Empowering Efficiency: Encouraging Insights for Nursing Excellence at the Bedside

As a nurse with 13 years of bedside experience, I’ve precepted and mentored many bedside nurses. With each nurse's remarkable journey past uncertainty and self-doubt, I am overwhelmed by an undeniable surge of accomplishment. Oftentimes, witnessing these nurses' progress within our profession affirms the significant contributions of those who mentor and support them through their challenges.

Unfortunately, I’ve also carried the burden of sorrow as I’ve watched very capable nurses leave the bedside. Many of these nurses were natural empathizers and poised to learn how to become better nurses.

As time passed, these nurses discovered that they should have improved their bedside routines and efficiency much earlier. Unfortunately, the realization came too late, and the overwhelming demands of their daily workload led them to leave medical-surgical nursing for other specialties or new organizations where they could start over again.

Amidst the echoes of their footsteps, I write with a newfound sense of optimism.

I'm excited for this opportunity to focus on what I love most as a medical-surgical nurse — empowering bedside nurses with practical strategies to address their daily challenges. While words of encouragement are important, offering actionable solutions is even more powerful.

Optimizing Efficiency Through Strategic Focus

Improving time management skills is a priority for many medical-surgical nurses striving to efficiently deliver high-quality care. A well-defined strategy for efficiency empowers nurses to prioritize tasks effectively.

One effective strategy is the 80/20 principle, also known as the Pareto Principle. Originating from Italian economist Vilfredo Pareto, this principle suggests that roughly 80% of outcomes (or outputs) result from 20% of all causes (or inputs) for any given event (Pareto, 1896). By leveraging this principle, nurses can optimize their productivity using goal setting and increase their effectiveness during their shifts (Locke & Latham, 2002).

For example, after reviewing their daily workflow, a nurse with a 5:1 patient assignment has decided that the three tasks below impact 80% of their daily workflow and bedside efficiency.

1. Morning assessment and medication administration
2. Real-time documentation of bedside interventions
3. Optimizing nursing care through 5P rounding (Pain, Potty, Positioning, Personal Items, and Pumps)

Let's explore each category in more detail through examples of Specific, Measurable, Achievable, Relevant, and Time-bound (SMART) goals.    

Morning Assessment and Medication Administration    

• SMART Goal: Conduct thorough morning assessments within the first one to two of the shift for all patients, including vital signs, pain assessment, and patient history review.
• SMART Goal: Administer scheduled morning medications no later than 30 minutes after their scheduled times. Consider clustering non-time-critical scheduled medications per your hospital’s policy.

Real-Time Documentation of Interventions    

• SMART Goal: Document all patient interventions in the electronic health record immediately after completion, ensuring accurate and up-to-date documentation.
• SMART Goal: Utilize structured documentation templates and checklists to streamline documentation processes, reducing time spent on charting while maintaining accuracy and completeness. Utilize focus charting frameworks like F-DAR and daily checklists to streamline documentation. This reduces unnecessary time spent on charting while maintaining accuracy and completeness (Blair & Smith, 2012).

Rounding to Address the 5Ps of Nursing Care    

• SMART Goal: Conduct hourly rounding on assigned patients to address pain management needs promptly, assess toileting needs, reposition patients for comfort and pressure ulcer prevention, assist with personal care tasks, and update the plan of care as needed.
• SMART Goal: Track the number of unnecessary walks to retrieve missed items often gathered before nurse or patient care rounding. Record how often required supplies or medications are forgotten before starting a task in a patient’s room.

By focusing on these three categories, nurses can prioritize their time effectively and maximize their impact on patient care. Obviously, these categories are hypothetical targets, but similar SMART goals can be used as guides to improve workflow for any nurse who wants to take ownership of their bedside experience.

The Power of Great Questions for Enhanced Bedside Care

Asking the right questions can be another effective bedside tool, challenging a nurse’s assumptions, fostering innovation, and driving greater efficiency. For example, when a nurse wraps up their 5P rounds by asking, "What can I bring you during my next round to improve your stay?" they open the door to gaining deeper insights into their patients' needs (Ward et al., 2013). This simple yet effective approach not only allows nurses to address patient concerns more proactively but also helps them anticipate potential challenges, streamlining their workflow and enhancing overall efficiency.

 "What can I bring you during my next round to improve your stay?" will likely gain clearer insights into their patients’ needs, allowing them to anticipate challenges, streamline workflows, and deliver high-quality care in a more organized and effective manner.

Great questions have the potential to create great feedback, another component of improved bedside workflow efficiency.

Conclusion

As medical-surgical nurses, we are uniquely positioned to create a ripple effect of positive change within healthcare. Our daily commitment to uplifting and empowering our peers not only strengthens our team but also enhances the quality of care our patients receive throughout our specialty.

By introducing our colleagues to the usefulness of SMART goals and the practice of engaging patients with thoughtful questions, we provide them with valuable strategies and perspectives that can positively influence their daily bedside workload and professional outlook.

During our nursing school days, many of us envisioned becoming the perfect nurse for our patients. By prioritizing practical solutions for the collective workflow challenges faced by our bedside colleagues, we can transform patient care and offer every medical-surgical nurse the opportunity to excel, thrive, and realize the professional aspirations they once dreamed of.

References

Blair, W., & Smith, B. (2012). Nursing documentation: Frameworks and barriers. Contemporary Nurse, 41, 160 - 168. https://doi.org/10.5172/conu.2012.41.2.160

Locke, E. A., & Latham, G. P. (2002). Building a Practically Useful Theory of Goal Setting and Task Motivation: A 35-Year Odyssey. American Psychologist, 57(9), 705–717. https://doi.org/10.1037/0003-066X.57.9.705

Pareto, V. (1896). Cours d'economie politique. Lausanne: Rouge.

Ward, H., Kibble, S., Mehta, G., Franklin, M., Kovoor, J., Jones, A., Panesar, S., & Carson-Stevens, A. (2013). How asking patients a simple question enhances care at the bedside: Medical students as agents of quality improvement. The Permanente Journal, 17 4, 27-31. https://doi.org/10.7812/TPP/13-028