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Nursing has always been a challenging profession with multiple, competing priorities, but in the 21st century the challenges are becoming even greater. Forced to do more with less, nurses are finding themselves pulled in many directions. Along with the increasing patient demands are the needs to learn new software and adapt to new technology. Add to this the ever-increasing regulatory requirements that have a significant impact on documentation-the list could go on and on.
It's not surprising that given this multi-dimensional world in which nurses find themselves that time management is a priority.
LeaRae Keyes, RN, is the executive director of the Nurse Entrepreneur Network in Andover, MN.
"Nurses need to be very self-disciplined," said Keyes. "There's nobody telling them what to do or how to spend their time, so they have to determine how best to spend their time." One of the keys is establishing daily priorities, she added. "What are the most important things you need to get done today?" Keyes said she generally identified three things each day that are "must do's." But that's the easy part. The challenge is staying focused amid all of the competing priorities and "urgencies" that crop up in a typical day.
"Often times we focus on what's urgent and not necessarily what's important," said Keyes. "We need to spend time on what's important." Making the distinction can be difficult, she acknowledges, especially when others attempt to make their priorities your priorities.
But, when that happens, she said, it's okay to ask for help in re-prioritizing. "I think we tend to feel it's a sign of weakness if we can't get everything done that's been assigned to us. But in the long run, asking for help makes you a better nurse."
The Challenge-Communication
In a people-intensive industry, communication is a given-and a constant challenge. Interactions with patients, colleagues, doctors, staff, families, etc., are ongoing and can take a toll.
A recent study conducted by Zogby International and commissioned by Cisco, provides some insights into the specific areas of challenge for nurses. The study involved more than 250 practicing nurses in medical-surgical, emergency room, operating room and critical care-intensive care units. Key findings included:
§ The opportunity to improve communications was the primary issue identified.
§ The time that nurses spend "chasing other people to get answers" was twice as great as the time they spent locating other resources.
§ When asked how many minutes per shift are typically spent chasing other people to get answers, up to 86 percent of respondents estimated wasting as much as two hours per shift.
§ About 60 percent of nurses in the study estimate they work up to 10 hours of overtime each week due to time wasted or lost trying to communicate with other staff.
Linda Henman, Ph.D., is the author of The Magnetic Boss: How to Become the Boss No One Wants to Leave(EFG Publishing, Inc., 2006). Encouraging robust discussion can be a catalyst in improving communication in organizations, she said, and it starts at the top. "Robust discussion is not something that happens automatically among members of a team. It has to start with the boss," said Dr. Henman. "Are you willing to put issues on the table and engage in frankness and straightforwardness? If you aren't, it's unlikely that you'll encourage it, yet a high level of candor is critical to the team's creative problem solving."
Taking initiative to be part of the communication solution, rather than part of the problem, is an important first step. Nurses have an opportunity to be catalysts in improving the flow of information between themselves and those around them.
Nurses in a leadership role have the opportunity to identify and work to remove communication barriers. Nurses in staff roles dealing with the types of communication barriers identified in the Cisco study, need to bring those issues to the forefront where they can be addressed. Drilling down into the reasons that they may be "chasing other people to get answers," for instance, might suggest opportunities to develop systems or use technology to provide more ready access to commonly needed information, for example.
Of course, while technology can help, face-to-face communication will always be a necessary and very important part of the nurse's role. It can't be removed, but it can be managed.
While one-on-one communication is often pointed to as a time management challenge, another looming issue for many nurses is what many consider to be an unnecessary - and ever-growing - number of meetings.
Productive Meetings
Ray Silverstein is the author of The Best Secrets of Great Small Businesses. Like many others, Silverstein noted that many workers-both managers and employees-feel that meetings are a waste of time. They don't help people meet their goals. They often don't start on time, don't have a clear direction and, worst of all, don't result in any meaningful conclusions, he says. Successful meetings, he said, should:
§ Start precisely on time - whether everybody is there or not.
§ Have a clearly stated objective.
§ Have a written agenda, identifying topics to be covered.
§ Have a formal schedule - and participants must adhere to it. Each portion of the agenda should be allotted a specific amount of time.
§ Assign responsibility for each portion of the agenda to one or more attendees - in advance.
§ End with a formal, stated conclusion.
Nurses who lead meetings can initiate these actions to improve productivity and ensure that meetings will result in meaningful outcomes. Even as a meeting participant, nurses can "lead by example" by asking questions to help guide the meeting more productively if the assigned leader is not doing so effectively.
For those in a leadership role, Henman offered some additional tips:
§ Start and end on time. "As self-evident as this idea is, you'd be surprised how seldom it is followed," she says. "Frequently the group waits for one of two tragglers. Then, because of a late start, the meeting runs over the allotted time. Both build resentment."
§ Utilize a "parking lot." Even meetings with an agenda can sometimes be sidetracked when team members bring up "new issues." When this happens, suggests Henman, write the issue on a flip chart - the "parking lot." Establishing the parking lot does two things, she says: "first it captures the problems and questions so they are not forgotten - second, it communicates an eagerness to hear the ideas and opinions of each member at the appropriate time."
§ Have the boss speak last. "One of the surest ways to encourage GroupThink and currying favor is for bosses to let people know what you want them to say," said Henman. "Then, each team member will take a turn being the echo, telling you exactly what you want to hear. As harmonious as this seems, it is not the reason for a meeting and it's not the best way to solve problems."
Effective Time Management Pays Off
There are personal and professional benefits for nurses who practice effective time management, notes Keyes. Personally, the more nurses are able to manage their time, the less stress they will feel. Professionally, she noted: "The more organized you can be and the more productive you can be, the more likely it is that you will be considered for advancement. If you can't manage your own time, how will you be able to manage other people?"
As Keyes previously noted, nurses are often "on their own" in terms of establishing priorities and meeting the challenges of day-to-day demands. Becoming an effective "self-manager," said Keyes, will pay off in many ways.
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