Importance of time management and documentation in the role of RN and nursing students
Importance of Time Management and Documentation in the Role of RN and Nursing Student
Time management is a way of developing and using tools and processes for maximum effectiveness, efficiency, and productivity (Said, 2010). It entails mastery of skills like goal setting and planning. It is also defined as effective use of time in the achievement of desired results. It not only involves better time management but also the making of better decisions on what one does and how he or she does it. The outcome of time management is better performance. Time management helps one to complete work faster and to expedite less effort. It also enables one to seize opportunities (Hackworth, 2008). Documentation, on the other hand, refers to any written or electronically produced information about a client or patient that describes the service or care rendered to the client or patient. Health records include paper documents and electronic documents. It is through documentation that nurses and nursing students communicate their observations, judgments, interventions and outcomes of these interventions for clients (College of Registered Nurses of British Columbia, 2007). Documentation should be an accurate account of what transpired and when it occurred. When documenting, nurse can record information about individual clients or a group(s) of clients (Campos, 2010).
Nurses work in fast-paced environments. Nursing work is naturally associated with some stressors and challenges. Time is one of the resources that nurses manage. Planning and prioritization helps nurses to provide better care to their patients. Effective time management skills help nurses to work smarter and survive the day-to-day busy shifts. Time management is also essential as it influences how nurse managers schedule staffs and allocate tasks. It also enables them to balance their personal and professional lives more efficiently and effectively. For instance, nurses often cite lack of time as a reason for not pursuing continued professional education (Said, 2014).
Time management is a vital component of professional nursing practice and work performance. Nurses are usually responsible for a range of tasks. In addition, they often have to make decisions about patient care and well-being quickly. Working fast leaves less time for thinking, planning and evaluation. Additionally, it can result in careless errors that risk patient safety. Working for long hours, on the other hand, leads to stress and fatigue. Time management skills are thus essential as they help nurses to work smarter and attend to more patient needs in less time. Working smarter also helps to create time that nurses can spend with their patients and to intervene promptly as per patient needs. Prioritization of tasks in nursing also helps to reduce stress and to manage nursing work more effectively and efficiently (Hackworth, 2008).
Time management is also essential for evidence-based practice and successful adoption of quality improvement initiatives. A frequently cited reason for the failure of nurses to adopt evidence-based practices is lack of time. Nurses often cite lack of time to research and evaluate evidence-based practices as one of the challenges in their adopting evidence-based practices. Time also influences the success of quality improvement initiatives as nurses are usually the targets of numerous quality improvement initiatives in healthcare settings. Time in quality improvement initiatives is required for training of staffs on the proposed change and their facilitation in implementation of the changes. For instance, in the implementation of electronic health record systems, time is required to educate nurses about the systems. In addition, during the transition period from paper to electronic-based recording systems, nurses often have to document patient information in both systems which is more time-consuming.
For nursing students, time management is important as it helps them to balance between their school and personal lives. In addition, time management also helps nursing students to prioritize patient care and deliver care to the right patient at the right time. It also prepares them for practice and is one of the competencies necessary for licensing. Time management skills in particular help them in their transition from student to professional life (Ong, 2013).
Documentation is important for registered nurses and nursing students because it helps to promote the continuity and safety of patient care, facilitates communication, meet the nurses legal and ethical obligations, acts as a point of future reference, and can be used for quality improvement purposes (Campos, 2010; College of Registered Nurses of British Columbia, 2007). Nurses rely on the information provided to them or recorded in a patient’s file and document when taking over a patient’s care. Nursing colleagues should thus be able to review the notes written by other nurses and continue providing care to patients in a seamless continuum. To perform effectively, therefore, nursing students and registered nurses must be capable of communicating their contributions to the care of a patient to other nurses as well as other members of the multidisciplinary care team (College of Registered Nurses of British Columbia, 2007).
On the issue of facilitating communication, it is through documentation that nurses relay information to other nurses and healthcare providers about their assessments of clients’ status, nursing interventions implemented, and the outcomes of such interventions. Documentation of such information improves the chances of a client receiving consistent and informed care. In addition, thorough and accurate documentation minimizes the likelihood of miscommunication and errors. Patients and family members should participate in documentation whenever possible. This helps to communicate information provided by the patient and relatives to members of the healthcare team (College of Registered Nurses of British Columbia, 2007).
Regarding the issue of fulfilling legal and ethical standards, documentation is an invaluable way of demonstrating that, within the context of the therapeutic relationship, the nurse applied nursing knowledge, skills, and judgment consistent with professional standards (Blair & Smith, 2012). The process of nursing documentation is regulated by state and national laws as well as by nursing practice acts. Records prepared by nurses are used as evidence in legal proceedings for instance in lawsuits and disciplinary hearings conducted by professional regulatory bodies. The healthcare environment has become increasingly complex due to increased public awareness of individual rights. In a court of law, a patient’s health record acts as the legal record of the nature and type of care or service provided to the patient in question. Courts of law adopt the attitude that something not documented was not done. The manner in which documentation is done also creates impressions about the professionalism of the author. There is in particular a tendency to generalize that unprofessionally maintained records reflect unprofessionalism towards patient care (Campos, 2010). The importance of documentation for nurses is enhanced by the fact that nurses, on account of having to attend to hundreds of patients, are unlikely to precisely remember the events that transpired in response to a patient’s allegations. Patients, on the other hand, are likely to recall in an in-depth manner what happened to them. Therefore, good quality records are likely to be influential in these circumstances as they enable nurses to give evidence that relates precisely to what transpired (Wood, 2003).
Regarding the issue of improving the quality of nursing care, documentation enables nurses to assess the progress of clients and determine interventions that are effective and those that are ineffective. Documentation also helps to identify and document alterations to a client’s plan of care as necessary. Documentation is additionally a valuable source of data for decision-making on issues of funding and resource management. Documentation also facilitates nursing research. Improved resource management, funding, and nursing research can enhance the quality of client care and nursing practice. Individual nurses can also use data on outcomes or information derived from critical events to reflect on their practice and institute needed changes based on the evidence (College of Registered Nurses of British Columbia, 2007).
Documentation for nursing students is also important for the purposes of facilitating communication, ensuring continuity and consistency in patient care, and meeting legal and ethical obligations. In addition, documentation by nursing students helps them to reflect on their practice and documents the students’ acquisition and application of nursing knowledge, skills, and attitudes. Documentation prepared by nursing students can be used to assess the students’ competence and progress.
In summary, this paper has examined the importance of time management and documentation in the role of the registered nurse and nursing student. Time management is essential as it helps nurses and nursing students to attend to the care needs of their patients, balance their personal and professional lives, and avoid stress in a fast-paced environment. Documentation is essential in both roles as it helps to document the care provided to a client and facilitate continuity and consistency of patient care. It also helps nurses and nursing students meet their legal and ethical obligations. Most importantly, it documents the critical thinking and rationale behind clinical decisions and interventions whilst providing written evidence of the progress of a client.
References
Blair, W. & Smith, B. (2012). Nursing documentation: Frameworks and barriers. Contemporary Nurse, 41(2), 160-168.
Campos, N. K. (2010). The legalities of nursing documentation. Men In Nursing, 40(1), 7-9.
Hackworth, T. (2008). Professional development: Time management for the nurse leader. Critical Care, 3(2), 10-11.
Ong, G. L. (2013). Using final placements to prepare student nurses. Nursing Times, 109(3), 12- 14.
Said, B. N. (2014). Time management in nursing work. International Journal of Caring Sciences, 7(3), 746.
Wood, C. (2003). The importance of good record-keeping for nurses. Nursing Times, 99(2), 26.
