We often get asked questions about how we stayed organized in school + manage clinical on top of studying. Here is a brief + straight forward explanation of how we organize ourselves in clinical. Keeping on top of things in clinical is SO important; this is often the most looked upon thing from instructors as it gives them insight on how students will be able to manage + prioritize tasks when they graduate. As you progress through nursing school, you will need to adjust your organizational plan depending on multiple factors. Keep reading to learn how we excelled in clinical!
SIMPLE is BETTER
After years of adjusting our organizational plans, we have come to learn that a simple + straight forward sheet of paper works best for us. Clinical can be overwhelming, so looking at a clean + concise organizational plan can help prevent further unnecessary stress. Keep it to one side of a page so it is easy to refer to!
RESEARCH your Unit
Before beginning a new clinical rotation, we always research the unit that we will be on. For example, our local hospital has several medical floors - each with a different focus. Depending on the focus of the unit, research common medications, diagnoses, + treatments that would be seen with these types of patients. For example, we were on a medical unit focusing on GI + renal issues. We made a medication chart that had common medications for patients with GI + renal related diseases. Further, we researched treatments including hemodialysis + peritoneal dialysis as many patients underwent these treatments on the unit. We referred to our medical-surgical textbook + class notes to familiarize ourselves with diseases that we would be seeing. Gaining insight + understanding in to these factors allows you to be more aware of priority assessments + potential adverse effects. Further, having all this knowledge enhances your ability to connect the dots + make well-rounded clinical judgements.
Time Management + Prioritization
When you receive your patient assignments, create a plan as soon as possible. This plan will likely be adjusted throughout your shift as unexpected events often come up, however it helps to have a plan in place at the beginning of your shift. For example, when coming on to a morning shift, we plan things out like:
SAFETY CHECKS: First thing to do of course is check on your patient(s) + ensure they are safe. Check if they have all the required safety supplies in the room. Check oxygen + suction to ensure everything is working properly. Also check IV tubing + secondary lines to see if anything will need to be changed (knowing this ahead of time will help you later in the day when/if you have to administer IV medications). Also make sure to check the status of dressings, chest tubes, drains, etc.
PATIENT ACUITY: Depending on how far your are in your program, you may be caring for more than one patient. Make sure you prioritize the acuity of your patients! This is crucial. Always start with ABCs (airway, breathing, circulation) if you feel overwhelmed.
MEDICATIONS: Make sure to check the doctor orders first thing to ensure there have not been any changes to medications. Some medications need to be given at specific times with/without other medications. Also, some medications require labs to be checked prior to administering. The list could go on for medication safety! Review your medication administration notes + be mindful of these factors!
MEALS: Does the patient need blood glucose checked? If so, this should be a priority, because they will need insulin before they start eating meals (depending on the type of insulin).
TESTS/PROCEDURES: Make sure to listen in report + check the doctor orders to see if the patient has any tests scheduled for the day. Sometimes they get taken away quite early for diagnostic tests, so you will want to be on top of managing your time as the patient may require medications, dressing changes, personal care, etc.
BREAKS: Clinical can get VERY busy + it is easy for people to lose track of time (especially when caring for multiple patients)! This is where time management comes in. Make sure you plan time to take breaks. Not only does this give your body a mental break, it also shows instructors that you are able to organize care + manage time for yourself.
Here is an example of an organizational plan we used in our third year. We made it very clear + concise. We will go through a break down of what we included.
PATIENT IDENTIFIER
We left a spot on the top left to put a patient label. This allows us to do safety/identification checks before administering medications. This may seem silly if you only have one patient, but it is good to get in to the habit of always checking the patient's wrist band against another patient identifier. When you have a full patient load, it will help you with preventing avoidable errors that could potentially be very dangerous!
GENERAL INFO
Make sure to write down the name of your primary nurse, the attending physician, admission date, patient room number, mobility, allergies, as well as diet. You should be aware of all these things because they are YOUR patient. MAKE SURE TO BE AWARE OF YOUR PATIENT'S CODE STATUS! You never know what might happen on a shift, so if you find your patient unresponsive, you want to know if you should be calling a code blue.
DIAGNOSIS + HISTORY
Clearly write down your patient's diagnosis/diagnoses + medical history. These are important to be aware of as sometimes you will find links between comorbidities + current health conditions. Having this info will enhance your critical thinking + clinical judgement skills too!
SAFETY CHECK
At the top right, we have a small box with "IV" + "tubing" which we check during our safety check to ensure all the lines are new. We left room in this box to add other info that is find important to include on the organizational plan (ex: patient is on 3L oxygen via nasal prongs)
TESTS/OTHER
We included a box to write down info about any tests or procedures. For example, the patient may have a scheduled PICC insertion at 1130, or the patient may have radiation at 0930. It is important to be aware of these times so you can prioritize what needs to be done prior + what can wait until later.
TASKS
We created a blank box with little check boxes. This allows us to write down tasks and check them off as we complete them. For example, we might include: dressing change, flush IV, empty foley bag, mark chest tube drainage device at end of shift, etc. It is something helpful to write down these that may seem obvious, but ge often be forgotten when clinical gets busy. For example, maybe you gave a breakthrough pain medication at 1300. Depending on the route + type of medication, would should do a follow up pain assessment after the medication has absorbed in the body + started working. Say you gave a subcutaneous dose of dilaudid. Subcutaneous doses often kick in faster than oral, so you would want to plan to assess this patient's pain level depending on the route you administered the medication.
(Ex: Follow-up pain assessment in room 21 @ 1330)
LABS
We included a spot to write down lab results. We included labs that were most common on the unit. You can adjust this to whatever is relevant to what you are learning + what is common on your unit. We also left room at the bottom to include other labs that are significant to the individual.
CHARTING
The hospital we practice at has online charting, so we found this checklist very helpful. Your charting may look very different from ours, but basically we included spots to check off assessments of each system, follow-up charting for any abnormal/significant findings from the systems assessment, pain, blood glucose/insulin, mobilization, oral intake, bowel movements/voiding, foley + IVs. These were the most common things we charted on for this particular unit, but we left a spot to add in additional charting as well. We check these off as we complete them, and sometimes highlight ones that we still need to complete.
SCHEDULE
We included an area at the bottom of the organizational plan to visually plan out our day. We write in assessments, washes, vital signs, medication times, appointments/procedures, breaks skills, + anything else that we find helpful to keep us organized!
We hope this was beneficial to help you create your own personalized organizational plan! It may take a while to figure out what works for you, but you will get it eventually with practice + experience !
GOOD LUCK TO YOU ALL!
REMEMBER - KEEP YOUR COFFEE STRONG + SCRUB GAME ON POINT!
xx
Tara + Sydney
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