Arrive early. Give yourself a few minutes to put your things away, get some coffee, and relax for a moment. Rushing in to clock in just on time won't give you the best start to your day. Check out the tone of your workplace. Has it been chaotic? Or is it quiet and calm? This will give you a clue at least how your shift will begin.

Every day in a hospital is a new adventure. No two days will be alike and it's almost guaranteed that something will happen when you least expect it. Expect the unexpected and it won't be so troublesome.

The best way to prepare for the unexpected is never to procrastinate. Whatever you have put off doing will almost always end up embroiled in chaos and even more of a chore to complete.

First Things First

Report will be more meaningful if you can find out what your assignment is before report and have a few minutes to gather some information about the patients. Then you can ask pertinent questions. If this isn't possible, pay close attention and take notes during report.

Ask your supervisor to try to arrange for you to have as many of the same patients as possible for a few days so that you can get used to the lay of the land and learn more about how things work in this facility. It will also be helpful since you can see more of what is important to the nurse reporting off and what you might feel could be more relevant. Then you'll learn what kinds of questions you need to ask.

Once you're finished with report, begin to prioritize your day. Plan for the possibility of a new admission or unexpected discharge. Even if you might not be assigned these responsibilities right away, you'll budget time for them. Then if someone else needs help, you'll be able to volunteer a little time. Helping out in this way will help make you part of the team.

Make lists of what needs to be done. These should be quick notes and not elaborate.

• What is urgent?

• What treatments such as dressing changes need to be done and how many times during your shift?

• Who is going for tests?

• Who is having other care such as physical therapy?

• Who needs assistance with ADLs?

• When are your meds due? Do you have them all? Are any new to you?

• Who was having pain issues, nausea, or was in need of many PRNs? Check to see when they had their last dose and make note of it. Write it down.

Some nurses carry a small notebook in their pocket, others use a clipboard and others use a PDA. The PDA affords you many options for collecting and accessing data on your patients. Whatever your choice, always have something to write on. Don't rely on your memory.

Make Rounds

Even if an aide or tech is taking vital signs, look in on each patient. Introduce yourself as the person's nurse. Perhaps your facility has a white board in each room to write your name on. Ask how the patient feels and if he needs anything right now. Keep moving and don't linger. Write down any requests, so you can get them done right away.

When you are done, look at your lists. Who needs what now? Is that pain medication due, or do you need to remind yourself to get it in an hour? Let the patient know if there is any delay.

Get to your urgent issues first. Next, decide what you really don't want to do and get it over with. The longer you put off doing the things you dislike or are uncomfortable with, the more troublesome they can be to your day. These duties will weigh on you and, if you get behind, they will only make you feel that much more overwhelmed and out of control. Next, do any other treatments you need to complete and pass your meds. Make a quick check on everyone.

Then take inventory of what supplies you need to replenish in your pockets. It's always helpful and a time saver if you have a few supplies in your pockets. This can include items such as gloves (lots of them), adhesive bandages, alcohol swabs, a small roll of adhesive tape, and a tape measure or other wound measuring device. Depending on your unit, there may be other small items you could include in your pocket inventory. Some facilities have gloves in every room, which can be quite helpful.