Time management
Lecturer – Olena Bidovanets

Nurses manage care for individual clients,
families, and communities in hospitals,
outpatient settings, clinics, health
departments, home health agencies,
long-term care facilities, and
rehabilitation centers as well as in other
specialized healthcare organizations. The
strategies they use to organize care are
drawn from leadership and management
theories.

The approaches to leadership and
management reflect the dynamic state of
health-care delivery as nurse managers
and leaders strive to empower nurses to
provide care that produces optimal
outcomes. Management and leadership
have evolved and continue to evolve
from a hierarchical structure based in
early management theory to a more
flattened and inclusive approach that
incorporates concepts from the physical
and social sciences.

Managers have traditionally been
responsible for the control of resources
required to accomplish organizational
goals. These responsibilities include
budgeting, staffing, and maintaining the
functions of the organization while
simultaneously balancing fiduciary
responsibility for the resources of the
organization. Rowland and Rowland
(1997) define management as a five-step
process:
1. Planning
 2. Organizing
 3. Directing
 4. Coordinating
 5. Controlling


The manager is employed by an
organization and given the responsibility
to accomplish specified goals for the
organization. Managers are expected to
teach workers the best way to perform
the job; match the employee to the job;
provide motivational incentives to
workers; see that time, energy, and
materials are used efficiently, and ensure
that the organization fulfills its
objectives.

At the same time, managers seek to
enhance efficiency, develop resources
required to reach the goals of the
organization’s strategic plan, and
manage across boundaries in the
organization (Huber, 2000).

Newly graduated staff nurses assume
responsibility for leading a team of direct
care providers and, therefore, need to
know how to manage a patient care team
effectively. This team often includes
nursing assistants, patient care
technicians, licensed vocational/practical
nurses, and other registered nurses.

Nursing is a demanding job and it can
often feel as though there are not enough
hours in the day to complete all of your
tasks. Unlike other jobs, priorities can
change rapidly - when a patient is in
urgent need of your attention, your to-do
list can change rapidly. The hectic pace of
the job is one of the reasons that many
nurses get burned out and stressed out.

Using time management techniques
designed with nurses in mind is one way
to make your life a little easier, as well as
getting more done! Time management
strategies can be broken down into five
strategies:

1. Plan your day out in advance. Many
nurses say that while planning is a good
idea, their days are too unpredictable to
plan. However, nurses who do plan their
day will find that they get more done with
less stress. It is difficult to plan your day
because your environment can change
rapidly, and much of your day is spent
responding to the needs of patients.

However, if you plan out the tasks you
have to get done in a day they can
become more manageable. Make a list of
everything you must get done today. Then,
make a note of how long it will take and
rank the jobs in order of importance.

Start looking at tasks and seeing when
you will have time in your day to get one
or two items done, and when you have a
few minutes, complete a task that you can
get done in that time. You will also feel
better knowing that you are not
forgetting anything!

2. Focus on the most important activities
first. When you make the list above, also
focus on the items with the highest
priority. Remember, you may not be able
to get everything done but by completing
the most important tasks, you will be less
stressed.

Also, keep in mind that if nothing is going
on right now, you should be working on
one of your tasks because due to the
unpredictable nature of your job, you
can’t be sure that you will have time later.
As you complete tasks, check them off on
your list. It will give you a sense of
accomplishment and make your stress
level drop.


3. Don’t let interruptions disrupt your day.
Nurses have to deal with many
interruptions, many of which can’t be
helped. However, there are many
interruptions that are not so important.
Interruptions like long non-work related
chats with other staff members, checking
non-work email, or other non-essential
tasks can get you off track quickly

. Make time to relax, visit and do things to
lower your stress, but don’t let those
things become more important than your
work.

4. Keep yourself and your workspace
organized. Being organized saves time. If
you have a desk, spend a few minutes at
the end of the day to put papers where
they belong so that you can find them
when you need them. At the beginning of
the day, make sure all equipment is clean
and ready for use. This will lower your
stress level and make your day easier.

5. Learn to delegate tasks. Remember that
you can’t do it all, nor should you have to.
When you need help, ask. If someone asks
you to do something that you don’t have
time, it’s OK to say no. Remember, time
management is about making your day
easier and more productive! (Catherine Bynes )

As a nurse, you will have many people
competing for your time and attention.
Things change quickly in healthcare
environments, so it is important to be
flexible. Determining priorities, which
things must be done right away and which
can wait, is critical in maintaining your
equilibrium.

Work out a system where you get the
most important things done first and you
know how much there is left to do.You
also need to work out what could be
delegated to others.

The ABCD system is an excellent way to
organise and prioritise your tasks:
A: Absolutely must get done
 Tasks that must be done at a certain time.
 You will be interrupted to do a particular
task if it is not done soon.
 Others need it done to do their job.
 Waiting will cause a patient or his or her
family avoidable distress.
 A risk or hazard is present
 Most documentation and paperwork.
B: Better sooner than later
 Can wait, but not too long
 Must be done today or on this shift
 Will save time and resources if done
soon.
C: Can wait until later
 Things that do not have any time frame
attached.
 Getting things that will be needed later in
the day.
 Some paperwork.
D: Do not worry about it
 These are tasks that are beneficial, but if
left undone will not affect patients or
their care.
 These things should get done, but no one
will be hurt if they are not.

When you write down tasks or things
your patient needs, rate them A, B, C or
D. Get all the As done as soon as possible,
or at their scheduled times. Sometimes
you can combine tasks without costing
extra time. For example, while toileting
patients (A), you might wash them as well
(B). Make sure that tasks which could
cause interruptions or delay other people
are done first whenever possible.

As new tasks arise, decide where to put
them on your list. Tasks will sometimes
change in priority. If a patient vomits on
the sheets, for example, changing the linen
goes from a C to an A. Some tasks can be
avoided simply by being considerate and
cleaning up after yourself.

It is often difficult for nursing students to
delegate tasks, but it is an essential skill. To
delegate safely and appropriately, you have
to consider a number of points:
What tasks must a nurse do by law and
what must be done because it is trust
policy?
 If a particular task is delegated and things
go pear-shaped, how bad could it be?
 Does the person to whom you are
delegating have the knowledge and skill to
complete the delegated tasks?
 What is best for the patient?
 Are you being lazy by delegating?
 Will it be done in time if delegated?


Communication is key. Make certain that
the other person understands exactly
what you need and when you need it
done. Delegation and time management
are essential for developing professional
nursing practice. With practice you will
find they get easier and make your
working day go more smoothly. They also
give you the time you need to give the
best possible care. (Bethann Siviter is district nurse
team leader, past chair of the Association of Nursing Students
and former student member of RCN council)

“All of us spend time doing ridiculous things
that are a complete waste of time simply to
avoid going out of our comfort zone” – Dr.
Stephen Covey
What is really Urgent?

Understanding what is really urgent in
your work requires careful consideration
and it will be different in different roles.
Stephen Covey in his Seven Habits of
Highly Effective People presented a model
with four quadrants.

The goal here is to put first things first by
identifying different levels of urgency. even if the activity is something
unpleasant. All of our time can be divided
into one of these four quadrants. The
matrix below is an example of the model
with typical leadership
activities/responsibilities placed in each of
the four quadrants.

Categorizing our work requires honesty.
We may enjoy socializing or talking with
professional colleagues but is it really
category 2 or do we engage in so much of
it that it is category 4.
Using To-Do Lists

Using to-do lists can be quite helpful in making sure that
goals get accomplished. The challenge with these lists is that
sometimes they become so long that the lists themselves
seem overwhelming. Leo Babauta, author of the blog Zen
Habits, provides some good advice about this. He suggests
that we establish no more than 4 goals to achieve for the
week – which he describes as Big Rocks. Each day of the
week we should establish what our 1-3 most important tasks
are and then be sure to complete those. Babauta also
advises that it is easier to complete tasks if we can focus on
one task at a time and learn to say NO to commitments that
are not essential, don’t contribute to your goals or add value
to your life.

He suggests that we establish no more
than 4 goals to achieve for the week –
which he describes as Big Rocks. Each
day of the week we should establish what
our 1-3 most important tasks are and
then be sure to complete those. Babauta
also advises that it is easier to complete
tasks if we can focus on one task at a
time and learn to say NO to
commitments that are not essential, don’t
contribute to your goals or add value to
your life.
Avoiding Interruptions

Interruptions to our work flow are
routine especially in health care settings
but are they really acceptable?
Increasingly in clinical practice, it is
recognized that they can present risks to
patient safety.

Hall, Pedersen and Fairley in recent
research conducted in Canadian hospitals
found that workplace interruptions are a
significant issue on nursing units.
Interestingly, the majority of the
interruptions came from unexpected
interactions with other health care team
members most often communication
related to patient care issues.

Most of the interruptions observed could
have had a negative effect on patient
safety versus improving patients care.

Researchers have found that it can take
between 10 and 20 minutes to get back
on track after an interruption so they also
need to be viewed as significant time
wasters. In clinical environments, we have
seen the introduction of interruption-free
zones in medication rooms. Some good
tips to avoid interruptions and reduce
distractions in your environment include
the following:
Develop an awareness of the negative
issues with interruptions.
 Abstain from being the cause of an
interruption….ask Is this a good time for
You?
 If you need a distraction free zone –
close the door and put a sign on it.

If you have only five minutes to talk – say
that up front so the conversation can be
focused.
 If you need to finish a task you have
started, say so let the person know when
you will be free.
 Let your phone go to voice mail, turn off
your email, text messages or other
communication devices when you are
trying to focus.


(By Rose O. Sherman, EdD, RN, FAAN)