determine lifethreatening
 Airway




Is it patent and open?
Any obstructions or foreign body?
Need for artificial for artificial airway
To maximize opening of airway
 Jaw-thrust
 Chin-lift
maneuver (suspected head or neck
trauma)
ABC’s continued
 Breathing

Adequate respirations?
 Rate,
rhythm, depth, chest rise, and work of
breathing
 Advantageous or absent breath sounds
 Pulse oximetry
 Use of accessory muscles, retractions or seesaw pattern

Provide ventilation
 Inadequate
respirations
ABC’s lastly

Circulation

Pulse
Slow, irregular, weak or rapid
 Bounding and full


Blood pressure


Skin color and temperature


High vs. low
Warms and dry vs. cool and clammy
Possibility of hemorrhage

internal or external
General Appearance, & LOC
 Level


of Consciousness
Is the pt alert and oriented? Confused?
Unresponsive?
Glasgow Coma Score can be used to
determine the LOC
 General

appearance-
How does the patient look and act?
Table 18-2 Top Priority with
Potential Threats to Their ABC’s

Respiratory





Cardiovascular




Airway compromise
Choking
Asthma
Chest trauma
Cardiac arrest
Shock
Hemorrhage
Neurological



Major head trauma
Unconscious/
Unresponsive
Seizures

Other









Major trauma
Major amputation
Major burn especially
involving airway
Abdominal trauma
Vaginal bleeding
Anaphylaxis
Diabetic with altered
LOC
Septic Shock
Child or Elder Abuse
Activity

Scenario 1


You are a nurse who has stopped at the scene of a motor
vehicle crash. You are first on the scene. As the ambulances
begin to arrive you direct which patients need to be
transported in which order.
Scenario 2

You are on duty at a small community hospital early one
morning when receive reports of a construction accident a
mile away. You call the physician on call and then prepare
to receive the patients. Three ambulances arrive
simultaneously with 5 patients.
Gurney, D. (2004). Exercise in Critical thinking at triage:
prioritizing patients with similar acuities. Journal of
Emergency Nursing, 30(5), 514-515. DOI:
10.1016/j.jen.2004.07.005
Maslow’s
Hierarchy
Page 20-21
SelfActualization
Morality,
creativity
Esteem Needs
Self esteem,
confidence,
achievement
Social Needs/Love and
Belonging
Interaction with others,
friendships
Safety Needs
Safety of the body, family, health
Safe working conditions, job security,
benefits
Physiological Needs
Breathing, food, water, excretion
Breaks, adequate salary, working conditions
Spend your time
according to your
needs, or your
patients needs.
A Nursing Team Leader Caring
for Multiple Clients
 You
are the team leader providing care
for six clients. The team includes yourself
(RN), an LVP, and a newly hired nursing
assistant.






Mr. C, 68 y/o M with
unstable angina who needs
teaching for a cardiac
catheterization scheduled
this morning.
Ms. J, a 45 y/o F
experiencing chest pain
scheduled for a graded
exercise test later today.
Mr. R., a 75 y/o M with a 4day-old left sided stroke
Ms. S. an 83 y/o woman
with heart disease, a history
of MI, and mild dementia.
Ms. B, a 93 y/o F, newly
admitted from long-term
care with decreased UO,
ALOC and an elevated
temperature of 99.5F
Mr. L, a 59 y/o man with
mild SOB and chronic
emphysema
1.
2.
Which clients
should you assign
to the LVN?
Which client
should you assess
first?
1.
2.
3.
4.
Mr. C
Ms. J
Ms. B
Mr. L






Mr. C, 68 y/o M with
unstable angina who needs
teaching for a cardiac
catheterization scheduled
this morning.
Ms. J, a 45 y/o F
experiencing chest pain
scheduled for a graded
exercise test later today.
Mr. R., a 75 y/o M with a 4day-old left sided stroke
Ms. S. an 83 y/o woman
with heart disease, a history
of MI, and mild dementia.
Ms. B, a 93 y/o F, newly
admitted from long-term
care with decreased UO,
ALOC and an elevated
temperature of 99.5F
Mr. L, a 59 y/o man with
mild SOB and chronic
emphysema

1.
2.
3.
4.
Which of the
following tasks should
you delegate to the
nursing assistant?
Ask Ms. S memorytesting questions.
Tell Ms. J about
treadmill exercise
testing.
Check pulse
oximetry for Mr. L.
Monitor urine
output for Ms. B.

1.
2.
3.
4.
Close to the end of the shift, the LVN reports
that the nursing assistant has not totaled
clients’ intake and output for the past 8 hours.
What is your best action?
Confront the nursing assistant and instruct
her to complete this assignment.
Delegate this task to the LVN as the nursing
assistant may not have been educated in
this task.
Ask the nursing assistant if she needs
assistance in completing the intake and
output records.
Notify the nurse manager to include this on
the nursing assistant’s evaluation.
Shortness of breath, Edema,
and Decreased Urine Output

Ms. J. is a 63 y/o F who is admitted directly to
the medical unit after visiting her physician for
SOB and increased swelling in her ankles and
calves. Her admitting DX is rule out chronic
renal failure (CRF). Ms. J states that her
symptoms have become worse over the past
two to three months and that she uses the
bathroom less often and urinates in smaller
amounts. Her past medical history includes
HTN (30 years), CAD (18 years) and type 2
diabetes.

Ms. J. is a 63 y/o F who is
admitted directly to the
medical unit after visiting
her physician for SOB and
increased swelling in her
ankles and calves. Her
admitting DX is rule out
chronic renal failure
(CRF). Ms. J states that her
symptoms have become
worse over the past two
to three months and that
she uses the bathroom
less often and urinates in
smaller amounts. Her past
medical history includes
HTN (30 years), CAD (18
years) and type 2
diabetes.

Admission vital signs:






Temp: 97.8 F
BP: 162/96
HR: 88
RR: 28
Pulse ox: 91% on
room air
Admission lab tests to
be collected on the
unit include serum
electrolytes, renal
function tests, CBC
and urinalysis. A 24
hour collection for
creatinine clearance
has also been
ordered.
 You
are the team leader, supervising an
LVN. Which nursing care action for Ms. J
should you delegate to the LVN?
1. Insert and intermittent catheter to assess
for residual urine.
2. Plan fluid restriction amounts to be given
with meals.
3. Check breath sounds for presence of
increased crackles.
4. Discuss renal replacement therapies with
the patient.
 As
team leader, you observe the nursing
assistant (NA) perform all of these actions
for Ms. J. For which action must you
intervene?
1. NA assists Ms. J to replace oxygen nasal
cannula.
2. NA checks Ms. J.’s vital signs after the
patient drinks fluids.
3. NA ambulates with Ms. J to the
bathroom and back.
4. NA washes Ms. J’s back, legs, and feet
with warm water.

1.
2.
3.
4.
You are supervising a new orienting nurse
providing care for Ms. J, who has had surgery
to create a left forearm dialysis access. Which
of the following actions performed by the
nurse requires that you intervene?
The nurse monitors the patient’s operative
site dressing for evidence of bleeding.
The nurse obtains BP reading by placing the
cuff on the right arm.
The nurse draws post-operative lab studies
from temporary dialysis access.
The nurse administers oxycodone by mouth
for moderate post-operative pain.
 Assessment
of Ms. J after dialysis reveals
all of these findings. Which assessment
finding necessitates immediate action?
1. Ms. J’s weight is decreased by 4.5
pounds
2. Ms. J’s systolic blood pressure is
decreased by 14 mm Hg.
3. Ms. J’s level of consciousness is
decreased.
4. Ms. J.’s temporary catheter dressing has
a small blood spot.

1.
2.
3.
4.
Six months later, Ms. J is readmitted to the
unit. She has just returned from hemodialysis.
Which nursing care action should you
delegate to the nursing assistant?
Obtain vital signs and post-dialysis weight.
Assess hemodialysis access site for bruit and
thrill.
Check and assess site dressing for bleeding.
Instruct patient to request assistance getting
out of bed.
Cardiovascular Problems

1.
2.
3.
4.
You are the charge nurse for the coronary step
down unit. Which patient is best to assign to an RN
who has floated for the day from the general
medical-surgical unit?
Patient requiring discharge teaching about
coronary artery stenting prior to going home with
spouse today.
Patient receiving IV furosemide (Lasix) to treat
acute left ventricular failure.
Patient just transferred from the radiology
department after a coronary angioplasty.
Patient just admitted with unstable angina and
who has orders for a heparin infusion and aspirin.
 You
are working in the ED caring for a
patient who was just admitted with left
anterior chest pain, possible unstable
angina or myocardial infarction. Which
nursing activity will you accomplish first?
1. Auscultate heart sounds.
2. Administer SL nitro.
3. Insert an IV catheter.
4. Obtain a brief patient health history.
A
patient with atrial fibrillation is
ambulating in the hallway on the
coronary step-down unit and suddenly
tells you, “I feel really dizzy.” Which action
should you take first?
1. Help the patient to sit down.
2. Check the patient’s apical pulse.
3. Take the patient’s BP.
4. Have the patient breath deeply.
A
diagnosis of ventricular fibrillation is
identified for an unresponsive 50-year-old
patient who has just arrived in the ED.
Which action will you take first?
1. Defibrillate at 200 Joules
2. Start CPR
3. Administer Epi 1 Mg IV
4. Intubate and manually ventilate.
 You
are ambulating a cardiac surgery
patient who has telemetry cardiac
monitoring when another staff member
tells you that the patient has developed a
supraventricular tachycardia with a rate
of 146 beats per minute. In which order
will you take these actions?
1. Call the patients physician.
2. Have the patient sit down.
3. Check the patients blood pressure.
4. Administer oxygen by nasal canula.