Under the Nursing and Midwifery Council Guidance on professional conduct confidentiality and anonymity will be maintained at all times to protect the identity of service users, careers, families, healthcare settings and professionals involved (NMC 2009).
The NMC Standard of proficiency for pre-registration nursing education (2004) requires student nurses to complete set proficiency, this is to ensure they have the appropriate knowledge and skill required to become a qualified registered nurse. Through learning these specific skills and acquiring the appropriate knowledge, student nurses will be able to perform the role suitable to the position of a qualified staff nurse. One standard of proficiency for entry to the register is care management. Under the domain of care management one must: “Demonstrate knowledge of effective inter-professional working practices which respect and utilize the contributions of members of the health and social care team, Delegate duties to others, as appropriate, ensuring that they are supervised and monitored and Demonstrate key skills (such as literacy, numeracy and computer skills needed to record, enter, store, retrieve and organize data essential for care delivery “(NMC 2004).
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The term management “is a process of coordination and integration of resources through planning, organizing, coordinating, directing and controlling to accomplish specific institutional goals and objectives” (Huber 2006). In relation to care management the care of patients/clients goes through this process of being planned, organized, coordinated, directed and controlled (with input from the clients themselves) by the individual in charge of their care.
My experience of care management was both exciting and terrifying. When I was in charge of a bay, I was involved in assessing, delegating and prioritizing patients’ needs, ensuring tasks such as patient washes, bed change and the drug round (using the seven rights) was completed safely and in an appropriate time. I also had to ensure tasks were being completed and that the workload was disturbed evenly with appropriate help. I was also involved in a working with and exchanging information in a multidisciplinary team, such as doctors, surgeons, physiotherapist and social workers.
In order to succeed in care management, there are many skills one must acquire and build on. One of these skills is known as time management. Time management is making optimal use of time available. There are three basic steps to time management, first is setting aside time for planning and establishing priorities. Second is completing the highest priority task first, when possible and finishing one task before starting another. Third is reprioritizing tasks when there is new information (Marquis and Huston 2009).
Student nurses will go through a period of transition when they have qualified. By developing skills such as time management one can prepare themselves for the following role transition. The concept of role transition is used to refer to “a process of changing from one state to another, a set of expectations that de¬ne the behavior deems appropriate for the position and involves changing the way one thinks, abilities and acts” (Lee, Lin and Hu 2011). Considering the role of a student as a learner compared to the role of a qualified nurse of leading in care management and care delivery situations, maintaining standards of care, making ethical and legal decisions, being accountable, working in teams and teaching others (Burton and Ormrod 2011).
When I was allocated my own bay, in terms of completing set task on time, the paper work and helping patients with their needs, time seemed to be my enemy. While being in charge I find it difficult to manage and it seemed as if tasks would increase as I was often interrupted by patients who needed assistant. However, having experience this, I realized the ability to manage my time effectively is very important. By using certain aspect of time management such as planning and prioritizing, caring out clients care occurs more efficiently. In terms of becoming a qualified staff nurse and having experience being in charge, being able to manage my time effectively will significantly help in terms of my role transition and ensuring that effective patient care will be carried out.
Although my time management skill is not on par with those of an experience qualified nurse, I can improve. Reflection is a way of making sense of events, situations and actions that occurs. It enables an in-depth look at oneself, the patients and the care being provided. By using Gibbs’ (1998) model of reflection of description of event, identifying your feelings, evaluation the experience, analyze the experience, draw a conclusion with alternative actions and make and action plan for the further (Oelofsen 2012). On reflecting on how I have manage my time so far, I will be able to identify areas I need to further develop with an action plan/goals to work towards..
During an episode of my care management, the ward was under staff. As my mentor was a sister she was in charge and often out of my bay and I was alone. During that time managing my patients was difficult as a lot of tasks needed to be complete, such as bed baths, bed change, patient feeding, observations, patient assistant in transferring, daily wound dressing and paper work such as fluid and food charts. Instead of prioritizing, it was more of multitasking with no objective. This made managing my patients more difficult as what needed to done was not being done. It was made more difficult due to interruptions from patients, such as wanting a commode or bed pan.
I was feeling overwhelmed, panic and stressed. I wasn’t thinking about prioritizing or planning. I was just doing the tasks as I know them, when I get them and moving on as I finish. I kept on thinking of that there was so much to do; all I was focus on was the amount of tasks needed to be done. What was bad about this experience was the feelings of being overwhelm. What was good about this experience was even through I was going about thing in a round-about way. I was able to complete the majority of task that was needed to complete including those which were important.
Looking at this situation my lack of planning and prioritizing my task let me down. Although multitasking is important in time management, however it is essential to recognize top priorities to ensure high quality nursing care for the patient under your care (Lipe & Beasley 2004). To prioritize is to “designate or treat (something) as being very or most important and to determine the order for dealing with (a series of items or tasks) according to their relative importance” (Oxford Dictionaries 2012).
There are strategies that allows for effective prioritizing. Sellman and Snelling (2010) suggest first categorizing tasks into two dimensions: their urgency and importance. If the task is urgent and important, do it. On the other hand if it is urgent but not important, delegate it. For those tasks that are not urgent but important, plan it. Lastly, if the task is both not urgent and not important, leave it. By using as strategies as this daily, one can improve on their time management.
What I should have done was stop for few minutes, think, plan, prioritize and then do. What I have learnt, is not to look at the amount of task needed to be done. However, look at the important task first, complete them and this will allow for more time, with less urgency to complete the other tasks. If this situation was to arise again, I will not make the amount of tasks needed to be complete panic me or overwhelm me. I will make a list and prioritize each care/task.
Another example of my inefficient time management was during a drug round one morning. It was time to prepare a drug trolley and I was unsure of what medication my patients were on. I told my mentor and was about to go check their drug charts. My mentor advised me to just get different type of analgesia, laxatives and that the rest will be in their drug pod. However, during the drug round, I kept on going back and forth to the drug cupboard. The time used was more than what was allocated.
I kept on think this was taking too long, that it was getting very late to still be doing a drug round. I felt somewhat useless, each time I went back I felt slightly depressed. The longer it took the more a felt agitated and stressed. What was bad about this experience was what I was feeling. I also didn’t stop to think of a solution. However, what was good was although I was agitated and stressed, I didn’t make any mistakes and followed the five rights in drug administration.
Looking at this situation/experience, if I had taken some time and had planned ahead it would have turned out differently. Planning is defined as “the process of deciding in detail how to do something before actually starting to do it” (Collins Dictionary 2012). Strategies for effective planning! Fore casting
Firstly, during bed side handover, as I didn’t know the patients I should have checked the drug chart then. I could also have negotiated with my mentor and asked to check the patients’ drug chart as I don’t know them well enough. After the first or second trip back to the drug cupboard I could have just inform her I was just going to check the other drug charts to prevent me from return trips. I have learnt that also advice can be good, I must trust myself and do what I feel will make me more comfortable. If this was too happened again, would first make myself relax, stop and check the drug charts to prevent return trips.
As indicated below, I have developed a personal development plan in the form of a table, to enable me to develop in the areas of planning and prioritizing, to ultimately improve my skills in time management:
Objective / Developing needs
What is hindering my progress?
Action plan to achieve objective
Review of progress / How and when
To manage my time effectively by prioritizing task appropriately
– Taking on too much task
– Not delegating enough
– Under staff
– Multitasking without prioritizing
– Interruption with new tasks
– Compile a to do list
– Think what is urgent and important task
– Think what can be delegated and what can wait
– Weekly discussion with mentor
– Reflective diary for each day using Gibbs’ model
– Reflect on how much I have check off on my list each day
– review to do list I and see how much I was able to complete each day
– ask for feedback from mentor and other staff member
To manage my time effectively by planning ahead
– Advice is good, however trust your self
– Not firm in saying your reasons
– Working with not enough information
– During hand over, write tasks next to patient name while circling those which are high priority.
– During bed side handover check patient drug chart and other care chart to get awareness.
– Check off what was completed to not confused my self
– Roughly, estimate time for each task
– While planning set aside time to concentrated on difficult task
In conclusion care management is an important aspect in the education of student nurses. The skills involved in care management such as time management is important in the transition following being qualified. Time management is an important skill to delivering efficient patient care in the amount of time you have. Having the experience and developing my time management skill, I feel more confident and more prepared for the upcoming transition I will face. During my episode of care management, having to manage my time effectively, it has also increase my awareness of what will be expected in becoming a qualified staff nurses and the consequence of not being able to complete my tasks will have on my team. It has also made me realize the necessity of constant reflection on my skills and knowledge. Through reflection I have recognize my weakness and have built action plans to which I will work to achieve.
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