There’s no way around it, nursing care often involves a lot of busy work. Checking medical charts, documentation, securing meds, tracking down doctors, turning a patient, fetching a pillow or extra blanket…the list goes on and on.
Richard Villarreal, BSN, RN, Solid Organ Transplant Unit, remembers feeling overwhelmed when he started his first year on the job as a nurse. Having a knack for technology, he decided to tackle the issue head-on by using the electronic medical records system at Nebraska Medicine — One Chart, to organize and prioritize his duties throughout the day to improve his efficiency.
“In my downtime, I spent a lot of time browsing through One Chart looking at all the different menus, options and columns available for patient lists,” Villarreal explains. “I then personalized nearly every menu that is able to be personalized so that it fit my needs and helped me make the most of my time. Now when I open One Chart, I can easily see if any of my assigned patients have new orders, new notes, new results, if any telemetry or isolation has been ordered, what their code status is and their fall risk. I can see all of this information without even opening a patient’s chart.”
Villarreal, a now supervisor in the Solid Organ Transplant Unit, says his tweaks to One Chart in addition to a few other time-saving techniques, have saved him much time and stress over the last few years.
“With the busy workload of most nurses, you want to make the most of every minute,” says Villarreal. “These simple changes to my work day helped cut out many of the unnecessary back and forth trips and helped me become a more efficient provider. This in turn, allowed me to spend more time with my patients, which ultimately, is the goal.”
Villarreal shares some of his time-saving tips that will allow you to prioritize and organize your tasks, and take more control of your day.
- Pay attention during One Chart training. “During orientation, you will get a fairly comprehensive review of how to use the One Chart electronic medical recording system,” notes Villarreal. “Other than patient care, this is where you will be spending most of your time. So pay attention. It will pay off later”
- Customize your One Chart lists. When you have some downtime, take time to sign in to One Chart, where you will see your list of patients. Next to the patients are columns that provide basic information about them, such room number, attending physician, service team and admitting diagnosis. Villarreal suggests creating additional customized columns that show more details about each patient so you don’t have to actually click into each patient record every time you log into One Chart. To do this, simply click on the properties button to see what your options are. Depending on what type of information would be useful for you, add new columns for things like unacknowledged or expiring orders, active Foley catheter, active central line, or any telemetry orders. There are features built into these columns that many people do not know about. For telemetry, for example, there are symbols that indicate whether the patient is actively being monitored on telemetry and if there is or is not an order for the patient to be monitored. It will also tell you if the patient should be on telemetry, but is not. Similarly, for one of the isolation columns, there is a symbol that pops up if the patient does not have the correct isolation ordered for their diagnosis or infection
- Stay up to date on changes. Occasionally check the Nursing home page where all changes to the One Chart system are listed and explained. It also includes who to contact if you need help or have issues
- Share your ideas. Write down your ideas on how to change or tweak the system and share them. Click on the One Chart enhancement tab and explain your ideas. A nursing advisory team reviews all suggestions and determines if the change is significant enough to be made
- Use The Brain. This is a list of tasks that need to be completed for each patient for each hour on your shift. This will help reduce multiple trips for the same things, says Villarreal. “For instance, if several patients need meds, you can grab the meds for all of them at the same time. If a patient needs meds and vitals checked, you know to do them both at the same time”
- Create a work list. Like the “brain” concept in One Chart, Villarreal likes to use a physical work list that he can fill out for each patient during hand offs. “I prefer a physical list of what needs to be completed for each patient that I can refer to for quick reference throughout my shift, so I don’t have to log into One Chart as often,” he says. “After the hand off is completed, I go through all the orders for each patient and add what medications, assessments and tasks are needed each hour in my work list. It takes a little extra time up front, but more than makes up for it later by allowing me to be more efficient throughout the day”
- Prioritize your patients according to needs. Review each patient to determine who needs meds or other care first. If possible, save the more difficult patients for last as they will likely take more time. “Critical thinking must be used wisely in this situation, however, as a busier patient may have needs that should be addressed now, even though it might take a long time,” Villarreal says
- Keep hand-offs to 30 minutes or less. “The patient hand-off is not meant to be a time to get a comprehensive overview of each patient,” says Villarreal. “Save your questions. Use this time to get a quick overview and then go back to the patient’s chart afterwards to review orders and get more details about your patients. Most of your questions will be answered there. Take good notes and develop your own shorthand to keep things moving along more quickly”
- Use the “Quick Access” buttons. These buttons are located above each patient name and will take you to specific parts of the patient record to save time. “When you’re in a hurry, you can forget about these time-saving techniques that add up throughout the day,” says Villarreal
- Take advantage of refresher courses. Nebraska Medicine occasionally offers refresher One Chart courses. “If you are struggling, or just want to learn to use the system more efficiently, take advantage of these classes or find someone to help you,” recommends Villarreal. “We spend a lot of time charting, so it’s important to learn how to use it well”
As you get more comfortable and efficient in your job, you will be able to develop more techniques to save time and reduce stress, says Villarreal. While the beginning may feel like a whirlwind, things will eventually start clicking and that will allow you to devote more time to your patients and connecting with them, and that will make your job more rewarding.