Time management skills save nurses from drowning in sea of documentation
Experts say saving time is a three-step process
It’s a common scenario these days: Nurses are so busy seeing patient after patient that they seem to be drowning in documentation of Medicare and insurance details.
"I just see many of our nurses getting swamped with paperwork and not having any clue of how to get out of it," says Hazel Curtis, RN, MPH, nurse educator with Loma Linda (CA) University Medical Center Home Health Care. "They need to do their job and do it well, but they don’t need it to take up their whole life," she says.
Curtis offered Loma Linda’s home care nurses some help through an inservice on time management. She used a lecture and slide format, which punctuated the key time management points she needed to get across. (See time management outline, slides, inserted in this issue.)
Later, Curtis provided some additional training on how nurses can use a calendar or planner more effectively. What kind of scheduling tool nurses choose isn’t as important as using it consistently, she says. Nurses can waste time and lose track of important appointments if they continually switch calendars.
An expert on time management recommends nurses draw up a personal mission statement as a first step to turning over a new leaf in time management. "It’s a written document that states what’s most important to you, the values in your life," says Debra Lund, manager of public relations and a time management speaker for Franklin Covey Co. of Salt Lake City.
Lund says her own mission statement lists her family as a top priority, and it reflects how she wants to make a difference in the world no matter what her job is.
Franklin Covey resulted from a merger of Franklin Quest Co., which makes the Franklin planners, and the Covey Leadership Center, which publishes motivational books and holds seminars.
Start with the basics
Education managers who want to teach nurses about time management should keep in mind these three important steps, Curtis says: Prioritize, Maximize, and Energize.
1. Prioritize what you must accomplish each day.
"We often spend all of our time doing nothing instead of working on the big tasks because they are so intimidating," Curtis explains. "Often my employees come to the office, and there’s an automatic thing that happens when they walk in the front door: They debit an hour of their life."
The phone rings; yellow Post-it notes stuck all over their desks cry out for attention; co-workers stick their heads in the door to say "Hello" or pass on some information.
Because patients are the nurses’ first priority, they probably would save time by visiting their patients first and then returning to the office, Curtis suggests.
"You want to focus your life, and you don’t want to live in the emergencies of your life very much," she says. "Live in the important, not in the urgent. Don’t live to put out fires. Do well enough that you can focus on the important details but not the fires."
The best way to do this is to pick those activities that must be done, make a list, and stick to it, Curtis says.
Breaking tasks down
Lund says nurses can determine their priorities by asking themselves what are the three, five, or 10 things that they absolutely must do this week. "What are the big rocks? Which things will make a big difference in my personal life, work life, home life? Those are things that get the first priority," she says.
Many people tend to get bogged down in time-eating work chores and lose sight of their top priorities, Lund says. (See story on how people spend/waste their time, p. 135.)
2. Maximize your time by working smarter not harder.
"Most people have had a day in the office where they get to the end of the day and say, I didn’t do anything What did I do today?’" Curtis says.
This happens because it’s easy to become distracted with the little interruptions, such as phone calls. "Not every telephone call needs to be answered. Let it go on the voice mail," Curtis says. "Or just because someone says Gotta minute?’ doesn’t mean you have to give them a minute."
Waiting for physicians to return calls is another time-waster. Typically, the nurse will call the physician’s beeper and leave a message. Then the nurse might wait around the office until the call is returned.
Curtis recommends nurses use this time more constructively. First, they could page two or three physicians at one time and then catch up on their paperwork while they’re waiting for the doctors to return the calls. "Batch your time and paperwork," she says.
She also has saved time by paging doctors to her home phone either before or after work so she can do housework, cook dinner, or relax while waiting for their calls.
Most people could make better use of their time by saying just one little word: "No," Lund says, adding that people need to learn to say this word graciously. "This comes into having integrity at the moment of choice," she says. "If you keep a promise to say no’ to yourself, then it helps you keep promises to other people."
Lund says it’s difficult to remember the word no when an associate rushes in to discuss a work problem or when a family member calls about an "emergency" that isn’t so urgent.
"Everybody has the same amount of time in the day," she notes. "People who say they don’t have enough time may not be choosing to work on and spend time with what’s really important."
Ask the right questions
A good strategy for maximizing one’s time, Curtis says, is to ask these three questions each morning:
• What must get done today?
• What would be nice to do today?
• What are those things that really don’t matter when I do them?
Another tip is to use otherwise unproductive time to do something productive, Curtis says. For example, nurses spend a lot of time driving from one home to the next. "You could listen to a book on tape for that hour drive."
Nurses can maximize the time they spend on documentation by filling out some of the paperwork in the patient’s home or in their car after they leave the home, Curtis suggests. Paperwork will be easier to complete if they fill it out a little at a time immediately after the tasks or conversations that need documentation.
Next, nurses should choose a calendar or time planner that fits their personal style so they’ll be comfortable using it. If they prefer to stick Post-it notes all over their desks to remind themselves of appointments, they should do so.
Curtis says the important thing is that nurses use planning tools to organize their time and help them take care of business while at work.
3. Energize yourself. Emotions particularly anger, frustration, and sadness can drain energy very quickly. Lund recommends employees repair the broken work relationships quickly.
"It takes so much time to worry about that broken relationship when you could clean it up, apologize if you need to, or even if you don’t need to, then apologize anyway," Lund says.
Work to live don’t live to work
Nurses also can find their time and energy depleted when they become too emotionally attached to their patients’ problems or when they take work crises home.
"Most of us work not because we want to so much but because we need the income," Curtis says. "For most of us, our first priority is our friends and family, so we need to focus on getting our jobs done well, so we can go home at the end of the day and not drag our jobs home with us.
"I’ve seen the nurses who are just so burned out because they’re always at work, doing this and that," Curtis says. "I tell them, You cannot be the mother to the world; no one asked you to do that, so don’t take on the patient’s emotional problems.’"
A first step toward energizing oneself is to realize that everyone has limitations, and no one can expect to fix all the world’s problems. Curtis recommends that nurses continually remind themselves, "I don’t have to take that patient’s worry on myself."
Another step is to balance one’s physical, emotional, spiritual, and mental activities, Lund says. Even when nurses are extremely busy, they should remember to eat right, exercise, and spend time with loved ones or pets, she advises. She makes it a goal to exercise three times a week and exercise can include something as simple as walking up the staircase instead of taking the elevator.
Some days she treats herself to a few pages of a good book or a few minutes with her pet, even if it’s late when she returns home.
"Sometimes at 1 a.m., if I’m coming home late, I’ll spend 15 to 20 minutes holding and petting my dog before I go to bed," she says. "Something like that will rejuvenate you and inspire you."
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