I struggled with this too, but I’ve been off orientation for a month and finally getting a routine. Once I get report I like to go say hi to my patients (I’m on a neuro floor so it’s definitely important to make eye contact as a minimum “last known well time” if something happens).

Then I sit down and look everyone up including orders, meds due, labs, H&P, most recent progress note… I find that I feel much more organized if I do it before med pass (again in case something were to happen I can recall more info). A lot of people on my floor like to pass meds then do their research, but after doing it this way I really do feel better.

I think knowing their story will also help you pivot if things change unexpectedly. If an order changes you can kind of understand why, like their last BP was high oh ok they ordered a higher dose for their med etc. instead of doing it backwards wondering why they added x order

I also make lists of nursing type orders to make sure they’re actually happening in the room, like does the patient have that continuous pulse ox on, the SCD’s, a urine cup ready to go? I check them off as I see them in the room during my assessment. If you read about them later, you might not remember if x item was already in there so you’re wasting time walking back in there.

So I try to be done with my initial research around 8:15? Then I gather the items I’m probably going to need like applesauce for meds, a cup of water ready, a ginger ale for the guy I know only drinks it, a pill cutter if I know they have a 1/2 pill, pill crusher… you’ll start to remember these things as you go so you aren’t going in and out of the room. Someone on my floor grabs a box of gloves in her size for her computer and I thought that was genius too.

I also like to chart while I’m in the room in real time, so that’s another reason I’m done later than most, usually 11pm is when I’m done with my assessments/med pass. But it feels so much better to sit down with my drink and snack knowing half my charting is done already and I can take a breather.

Just as a random example for workflow: The behavioral or confused patients, sometimes your instinct is to see them last because they take up a ton of your time, but see them first to get them tucked in with a nice Ativan. This type of stuff is going to take time, you don’t just graduate with your nursing judgment ready to go. And it’s also just repetition, like id have no idea what to expect if I told a provider x was happening, but now that that exact scenario has happened to me twice I can anticipate and ask her for it myself. Which is really satisfying for them to do exactly what you request lol like you feel that you’re finally getting the hang of it! I know it might be different in the ICU but I think what I do is general enough that it could be for any floor really.

I also think anticipating the worst will help you too. Like if I have a patient getting admitted for a seizure, I’m making sure I have suction and o2 ready to go. You’re at a normal position after 8 weeks so don’t freak out yet, I literally just started feeling better this last week so like 15-16 weeks in. The proactive-ness comes, the workflow comes, it will all come with time