Essentials of Nursing Leadership and Management, 5th Edition

chapter 11 | Time Management 163

folders is often helpful. Each color holds docu-
ments that are related to one another. For example,
all continuing education credits might be placed in
a blue folder, anything pertaining to licensure in a
yellow folder, and so on.

Setting Limits

To set limits, it is necessary to identify your objec-
tives and then arrange the actions needed to meet
them in order of their priority (Haynes, 1991;
Navuluri, 2001). The focus of time management
exists on two levels: temporal and spatial. Nurses
need to focus on patient care needs during the shift
(temporal) or within the boundaries of the working
environment (spatial).

Saying No

Saying no to low-priority demands on your time is
an important but difficult part of setting limits.
Assertiveness and determination are necessary for
effective time management. Learn to say no tact-
fully at least once a day (Hammerschmidt &
Meador, 1993). Patient care is a team effort.
Effective time management requires you to look at
other members of the team who may be able to
take on the task.
The wisdom of time management is that you
may have to let others help you while never giving
up ownership of your time. In other words,
although supervisors and managers tell you what to
do, how you accomplish this remains up to you
(Navuluri, 2001). Is it possible to say no to your
supervisor or manager? It may not seem so at first,
but many requests are negotiable. Requests some-
times are in conflict with career goals. Rather than
sit on a committee in which you have no interest,
respectfully decline, and volunteer for one that
holds promise for you as well as meets the needs of
your unit.
Can you refuse an assignment? Your manager
may ask you to work overtime or to come in on
your scheduled day off, but you can decline. You
may not refuse to care for a group of patients or to
take a report because you think the assignment is
too difficult or unsafe. You may, however, discuss
the situation with your supervisor and, together,
work out alternatives. You can also confront the
issue of understaffing by filing an unsafe staffing
complaint. Failure to accept an assignment may
result in accusations of abandonment.

Some people have difficulty saying no.

Ambition keeps some people from declining any

opportunity, no matter how overloaded they are.

Many individuals are afraid of displeasing others

and therefore feel obligated to take on continuous-

ly all types of additional assignments. Still others

have such a great need to be needed that they con-

tinually give of themselves, not only to patients but

also to their coworkers and supervisors. They fail to

stop and replenish themselves, and then they

become exhausted. Remember, no one can be all

things to all people at all times without creating

serious guilt, anger, bitterness, and disillusionment.

“Anyone who says it’s possible has never tried it”

(Turkington, 1996, p. 9).

Eliminating Unnecessary Work

Some work has become so deeply embedded in

one’s routines that it appears essential, although it

is really unnecessary. Some nursing routines fall

into this category. Taking vital signs, giving baths,

changing linens, changing dressings, performing

irrigations, and doing similar basic tasks are more

often done according to schedule rather than

according to patient need, which may be much

more or much less often than the routine specifies.

Some of these tasks may appropriately be delegated

to others:

■If patients are ambulatory, bed linens may not

need to be changed daily. Incontinent and

diaphoretic patients need to have fresh linens

more frequently. Not all patients need a com-

plete bed bath every day. Elderly patients have

dry, fragile skin; giving them good mouth, facial,

and perineal care may be all that is required on

certain days. This should be included in the

patient’s care plan.

■Much paperwork is duplicative, and some is alto-

gether unnecessary. For example, is it necessary

to chart nursing interventions in two or three

places on the patient record? Charting by excep-

tion, flow sheets, and computerized records are

attempts to eliminate some of these problems.

■Socialization in the workplace is an important

aspect in maintaining interpersonal relation-

ships. When there is a social component to

interactions in a group, the result is usually

positive. However, too much socialization can

reduce productivity. Use judgment in deciding

when socializing is interfering with work.