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| Rapid Response | Time Management | Critical Thinking | SBAR


TIME MANAGEMENT
Guide to a 4 Hour Shift

Oh no! You were scheduled multiple 4 hours shifts. Or worse, you floated for 4 hours, and floated for another 4 hours, with report putting that down to 3 hours (minusing your break). How do you optimize workflow and get everything done and know what you are doing? Don't fret.

1) Look at the patients. Do a quick scan. Then rapid fire quick scan of their chart: Look for abnormal labs, Pending procedures, Diet, Code status, Vitals.

2) Quick assess: Mental status, IV Site, Airway, Drips running, Drains, pain, and skin assessment.

3) Cluster EVERYTHING. This is key. Cluster all your meds passes, fluids, glucose, assessment, Emptying drains, repositioning, vitals if needed. Do not return to pt's room unless necessary. On a 4 hour shift your goal is to be a task monkey and prioritiziation. This is not the time for customer service, getting warm blankets, and getting snacks, or getting stuck in patient rooms. Delegate more due to time limitations.

4) Deal with your disaster patient first before your shift spirals. Pain, behavioral, confused fall risk, etc.

5) Chart immediately after each room. Your brain is fastest when info is fresh.

6) Accept that some things won't get done. No time for long conversations with patients, deep chart review, whiteboards, blankets, non-urgent care tasks. Focus on meds, assessment, safety, acute changes, and documentation.

7) Utilize relief nurse. IV out? Don't even try. You don't have time. Get relief nurse to help with labs and IV's.

8) Walk into the room knowing already what to do: Assessment, flush IV, meds.

Guide to Being a Clinical I Relief Nurse

You've only been a nurse for 1 year and they've assigned you as relief nurse. You're afraid of not knowing what to do and the ambiguity of this role. You must now think big-picture. You're uncomfortable without structure, but this entry will serve as a guide to giving "structure" to your role as relief nurse.

First, what does being a relief nurse require? You need big-picture awareness of the whole unit, delegation clarity, and rapid prioritization across multiple assignments. How do you gain big-picture awareness of the unit? Think about: Who is unstable? Who’s about to admit? Are labs pending? Any teles going wild? Staffing issues? Who needs help? Who’s drowning but won’t say it?
During chart review, ask yourself: "Wait, who has the admit?", "What’s the plan for that lactate?", "Did anyone call about bed 12?", "What do I even prioritize right now?"

You are there to see what others can’t see (big picture), prevent small problems from becoming RRTs, support flow, protect the most overwhelmed nurse on the floor
DO NOT: Hover awkwardly, Insert yourself into every room, Be everyone’s extra pair of hands all at once, read minds.

Guide to an RRT as a Clinical I Relief Nurse

One of the bedside RN's just called an RRT on one of their patients. You're relief. You're expected to intervene and assist. What do you do? Let's bring structure to chaos. As a relief nurse, your role during a RRT is extremely valuable. The bedside nurse is focused on the patient; you become the unit stabilizer and logistics coordinator.

1) Immediately go to the room. Your first job is to quickly assess the scene. Ask the bedside nurse one question: “What’s going on?” You only need the 10-second summary: Example: “He desatted to 78%.” “BP suddenly 70/40.” “New stroke symptoms.” “He collapsed.” This tells you which direction the situation is going.

2) Take over the room logistics. The bedside nurse should stay with the patient. You help with everything else. Immediately check: Monitoring → Ensure telemetry attached, pulse ox waveform good, BP cycling every 2–3 min. Oxygen → Check if oxygen actually connected? Is flow turned up? Is mask fitted correctly? Access Do they have an IV? Is it working? If not → get supplies ready.

3) Clear the room. RRT rooms become chaotic. Your job is to control the environment.

4) Prepare for what the RRT will need. Equipment: Crash cart outside room, Suction Setup, Yankauer ready, Ambu bag, Extra oxygen mask, Non-rebreather. Supplies:IV start kit, Flushes, saline bag, pressure bag, lab tubes, EKG leads.

5) While the bedside nurse is tied up, their other patients still exist. You should: Cover their call lights, give their scheduled meds if needed, answer alarms, update the charge nurse if more help is needed. Think: “How do I protect the rest of the unit while this is happening?”

6) When RRT or MD arrives, the bedside nurse will give SBAR. You help by filling in missing information if needed. Example things you may know: Recent labs, Recent vitals, What meds were just given, Baseline mental status.

7)Assist with tasks: Starting an IV, drawing labs, hanging fluids, getting an EKG, getting supplies, running specimens. You become extra hands.

8) Watch for patient deterioration. Notice things like: Patient becoming lethargic, work of breathing worsening, telemetry changes, BP crashing. If something changes, say it out loud to keep the team aware.

9) Prepare for possible transfer. Many RRTs end with ICU transfer. You can start preparing: Patient chart ready, transport monitor, gather belongings, call report assistance if needed.

10) After RRT, recheck other patients.

Focus on environment, equipment, and workflow.

Crash Cart Checklist

The standards is that for the crash cart, the daily checklist should be completed, no clutter on top, locked (including extra locks secured), and no expired medications or supplies noted

Crash Cart Tips
Code Blue Tips
Daily Compliance Checklist