After 2.5 years in the ICU I still find time management a problem. Not sure why I struggle so much. I have gotten a little better but I feel adhd my be to blame. Can anyone share their night shift routine with me to give more insight?

ICU RN over 8 yrs.. BEST ADVICE: Stay ahead! Start assessments right after shift change, turn, note skin, note your drips (including tube feeds), and untangle lines and reorder before low, get that first assessment charted asap after patients are settled. Then address new orders, check labs and redraws, note any meds coming up or missed by day shift so you can address with pharmacy before they are due.. You can give meds up to an hour early and an hour late, so group together, ex: 7-9 cause you know day shift didn’t give that 7:00 because they were waiting on pharmacy.. (yea, ok day shift) Try to do your baths early with wound care, and STOCK your rooms with supplies you are going to need at the beginning of the shift and note things you forget in groups. Ex: When I get ice for the family member I’m going to check to see if any drips are in and hang them in the room unspiked (unless narcs of course), to replace when beeping pump is addressed. Anything to cut down on your running. Next, chart that first assessment right after meds and START your midnight assessment at 11:00pm. Start with getting I’s & O’s then drips then turn and reposition then meds.. Your busiest time will be 7:00-1:00. Unless you have a crashing patient that takes up all your time. Delegate. Ask for help from co-workers, and be sure to offer to medicate or turn one of their patients when they are super busy..

I use a page of printer paper and break down my shift into 2 hour sections.. Fold the paper in half and then half again. Then just write down what things have to get done during those time frames for each of your two patients, include medications, baths, dressing changes and anything else specific to the patient that is required. make sure those things are done by or before the time that you have them written down as.

Try arriving on your unit 20 minutes early. Get on the computer and familiarize yourself with your patients, their meds, test and lab results. Write down all pertinent drips, meds, and test you will be responsible for during your shift. Read over your doctor's orders 2 times so not to miss anything . You're better prepared to receive your bedside report from the off going nurse and ask questions too. I took have worked night shift in the ICU for more 25 years. Try giving 1 bath before midnight and the 2nd before 4AM.Too much happening between 4-7AM.Stay on top of your charting every 2 hours. Don't be too proud ask for help from your fellow nurses and Charge RN. Take care

First off, don’t beat yourself up. It will be at the 5 year mark, when you look back and start to feel very confident. Right now you are asking the right question and wanting to push yourself to be better. I would work with you any day, why? Because you want to give the best care possible. Trying this approach, when you get your patient assignment and you done your reviews and mapped out your night, think to yourself what is a good night going to look like for my patient? ( titrating off a gtt. Getting some rest, weaning off vent in AM etc…..) Then look at what the bad road would look like, and what subtle changes would you want to be looking for. Think to yourself what tools do I have within my scope to use and when would phone a friend……. You got this we have been where you are, and your in a great place…. All the Best

Are you sufficiently staffed? Understaffing never catch up. Did ICU for 35 yrs than ED for 16 if there isn't enough help and there never was never got done chronic OT for entire staff staying after report to finish charting. Pray for you guys I couldn't take it anymore

Managing time effectively can be challenging, especially when working in demanding environments like the ICU. While I can provide you with a sample night shift routine, it's important to keep in mind that everyone's preferences and needs may differ. It's also worth considering seeking professional advice if you suspect you may have ADHD, as they can provide a more personalized approach to managing your symptoms. Here's a suggested routine that you can use as a starting point:

1. Before Your Shift:
- Ensure you get sufficient rest before starting your night shift. Aim for 7-9 hours of uninterrupted sleep during the day.
- Establish a relaxing pre-shift routine that helps you wind down and prepare for work. This may include activities like reading, taking a warm bath, or practicing relaxation techniques.

2. During Your Shift:
- Start your shift with a brief review of the patient assignments, priorities, and any pending tasks.
- Organize your workspace and gather essential supplies before the workload increases.
- Break down your tasks into smaller, manageable chunks. Prioritize tasks based on urgency and importance.
- Use tools like checklists, timers, or digital task management apps to help you stay organized and focused.
- Minimize distractions by creating a quiet and well-lit work environment. Communicate with your colleagues about the importance of minimizing interruptions when possible.
- Take short, regular breaks to rest and recharge. Use these breaks for stretching, hydrating, or having a light snack.
- Communicate with your team members effectively. Clear and concise communication can help prevent misunderstandings and delays.

3. Managing Personal Well-being:
- Maintain a healthy diet and stay hydrated throughout your shift. Avoid heavy meals that may make you feel sluggish.
- Incorporate light physical activity, such as stretching or taking short walks, to combat sedentary behavior during breaks.
- Stay mentally alert by engaging in brief cognitive exercises or puzzles during downtime, if permitted.
- Stay connected with your support system outside of work. Regularly communicate with your loved ones, friends, or support groups to share experiences and seek emotional support.

4. After Your Shift:
- Establish a consistent post-shift routine that helps you wind down and transition back to your personal life. This may involve activities like practicing relaxation techniques, listening to calming music, or engaging in a hobby.
- Allocate time for self-care, such as getting regular exercise, maintaining hobbies, or engaging in activities that bring you joy.
- Prioritize sleep and establish a consistent sleep schedule, even on your days off.

Remember, finding the right routine takes time and experimentation. Adjustments may be necessary as you discover what works best for you. Consider seeking advice from healthcare professionals or colleagues who have experience in managing night shifts effectively.

Spend a couple shifts noticing where you spend your time. I bundle my tasks meds/treatments/ settling pt in for night at beginning . If vented and sedated get the bath done between 2-3. Also a lot happens between 5-6am start 1/2 earlier on tasks use your 30 minute window earlier than when due. Take a deep breath. Ask someone you trust for feedback on your care delivery style

It could be wise to check into some help with your ADHD.

Make yourself a shift sheet for each patient. 7 am to 7 pm or 7 pm to 7 am. Put your meds, IVs, treatments in the time slots they go in, dressing changes, tubing changes, lab draw times, diet, what lines they have, drips, etc.... Have a space for the names of doctors to call if the need arises, have a space for vent settings. Most of the EMR will let you print it out. If you have a lockable mobile workstation, get a baggie and withdraw all of the meds you can at one time and label with with tape...that might also help. Baths are given as early as possible, do not wait till 5 am...make a bedroll or two so if your patient soils the clean roll, wipe down and roll out the new one. Start to close your charts at the earliest in the AM...get your urine, NG output, drain output all charted, clear your pumps ASAP.

Start with a good report sheet that you can check at a glance. After report check on everyone and do vital signs. Bring along your ice water and check for pain. That will keep them off your back while you organize for the night. Then prioritize. Sometimes this means seeing the walkie talkie patient first because it will leave you lots more time for the total care person. Or vice versa. Its up to you

My recommendation is to ensure that you have everything with you that you need, i.e. flushes, a thermometer, fresh water. Most hospitals that I have worked with as well as EBP state that 2 hours is an allowable time to pass meds, so do you your meds in 2 hour increments. It’s a hard thing to get down!! Especially with pressors and what not.

Besidees6all the organisational advice talk to your PCP Zabout treatment for adhd.

Talk with

I work night shift for years o feel that maybe organize your day more get report look at labs and medications assess critically I’ll patient first bring meds in for 8,9 and Iv bags and drip of near empty this should have been access during shift report them access other patient bring in medications do hourly rounds accessing patient needs before going in like medications labs water etc between 12 and four do baths and charts this good way to asses skin mobility and other issues then between 4-6 labs critical values meds clean up last of charting

I SUPPORT R.N. JACQUELINE MARTIN GARRETT FOR HER INTELLECTUAL ADVICED, IF ALL NURSES WILL BE LIKE HER WE DONT NEED MD'S

HEY BUDDY JUST RELAX,AND YOU DONT NEED TO MASTER PATHOPHYSIOLOGY,ALL YOU NEED TO DO JUST REMEMBER ALL THE NORMAL VALUES FOR CBC, TRANS AMINASES, LIPIDS, ETC..ECT.. AND JUST PHARMACOLOGY ,JUST FOCUS ON THE MECHANISM OF ACTION, REACTION WITH OTHER DRUGS,ELIMINATION LIVER OR RENAL, FORGET THAT TIME MANAGEMENT ,IT WILL ONLY STRESSED YOU, JUST MAKE IT A DAILY RELAXATION BY READING THEM AGAIN AND AGAIN,DONT MEMORIZED ,JUST REMEMBER!,PATHOLOGIC BASIS OF DISEASES 4GET THAT ,EVEN SOME MEDICAL RESIDENTS UP TO NOW CANT DIAGNOSED A SIMPLE CASE, ASK THEM A CARDIAC DIAGNOSES THEY WILL JUST SCRATCH THEIR HEAD, BUT THEY ARE GOOD IN CODINGS LIKE PAIN HEADACHE ,YEAH WE CALL IT A GARBAGED DIAGNOSIS, AND AS AN ICU NURSE TRY TO REFRESH ON ECG ,HOW TO RECOGNIZED ARRYTHMIA, BLOCKS, WITH CLINICAL CORELATION,AND YOU ,I GUARANTEED WILL BE MUCH SMARTER THAN YOUR BELOVED M.D.

I find it very difficult to answer questions on this website which doesn't allow me to see what I have typed. What diesadhd stand for? The best thing to do during the night shift is to get all of the required tasks done in the Complete as much of the Night Shift tasks as close to the beginning of the shift as possible. There are usually 2 hr. during which there is not a lot to do. Get your paperwork done. At about 4:00- 4:30 AM start to do the things which need to be completed by the end of the shift. I found it helpful to work 10 nights in a row and then have several days off in a row. It would take me 3 nights to get accustomed to sleeping during the day.

ask if you could job shadow for a couple of nights, that should be sufficient and make sure that it is a good fit for you as well as them...jmb

I write down a check list when I do research on my patients before my shift starts. Then I try to focus on the list to get my work done. It’s worked okay for me on my rough adhd days.

I created a “cheat” sheet that basically covered everything I needed to know and had space for notes. I filled it out prior to every shift. This kept organized and on track so when something unexpected came up I could deal with it and get right back on track without logging on to a computer every time.

I find it helpful to get report on my patients, prioritize them on paper from that report , Then immediately round on each of them and THEN prioritize each need from the face to face rounding. Lean into your support staff. Utilizing them to their fullest scope will not only assist in getting cares and tasks, you are helping to grow and mentor them as well. Keep after it- you got this!

ADHD is probably the problem! I know because I suffer from the same, both ADHD, and time management! I am constantly distracted. I don’t work night shift. However, my advice would be either a look into medication that may help with your focus or slow your roll. Take one task at a time. Make sure you finish it before you start the next, unless the nextttask is more urgent.

Write it down. Write down everything you need to do for the pt. Review your labs for the day see if anything else needs to be done. And when you get each one done check it off.

I worked ER and went from nights to mids (the hardest & busiest shift ) because at around 2-3 my special senses were not happy. If you have to stay on nights, assuming it's a 1:2 ratio - write out a plan and stick with it (report/meds/labs/document as you go/bed baths @4 or 5/catch up on documentation/meds/labs/be ready to give report). Hope this helps and good luck!

Important.. Take your lunch break. Often, we think we are doing a better job by plowing through the shift without a break.
Make rounds with off going nurse. Then there are no surprises! Questions formulate at the bedside that may not sitting at the desk receiving report.
Learn to utilize the computer effectively. most systems allow you to enter an assessment/progress note from the medication screen. Write your assessment/progress note immediately. you waste time when you go back to do the assessment.
If I see a resident appears to have changes I assess when I see it. I document it immediately. it really saves time.
People become frightened at night. Talk to patients to see if they give you a clue about what makes them fearful and what tools they may already have to deal with it.
Patients that are needy frequently have the call light on interrupting your flow. Each time you answer the light ask before leaving the bedside if there is anything else they may need. Give a reassuring word or two to let them know you are invested in their care. document your findings in the care plan and include it in report. Share with the team.
Make tasks a priority. Often others will ask you for help. Working together is important but not at your expense. Determine which resident require closer observation.
look at the medications due. i make a list of what is due when so in my head I know I wrote that I have meds/treatments at specific times allowing me to plan my time.
I do as many nightly tasks as possible at the beginning of the shift. i was trained to do as much as possible so when situations happen my whole plan is not disrupted.
I worked nights in RICU when I first graduated.

I don’t work ICU, however, i do work 12 hour nights in a very busy Rehab hospital. After taking report, go look at each patient, get VS, a quick assessment.

Look at labs, blood sugars etc. pull meds.

First let me say, i stay organized via my report sheet… I’m a scribbler with facts, observations and pt c/o, needs etc to keep me on track.

Go back to see each patient, administer meds and continue your assessment, wound care etc

Afterwards, being your charting, performing rounds, treatments, rechecking vitals, draw labs etc.

Good luck

Rest before work and stay hydrated. There are so many avenues and opportunities in Nursing. You must find the right fit for you. There is no shame in transferring and changing departments/ units.

It's been a while since I worked night shift ICU, but I have alternately worked all three ICU shifts and if you don't mind a night schedule, it is in some ways the easiest shift as far as time management. What you do for direct patient care isn't much different than other shifts, but you usually don't have to juggle your patient care time between new MD orders, multiple diagnostic imaging transports, accommodating respiratory treatments, new admits, and helping visitors understand what is happening to and for their loved one. Night nurses usually give baths and bed changes since shifts are usually more hectic for day nurses. In some aspects you have more responsibilities for patients on night shift since there is less oversight by other specialists coming and going. Hope this helps, and just to reassure you, time management is a challenge and key for virtually every nurse. Best wishes. Sue Salisbury, RN, BSN

If you have good rapport with your colleagues and leadership, I might ask one or two of them- "I want to be better organized, more efficient, feel more buttoned up at work. I'm looking for an objective, outside viewpoint- knowing me, my practice, what advice might you give me to help me improve and build on my practice?"

Of course, you have to take anything said with a grain of salt, but it could be helpful. Sometimes I've found I'm my own worst critic, and need someone to tell me, "You're good!" Or maybe everyone feels the way you do?

About ADHD-
I have a few bonafide diagnosed ADHD Nurse friends.
It's good that you're aware of the potential for this to interfere with your performance. There are a lot of tools and resources, and maybe even a online group for ADHD ICU Nurses- worth looking into.

Remember, too, ADHD can be a strength, an asset as well- high energy, often high intelligence. And ICU is hopefully challenging enough to keep your brain stimulated.

Failing all that, if you really have a documented or noticable problem at work, maybe talk to your provider about your ADHD med regimen?

Some nurses benefit from creating a checklist of things to complete. Obviously saving lives takes priority. In PEDS ICU, I try to accomplish my tasks earliest in the shift. Giving baths and other personal care items like brushing teeth, gtube and skin care. I like to clean and organize my rooms. I tend to spend 1-2 hours up front with each of my patients to be thorough, go over plan of care, and complete all these tasks, if time and acuity allow.