9

191

C H A P T E R

9

Time Management

The “too much to do and not enough time

to do it” phenomenon is rampant.

—Polly Gerber Zimmermann

Another part of the planning process is short-term planning. This operational planningfocuses on achieving specific tasks. Short-term plans involve a period of one hour tothree years and are usually less complex than strategic or long-range plans. Short-termplanning may be done annually, bimonthly, weekly, daily, or even hourly.

Previous chapters examined the need for prudent planning of resources, such asmoney, equipment, supplies, and labor. Time is an equally important resource. Ifmanagers are to direct employees effectively and maximize other resources, they mustfirst be able to find the time to do so. Time management is making optimal use ofavailable time. Because time is a finite and valuable resource, learning to use it wiselyrequires both leadership skills and management functions. The leader–manager mustinitiate an analysis of how time is managed on the unit level, involve team membersand gain their cooperation in maximizing time use, and guide work to its conclusionand successful implementation.

There is a close relationship between time management and stress. Managing timeappropriately is one method to reduce stress and increase productivity.The current sta-tus of health care, both the nursing shortage and decrease in funding, has resulted inmany healthcare organizations trying to do more with less. The effective use of time

192 UNIT 3 � Roles and Functions in Planning

Leadership Roles1. Is self-aware regarding personal blocks and barriers to efficient time management

as well as how one’s own value system influences one’s own use of time and theexpectations of followers.

2. Functions as a role model, supporter, and resource person to subordinates in settingpriorities.

3. Assists followers in working cooperatively to maximize time use.4. Prevents and/or filters interruptions that prevent effective time management.5. Role models flexibility in working cooperatively with other people whose primary time

management style is different.6. Presents a calm and reassuring demeanor during periods of high unit activity.

Management Functions1. Appropriately prioritizes day-to-day planning to meet short-term and long-term

unit goals.2. Builds time for planning into the work schedule.3. Analyzes how time is managed on the unit level using job analysis and time-and-

motion studies.4. Eliminates environmental barriers to effective time management for unit staff.5. Handles paperwork promptly and efficiently and maintains a neat work area.6. Breaks down large tasks into smaller ones that can more easily be accomplished

by unit members.7. Utilizes appropriate technology to facilitate timely communication and documentation.8. Discriminates between inadequate staffing and inefficient use of time when time

resources are inadequate to complete assigned tasks.

Leadership Roles and Management Functionsin Time Management

Display 9.1

management tools therefore, becomes even more important to enable managers tomeet personal and professional goals. Good time management skills allow an individ-ual to spend time on things that matter. Leadership roles and management functionsneeded for effective time management are included in Display 9.1.

THREE BASIC STEPS IN TIME MANAGEMENT

There are three basic steps to time management (Figure 9.1). The first step requiresthat time be set aside for planning and establishing priorities. The second stepentails completing the highest-priority task (as determined in step 1) whenever pos-sible and finishing one task before beginning another. In the final step, the personmust reprioritize the tasks to be accomplished based on new information received.Because this is a cyclic process, all three steps must be accomplished sequentially.

Unfortunately, two mistakes common to novice managers are underestimatingthe importance of a daily plan and not allowing adequate time for planning. Dailyplanning is essential if the manager is to manage by efficiency rather than by crisis.The old adage “fail to plan—plan to fail’’ is timeless. Managers may believe they areunproductive if they sit at their desk designing the plan of care for the day, ratherthan accomplishing a specific task. Without adequate planning, however, the man-ager finds getting started difficult and begins to manage by crisis. In addition, there

193CHAPTER 9 � Time Management

3. Reprioritize based on the remaining tasks and on new information that may have been received

2. Complete the highest priority task whenever possible, and finish one task before beginning another

1. Allow time for planning, and establish priorities

Figure 9.1 The three basic steps in time management.

can be no sense of achievement at day’s end if the goals for the day have not beenclearly delineated.

Planning takes time; it requires the ability to think, analyze data, envision alter-natives, and make decisions. Setting aside time at the beginning of each day to planthe day allows the manager to spend time on high-priority tasks. During this plan-ning time, the manager should review short-term, intermediate, and long-termgoals and determine what progress will be made toward these goals. Sometimes themanager does allow time for planning but has problems accurately predicting thelength of time it will take to complete an activity.

Priority Setting and Procrastination

Because managers are inundated with many requests for their time and energy, thenext step in time management is prioritizing. Priority setting is perhaps the mostcritical skill in good time management, because all actions we take have some typeof relative importance.

Vacarro (2001) suggests there are five priority-setting traps. The first is “whateverhits first.’’ This trap occurs when an individual simply responds to things as theyhappen rather than thinking first and then acting. The second trap is the “path ofleast resistance.’’ In this trap, the individual makes an erroneous assumption that itis always easier to do a task personally and fails to delegate appropriately. The thirdtrap is the “squeaky wheel.’’ In this trap, the individual falls prey to those who aremost vocal about their urgent requests. Compounding the trap is that the individualoften feels a need to respond to the time frame imposed by the “squeaky wheel,’’ ratherthan his or her own.The fourth trap is called “default.’’ In this trap, the individual feelsobligated to take on tasks that no one else has come forward to do. To keep this fromhappening, the individual must determine whether the undone job is truly his or herresponsibility and whether it serves to accomplish his or her stated goals. The last trapis “inspiration.’’ In inspiration, individuals wait until they become “inspired’’ to accom-plish a task. Some necessary tasks will never be inspiring, and the wise manager recog-nizes that the only thing that will complete these tasks is hard work and appropriateattention to the matter (see Display 9.2 for priority-setting traps).

One simple means of prioritizing what needs to be accomplished is to divideall requests into three categories: “don’t do,’’ “do later,’’ and “do now.’’ The “don’tdo’’ items probably reflect problems that will take care of themselves, are alreadyoutdated, or are better accomplished by someone else. The manager either throwsaway the unnecessary information or passes it on to the appropriate person in a


1. Whatever hits first2. Path of least resistance3. Squeaky wheel4. Managing by default5. Waiting for inspiration

Five Priority-Setting TrapsDisplay 9.2

timely fashion. In either case, the manager removes unneeded clutter from his orher work area.

Some “do later’’ items reflect trivial problems or those that do not have immedi-ate deadlines; thus, they may be procrastinated. Procrastination means to put offsomething until a future time, to postpone, or to delay needlessly. Bakunas (2001)states that procrastination is a major problem that can shrink productivity,undermine self-esteem, and affect a career. It is also a difficult problem to solvebecause it rarely results from a single cause and can involve a combination of dys-functional attitudes, rationalizations, and resentment. Indeed, Bakunas maintainsthat the major causes of procrastination are performance anxiety, low frustration toler-ance, resentment of working conditions, escapism, over-preparation, overworking,poor working conditions, over-commitment, and rationalizing.


Targeting Personal ProcrastinationSpend a few moments reflecting on the last two weeks of your life. Whatare the things that you put off doing? Do these things form a pattern?For instance, do you always put off writing a school paper until the lastminute? Do you wait to do certain tasks at work until you cannot avoidthe task any longer?Assignment: Write a one-page essay on at least two things that youprocrastinate and then develop two strategies for breaking each ofthese habits.

Learning Exercise 9.1 A

Although managers should selectively procrastinate, they should not avoid atask because it is overwhelming or unpleasant. Before setting “do later’’ items aside,the manager must be sure that large projects have been broken down into smallerprojects and that a specific time line and plan for implementation are in place. Theplan should include short-term, intermediate, and final deadlines. Likewise, a man-ager cannot ignore items without immediate time limits forever and must make adefinite time commitment in the near future to address these requests.

The “do now’’ requests most commonly reflect a unit’s day-to-day operationalneeds. These requests may include daily staffing needs, dealing with equipmentshortages, meeting schedules, conducting hiring interviews, and giving performanceappraisals. “Do now’’ requests also may represent items that had been put off earlier.

In prioritizing all the “do now’’ items, the manager may find preparing a writtenlist helpful. Remember, however, that a list is a plan, not a product and that the cre-ation of the list is not the final goal. The list is a planning tool. Although the man-ager may use monthly or weekly lists, a list also can assist in coordinating dailyoperations. This daily list, however, should not be longer than what can be realisti-cally accomplished in one day; otherwise, it demotivates instead of assisting themanager. In addition, although the manager must be cognizant of and plan for rou-tine tasks, it is not always necessary to place them on the list because they may only

Procrastination is not acharacter flaw but a setof behaviors, which weredeveloped over a periodof time, but they arebehaviors that can bechanged. The dread ofdoing a task uses moretime and energy thandoing the task itself.

distract attention from other priority tasks. Lists should allow adequate time foreach task and have blocks of time built in for the unexpected.


Creating Planning ListsDo you make a daily plan to organize what needs to be done? Mentallyor on paper, develop a list of five items that must be accomplished today.Prioritize that list. Now make a list of five items that must be done thisweek. Prioritize that list also.

Learning Exercise 9.2A

Making Big Projects ManageableMasikiewicz (2000) states that the best way to get big projects done is tobreak them down, with mini-deadlines that you set yourself. Think of thelast major paper you wrote for a class. Did you set short-term andintermediate deadlines? Did you break the task down into smaller tasksto eliminate a last-minute crisis? What short-term and intermediatedeadlines have you set to accomplish major projects that have beenassigned to you this quarter or semester?

Learning Exercise 9.3

Periodically, the manager should review lists from prior days to see what was notaccomplished or completed. If a task appears on a list for several successive days,the manager must reexamine it and assess why it was not accomplished. Some proj-ects need to be removed from the list. A project may not be accomplished becauseit was not broken down into manageable tasks. For example, many well-meaningpeople begin thinking about completing their tax returns in early January but feeloverwhelmed by a project that cannot be accomplished in one day. If preparing atax return is not broken down into several smaller tasks with intermediate dead-lines, it may be almost perpetually procrastinated.

The manager must remember that because the list is a planning tool, there mustbe some flexibility in its implementation. In fact, the last step in time managementis reprioritizing. Often the manager’s priorities or list will change during a day,week, or longer because new information is received. If the manager does not taketime to reprioritize after each major task is accomplished, other priorities set earliermay no longer be accurate.

In addition, no amount of planning can prevent an occasional crisis. If a crisisdoes occur, the individual may need to set aside the original priorities for the dayand reorganize, communicate, and delegate a new plan reflecting the new prioritiesassociated with the unexpected event causing the crisis.

MANAGING TIME AT WORK

Being overwhelmed by work and time constraints leads to increased errors, theomission of important tasks, and general feelings of stress and ineffectiveness.Although some people seem to be “naturals’’ with time management, the skill islearned and improves with practice.

All workers need to allow time for daily planning to appropriately manage timeat work. Examples of the types of plans a charge nurse might make in day-to-dayplanning include staffing schedules, patient care assignments, coordination of lunchand work break schedules, and interdisciplinary coordination of patient care. Exam-ples of an acute care staff nurse’s day-to-day planning might include determininghow reports will be given and received; the timing and method used for initialpatient assessments; the coordination of medication administration, treatments, andprocedures; and the organization of documentation of the day’s activities.

Some staff nurses appear disorganized in their efforts to care for patients. Usually,this disorganization results from poor planning. Planning occurs first in the manage-ment process because the ability to be organized develops from good planning. Dur-ing planning, there should be time to think about how plans will be translated intoaction. The planner must pause and decide how people, activities, and materials aregoing to be put together to carry out the objectives. The following suggestions usingindustrial engineering principles may assist the staff nurse in planning work activities:

• Gather all the supplies and equipment that will be needed before starting anactivity. Breaking a job down mentally into parts before beginning the activ-ity may help the staff nurse identify what supplies and equipment will beneeded to complete the activity.

• Group activities that are in the same location. If you have walked a longdistance down a hallway, attempt to do several things there before goingback to the nurses’ station. If you are a home health nurse, group patient vis-its geographically when possible to minimize travel time and maximize timewith patients.

• Use time estimates. For example, if you know an intermittent intravenousmedication (IV piggyback) will take 30 minutes to complete, then use thattime estimate for planning some other activity that can be completed in that30-minute window of time.

• Document your nursing interventions as soon as possible after an activity iscompleted. Waiting until the end of the workday to complete necessarydocumentation increases the risk of inaccuracies and incompletedocumentation.

• Always strive to end the workday on time. Although this is not always possi-ble, delegating appropriately to others and making sure that the workload goalfor any given day is reasonable are two strategies that will accomplish this goal.

Like staff nurses, unit managers need to coordinate how their duties will be car-ried out and devise methods to make work simpler and more efficient. Often thisincludes simple tasks, such as organizing how supplies are stored or determiningthe most efficient lunch and break schedules for staff. The goal in planning workand activities is to facilitate greater productivity and satisfaction. Daily planning



Setting Daily PrioritiesAssume that you are the RN leader of a team with one LVN and one nurs-ing assistant on the 7 AM to 3 PM shift at an acute care hospital. The threeof you are responsible for providing total care to 10 patients. Prioritizethe following list of 10 things you need to accomplish this morning. Use a1 for the first thing you will do and a 10 for the last. Be prepared to pro-vide rationale for your priorities.___Check medication cards/sheets against the rand or kardex___Listen to night shift report 0700–0720___Take brief walking rounds to assess the night shift report and to

introduce yourself to patients___Hang four 0900 IV medications___Set up the schedule for breaks and lunch among your team members___Give 0845 preop on patient going to surgery at 0900___Pass 0830 breakfast trays___Meet with team members to plan schedule for the day and to clarify

roles___Read charts of patients who are new to you___Check 0600 blood sugar lab results for 0730 insulin administration


actions that may help the unit manager identify and utilize time as a resource mostefficiently might include:

• At the start of each workday, identify key priorities to be accomplished thatday. Identify what specific actions need to be taken to accomplish thosepriorities and in what order they should be done. Also identify specificactions that should be taken to meet ongoing, long-term goals.

• Determine the level of achievement you expect for each prioritized task. Is amaximizing or “satisficing’’ approach more appropriate or more reasonablefor each of the goals you have identified?

• Assess the staff assigned to work with you. Assign work that must bedelegated to staff members who are both capable and willing to accomplishthe priority task you have identified. Be sure you have clearly expressed anyexpectations you may have about how and when a delegated task must becompleted. (Delegation will be discussed further in Chapter 20.)

• Review the short- and long-term plans of the unit regularly. Includecolleagues and subordinates in identifying unit problems or concerns so theycan be fully involved in planning for needed change.

• Plan ahead for meetings. Prepare and distribute agendas in advance.• Allow time at several points throughout the day and at the end of the day to

assess progress in meeting established daily goals and to determine if unantici-pated events have occurred or if new information has been received that mayhave altered your original plan. Setting new priorities or adjusting priorities toreflect ever-changing work situations is an ongoing reality for the unit manager.

Taking Breaks

Taking regularly scheduled breaks from work is important as breaks allow the workerto refresh both physically and mentally. Planning for periodic breaks from work duringthe workday is an integral part of an individual’s time and task management. InStrongman and Burt’s (2000) studies of students, hunger/thirst, boredom, feelingtired, lack of concentration, and mental exhaustion were identified most commonly asthe reasons given for taking breaks. Many more reasons were given for taking breaksfrom mental tasks than from physical tasks, and participants believed that breaksshould be taken sooner and more often from mental work than from physical work.Interestingly, those students who took shorter breaks, more often, tended to performat higher levels. Clearly, the working nurse who often faces both physical and mentalstress in the workplace must factor time for breaks into his or her daily plan.

Kriegel (2002) says that when individuals are overworked, they must recognizethat longer hours on the job do not necessarily produce the desired outcomes. Mostpeople’s knee-jerk response to pressure is to run harder and faster but Kriegel main-tains that working longer at a rushed pace not only increases the potential for stressand burnout but also results in more mistakes. Taking a 15-minute daily time out tothink creatively about how to achieve work objectives is recommended.

Dealing with Interruptions

All managers experience interruptions. Lower-level managers experience moreinterruptions than higher-level managers. This occurs in part because first- andmiddle-level managers are more involved in daily planning than higher-level man-agers and thus directly interact with a greater number of subordinates. In addition,many lower-level managers do not have a quiet workspace or clerical help to filterinterruptions. Frequent work interruptions result in situational stress and loweredjob satisfaction. Managers need to develop skill in preventing interruptions thatprevent effective time management.

Lancaster (1984) identified 10 external time-wasters that keep managers fromaccomplishing their “do now’’ and “do later’’ lists. These external time-wasters arelisted in Display 9.3. Several of these items are discussed in previous chapters; oth-ers are discussed in later chapters.

Time Wasters

Three time-wasters warrant special attention here. The first of the three is socializ-ing. Although socializing can help workers meet relationship needs or build power,it can tremendously deter productivity. People can be discouraged from taking up amanager’s time with idle chatter in several ways.

1. Don’t make yourself overly accessible. Make it easy for people to ignore you.Try not to “work’’ at the nursing station if this is possible. If charting is tobe done, sit with your back to others. If you have an office, close the door.Have people make appointments to see you. All these behaviors will dis-courage casual socializers.


A passionate 90% ofwork effort is moreeffective than a panicked110%. —R. Kriegel.

2. Interrupt. When someone is rambling on without getting to the point,break in and say gently, “Excuse me. Somehow I’m not getting your message. What exactly are you saying?’’

3. Avoid promoting socialization. Having several comfortable chairs in youroffice, a full candy dish, and posters on your walls that invite commentsencourage socializing in your office.

4. Be brief. Watch your own long-winded comments, and stand up when youare finished. This will signal an end to the conversation.

5. Schedule long-winded pests. If someone has a pattern of lengthy chatterand manages to corner you on rounds or at the nurse’s station, say, “I can’tspeak with you now, but I’m going to have some free time at 11 AM. Whydon’t you see me then?’’ Unless the meeting is important, the person whojust wishes to chat will not bother to make a formal appointment.

6. If you would like to chat and have the time to do so, use coffee breaks andlunch hours for socializing.

The other external time-wasters that a manager must conquer are paperworkoverload and a poor filing system. Managers are generally inundated with paperclutter, including organizational memos, staffing requests, quality assurancereports, incident reports, and patient evaluations. Because paperwork is oftenredundant or unnecessary, the manager needs to become an expert at handling it.Whenever possible, incoming correspondence should be handled the day it arrives;it should either be thrown away or filed according to the date to be completed. Tryto address each piece of correspondence only once.

An adequate filing system also is invaluable to handling paper overload. Keepingcorrespondence organized in easily retrievable files rather than disorganized stackssaves time when the manager needs to find specific information. The manager alsomay want to consider increased use of computerization and electronic mail to reducethe paper use and to increase response time in time-sensitive communication.


1. Telephone interruptions2. Socializing3. Meetings4. Lack of information5. Poor communication6. Lack of feedback7. Lack of adequately described policies and procedures8. Incompetent coworkers9. Poor filing system

10. Paperwork and readingLancaster, J. (1984). Making the most of every minute: Reminders for nursing leaders. In M. S. Berger, D. Elhart,

S. Firsich, S. Jordan, & S. Stone (Eds.), Management for nurses. St. Louis: C. V. Mosby.

External Time-WastersDisplay 9.3

Personal Time Management

Personal time management refers in part to the knowing of self. Self-awareness is aleadership skill. Managing time is difficult if a person is unsure of his or her prior-ities for time management, including personal short-term, intermediate, and long-term goals. These goals give structure to what should be accomplished today,tomorrow, and in the future. However, goals alone are not enough; a concrete planwith time lines is needed. Plans outlined in manageable steps are clearer, more real-istic, and attainable. By being self-aware and setting goals accordingly, peopledetermine how their time will be spent. If goals are not set, others often end updeciding how a person should spend his or her time.

Think for a moment about last week. Did you accomplish all you wanted toaccomplish? How much time did you or others waste? In your clinical practice, didyou spend your time hunting for supplies and medicines instead of teaching yourpatient about his or her diabetes? Morgenstern (2000) maintains that we shouldfirst analyze our work and time management efforts and then develop strategiesthat attack our problems because we each waste time differently.

Too often, irrelevant decisions and insignificant activities take priority over realpurposes. Clearly, work redesign, clarification of job descriptions, or a change in thetype of care delivery system may alleviate some of these problems. However, thesame general principle holds: Professional nurses who are self-aware and haveclearly identified personal goals and priorities have greater control over how theyexpend their energy and what they accomplish.

Hansten and Washburn (1998) suggest that there are three primary areas ofpractice that consume the time of the professional registered nurse: professional,technical, and amenity care. Professional practice refers to implementation of thenursing process—the ability to make assessments, plan care, effectively coordinatethe efforts of the healthcare team, and evaluate their effect. Technical practiceincludes technical or psychomotor tasks such as venous cannulation, catheteriza-tions, and injections. Amenity care is more service-oriented, such as focusing oncustomer satisfaction by ensuring appetizing meals, aesthetic environmental sur-roundings, and friendliness of the staff. Although all three areas of practice areimportant, the professional role must be valued more highly and time allocatedaccordingly in determining work priorities. Hansten and Washburn (1998) suggestthat “by realizing your part in the determination of what needs to be done, you areallowing yourself the time to practice the professional component of nursing—theimplementation of the nursing process’’ (p. 185). The extensive knowledge andjudgment of the registered nurse are key ingredients to planning and deliveringquality nursing care.

Monochronic and Polychronic Time Management Styles

In addition to being self-aware regarding the values that influence how people prior-itize the use of their time, people must be self-aware regarding their general tendencyto complete tasks in isolation or in combination. Davidhizar, Giger, and Turner(1994) suggest that most people have tendencies toward either a monochronic or


polychronic time management style. People with a monochronic style prefer to do onething at a time, whereas people with the polychronic style typically do two or morethings simultaneously. Monochronic people tend to begin and finish projects ontime, have clean and organized desks as a result of handling each piece of paperworkonly once, and are highly structured. Polychronic people tend to change plans, borrowand lend things frequently, emphasize relationships rather than tasks, and buildlonger-term relationships.

It is important to recognize one’s own preferred time management style and to beself-aware about how this orientation may affect your interaction with others in the


A Busy Day at the Public Health AgencyYou work in a public health agency. It is the agency’s policy that at leastone public health nurse is available in the office every day. Today is yourturn to remain in the office. From 1 PM to 5 PM, you will be the publichealth nurse at the scheduled immunization clinic; you hope to be able tospend some time finishing your end-of-month reports, which are due at5 PM. The office stays open during lunch; you have a luncheon meetingwith a Cancer Society group from noon to 1 PM today. The RN in the officeis to serve as a resource to the receptionist and handle patient phone callsand drop-ins. In addition to the receptionist, you may delegate appropri-ately to a clerical worker. However, the clerical worker also serves theother clinic nurses and is usually fairly busy. While you are in the officetoday trying to finish your reports, the following interruptions occur:

8:30 AM: Your supervisor, Anne, comes in and requests a count of thediabetic and hypertensive patients seen in the last month.

9:00 AM: An upset patient is waiting to see you about her daughterwho just found out she is pregnant.

9:00 AM: Three drop-in patients are waiting to be interviewed for possiblereferral to the chest clinic.

9:30 AM: The public health physician calls you and needs someone tocontact a family about a child’s immunization.

9:30 AM: The dental department drops off 20 referrals and needs you topull charts of these patients.

10:00 AM: A confused patient calls to find out what to do about thebills he has received.

10:45 AM: Six families have been waiting since 8:30 AM to sign up forfood vouchers.

11:45 AM: A patient calls about her drug use; she doesn’t know what todo. She has heard about Narcotics Anonymous and wants moreinformation now.

Assignment: How would you handle each interruption? Justify yourdecisions. Don’t forget lunch for yourself and the two office workers.Note: Attempt your own solution before reading the possible solutionpresented in the back of this book.



Realistic PrioritizingYou are an RN providing total patient care to four patients on an ortho-pedic unit during the 7 AM to 3 PM shift. Given the following patient infor-mation, prioritize your activities for the shift in eight one-hour blocks oftime. Be sure to include time for reports, planning your day’s activities,breaks, and lunch. Be realistic about what you can accomplish. What activ-ities will you delegate to the next shift? What overall goals have guidedyour time management? What personal values or priorities were factorsin setting your goals?101A—Ms. Jones, 84 years old. Fractured left hip secondary to fall at home. Disoriented

since admission, especially at night. Soft restraints in use. Moans frequently. Beinggiven IV pain medication every 2 hours prn. Vital signs and checks for circulation,feeling, and movement in toes ordered every 2 hours. Scheduled for surgery at 1030.Preoperative medications scheduled for 0930 and 1000. Consent yet to be signed.Family members will be here at 0800 and have expressed questions about the surgeryand recovery period. Patient to return from surgery at approximately 1430. Willrequire postoperative vital signs every 15 minutes.

101B—Ms. Wilkins, 26 years old. Compound fracture of the femur with postoperativefat emboli, now resolved. 10-lb Buck’s traction. Has been in the hospital threeweeks. Very bored and frustrated with prolonged hospitalization. Upset aboutroommate who calls out all night and keeps her from sleeping. Wants to be movedto new room. Has also requested to have hair washed during bath today. Has IVrunning at 100 cc/h. IV antibiotic piggybacks at 0800 and 1200. Oral medicationsat 0800, 0900, and 1200.

102A—Mr. Jenkins, 47 years old. T-6 quadriplegic due to diving accident 14 yearsago. Two days postoperative above-knee amputation due to osteomyelitis. Culturesshow methicillin-resistant Staphylococcus aureus. Strict wound isolation. Has beenhospitalized for two weeks. Expressing great deal of anger and frustration to anyonewho enters room. IV site red and puffy. IV needs to be restarted. Dressing change ofoperative site ordered daily. Heat lamp treatments ordered b.i.d. to small pressuresores on coccyx. IV antibiotic piggybacks at 0800, 1000, 1200, and 1400. Main IVbag to run out at 1000. 0600 lab work results to be called to physician this morn-ing. Needs total assistance in performing activities of daily living, such as bathingand feeding self.

103A—Mr. Novak, 19 years old. Severe tear of rotator cuff in left shoulder while play-ing football. One day postoperative rotator cuff repair. Very quiet and withdrawn.Refusing pain medication, which has been ordered every two hours prn. Says hecan handle pain and does not want to “mess up his body with drugs.’’ He wants tobe recruited into professional football after this semester. Nonverbal signs of gri-macing, moaning, and inability to sleep suggest moderate pain is present. Physicianstates that likelihood of Mr. Novak ever playing football again is very low but hasnot yet told patient. Girlfriend frequently in room at patient’s bedside. IV infusing at150 cc/h. IV antibiotics at 0800 and 1400. Has not had a bath since admission twodays ago.


workplace. For example, an agency manager with a polychronic time managementstyle may become frustrated and irritable when assigned to work with a departmentsecretary with more monochronic tendencies. Both people risk frustration and con-flict if they are unable to allow their coworker some discretion in how assigned workwill be accomplished.

Personal Time-Wasters

A significant part of personal time management depends on self-awareness abouthow and when a person is most productive. Everyone avoids certain types of workor has methods of wasting time. Likewise, each person works better at certain timesof the day or for certain lengths of time. Self-aware people schedule complex or dif-ficult tasks during the periods when they are most productive and simpler or rou-tine tasks during less productive times. Other personal or internal time-wasters areshown in Display 9.4.

Using a Time Inventory

Because most people have an inaccurate perception of the time they spend on aparticular task or the total amount of time they are productive during the day, atime inventory may provide insight. A time inventory is shown in Display 9.5.

Because the greatest benefit from a time inventory is being able to objectivelyidentify patterns of behavior, it may be necessary to maintain the time inventory forseveral days or even several weeks. It also may be helpful to repeat the time inven-tory annually to see if long-term behavior changes have been noted. Remember,there is no way to beg, borrow, or steal more hours in the day. If time is habituallyused ineffectively, being a manager will be very stressful.


1. Procrastination2. Poor planning3. Failure to establish goals and objectives4. Failure to set objectives5. Inability to delegate6. Inability to say no7. Management by crisis8. Haste9. Indecisiveness

10. Open-door policy

Internal Time-WastersDisplay 9.4

The time we have is allthe time available to us.Therefore, time oftenbecomes our one realbarrier because mostother things are flexible.


5:00 AM _______________________________________________________6:00 AM _______________________________________________________6:30 AM _______________________________________________________7:00 AM _______________________________________________________7:30 AM _______________________________________________________8:00 AM _______________________________________________________8:30 AM _______________________________________________________9:00 AM _______________________________________________________9:30 AM _______________________________________________________

10:00 AM _______________________________________________________10:30 AM _______________________________________________________11:00 AM _______________________________________________________11:30 AM _______________________________________________________12:00 PM _______________________________________________________12:30 PM _______________________________________________________1:00 PM _______________________________________________________1:30 PM _______________________________________________________2:00 PM _______________________________________________________2:30 PM _______________________________________________________3:00 PM _______________________________________________________3:30 PM _______________________________________________________4:00 PM _______________________________________________________4:30 PM _______________________________________________________5:00 PM _______________________________________________________5:30 PM _______________________________________________________6:00 PM _______________________________________________________6:30 PM _______________________________________________________7:00 PM _______________________________________________________7:30 PM _______________________________________________________8:00 PM _______________________________________________________8:30 PM _______________________________________________________9:00 PM _______________________________________________________9:30 PM _______________________________________________________

10:00 PM _______________________________________________________11:00 PM _______________________________________________________12:00 PM _______________________________________________________1:00 AM _______________________________________________________2:00 AM _______________________________________________________3:00 AM _______________________________________________________4:00 AM _______________________________________________________

Time InventoryDisplay 9.5

INTEGRATING LEADERSHIP ROLES AND MANAGEMENT FUNCTIONS IN TIME MANAGEMENT

The leadership skills needed to manage time resources draw heavily on interper-sonal communication skills. The leader is a resource and role model to subordinatesin how to manage time. As has been stressed in other phases of the managementprocess, the leadership skill of self-awareness also is necessary in time management.Leaders must understand their own value system, which influences how they usetime and how they expect subordinates to use time.

The management functions inherent in using time resources wisely are morerelated to productivity. The manager must be able to prioritize activities of unitfunctioning to meet short- and long-term unit needs.

Successful leader–managers are able to integrate leadership skills and manage-ment functions; they accomplish unit goals in a timely and efficient manner in aconcerted effort with subordinates. They also recognize time as a valuable unitresource and share responsibility for the use of that resource with subordinates. Per-haps most importantly, the integrated leader–manager with well-developed timemanagement skills is able to maintain greater control over time and energy con-straints in his or her personal and professional life.

❊Key Concepts

• Because time is a finite and valuable resource, learning to use it wisely isessential for effective management.

• Time management can be reduced to three cyclic steps: (1) allow time forplanning, and establish priorities; (2) complete the highest priority task,and, whenever possible, finish one task before beginning another; and (3) reprioritize based on remaining tasks and new information that mayhave been received.

• Setting aside time at the beginning of each day to plan the day allows themanager to spend appropriate time on high-priority tasks.

• Making lists is an appropriate tool to manage daily tasks. This list shouldnot be any longer than what can realistically be accomplished in a day andmust include adequate time to accomplish each item on the list and time forthe unexpected.


Writing a Personal Time InventoryUse the time inventory shown in Display 9.5 to identify your activities for a24-hour period. Record your activities on the time inventory on a regularbasis. Be specific. Do not trust your memory. Star the periods of time whenyou were most productive. Circle periods of time you were least productive.Do not include sleep time. Was this a typical day for you? Could you havemodified your activity during your least productive time periods? If so, how?


• A common cause of procrastination is failure to break large tasks down intosmaller ones so that the manager can set short-term, intermediate, andlong-term goals.

• Lower-level managers have more interruptions in their work than higher-level managers. This results in situational stress and lowered job satisfaction.

• Managers must learn strategies to cope with interruptions from socializing.• Because so much paperwork is redundant or unnecessary, the manager

needs to develop expertise at prioritizing it and eliminating unnecessaryclutter at the work site.

• An efficient filing system is invaluable to handling paper overload.• Personal time management refers to “the knowing of self.’’ Managing time

is difficult if a person is unsure of his or her priorities, including personalshort-term, intermediate, and long-term goals.

• Using a time inventory is one way to gain insight into how and when a per-son is most productive. It also assists in identifying internal time-wasters.

More Learning Exercises and Applications


Creating a Shift Time InventoryYou are a 3 PM to 11 PM shift coordinator for a skilled nursing facility. Youare the only registered nurse on your unit this shift. All the other personnelassigned to work with you this evening are unlicensed. The unit census is21. As the shift coordinator, your responsibility is to make shift assignments,provide needed patient treatments, administer intravenous medications,and coordinate the work of team members. The patients that you will needto administer treatments and/or medications to this evening include:

Room 101 A Gina Adams 88 years old. Senile dementia. Resident for six years.Confused—strikes out at staff. Soft wrist restraints bilaterally. Has small Grade 2 decubitus ulcer on coccyx, which requires evaluation and dressing change each shift.

Room 102 B Gus Taylor 64 years old. Diabetes. New resident. Bilateral AK amputee. Right amputation two weeks ago. Leftamputation performed eight years ago. Needs stump dressing on right amputation site this shift.Has developed MRSA in wound site. Wound isolation protocol ordered. IV antibiotics due at 4 PM and 10 PM tonight. Accu-checks due at 4:30 PM and 9:00 PM with sliding-scale coverage.

Room 106A Marvin Young 26 years old. Closed head injury five years ago.Resident since that time. Decerebrate posturing only. Does not follow commands. PEG feeding tube site red and inflamed; Dr. has not yet been notified.Needs feeding solution bag change this PM.



Room 107A Sheila Abood 93 years old. Functional decline. Refusing to eat.Physician has written an order not to resuscitate in the event of cardiac or respiratory failure, but wantsan intravenous line begun this PM to minimize patient dehydration. Family will also be here this PM and want to talk about their mother’s status.

Room 109C Tina Crowden 89 years old. Admit from local hospital, two weeks post-op left hip replacement. Anticipated length of stay—two weeks. Arrives by ambulance at 3:30 PM.Needs to have admission assessment and paperwork completed and care plan started.

Oral Medications ScheduleRoom 101A—4 PM, 8 PM

Room 101B—4 PM, 8 PM

Room 102A—5 PM, 9 PM


Room 104C—5 PM, 6 PM, 9 PM


Room 108C—9 PM

Room 109C—5 PM, 6 PM, 8 PM, 9 PM

Assignment: Create a time inventory from 3:00 PM to 11:30 PM using one-hour blocks of time. Plan what activities you will do during each one-hourblock. Be sure you start with the activities you have prioritized for theshift. Also, remember that you will be in shift report from 3:00 to 3:30 PM

and from 11:00 to 11:30 PM and that you need to schedule a dinner breakfor yourself. Allow adequate time for planning and dealing with theunexpected. Compare the inventory you created with other students inyour class. Did you identify the same priorities? Were you more focusedon professional, technical, or amenity care? Is your plan more monochron-ic or polychronic in nature? Was the time inventory you created realistic?Is this a workload you believe you could handle?

Plan Your DayIt is October of your second year as coordinator of nursing managementfor the surgical department. A copy of your appointment calendar forMonday, October 27, follows.

You will review your unfinished business from the preceding Friday andlook at the new items of business that have arrived on your desk thismorning. (The new items follow the appointment calendar.) The unitward clerk is usually free in the afternoon to provide you with one hourof clerical assistance, and you have a charge nurse on each shift to whomyou may delegate.1. Assign a priority to each item, with 1 being the most important and 5

being the least important.



2. Decide when you will deal with each item, being careful not to usemore time than you have open on your calendar.

3. If the problem is to be handled immediately, explain how you will dothis (e.g., delegated, phone call).

4. Explain the rationale for your decisions.

Monday, October 278:00 AM Arrive at work8:15 AM Daily rounds with each head nurse in your area8:30 AM Continuation of daily rounds with head nurses9:00 AM Open9:30 AM Open

10:00 AM Department Head meeting10:30 AM United Givers committee11:00 AM United Givers committee11:30 AM Open

Noon Lunch12:30 PM Lunch1:00 PM Weekly meeting with administrator—Budget

and annual report due1:30 PM Open2:00 PM Infection Control meeting2:30 PM Infection Control meeting continued3:00 PM Fire drill and critique of drill3:30 PM Fire drill and critique of drill continued4:00 PM Open4:30 PM Open5:00 PM Off duty

Correspondence

Item 1From the desk of M. Jones, personnel managerOctober 24Dear Joan:

I am sending you the names of two new graduate nurses who are inter-ested in working in your area. I have processed their applications; theyseem well qualified. Could you manage to see them as early as possible inthe week? I would hate to lose these prospective employees, and they areanxious to obtain definite confirmation of employment.

Item 2From the desk of John Brown, purchasing agentOctober 23Joan:

We really must get together this week and devise a method to controlsupplies. Your area has used three times the amount of thermometer coversas any other area. Are you taking that many more temperatures? This is justone of the supplies your area uses excessively. I’m open to suggestions.


Item 3Roger Johnson, MD, chief of surgical departmentOctober 24Ms. Kerr:

I know you have your budget ready to submit, but I just rememberedthis week that I forgot to include an arterial pressure monitor. Is thereanother item that we can leave out? I’ll drop by Monday morning, andwe’ll figure something out.

Item 4October 23Ms. Kerr:

The following personnel are due for merit raises, and I must have theircompleted and signed evaluations by Tuesday afternoon: Mary Rocas,Jim Newman, Marge Newfield.M. Jones, personnel manager

Item 5Roger Johnson, MD, chief of surgical departmentOctober 23Ms. Kerr:

The physicians are complaining about the availability of nurses toaccompany them on rounds. I believe you and I need to sit down with thedoctors and head nurses to discuss this recurring problem. I have somefree time Monday afternoon.

Item 65 AM

Joan:Sally Knight (your regular night RN) requested a leave of absence due

to her mother’s illness. I told her it would be OK to take the next threenights off. She is flying out of town on the 9 AM commuter flight to SanFrancisco, so phone her right away if you don’t want her to go. I felt I hadno choice but to say yes.Nancy Peters, night supervisor

P.S. You’ll need to find a replacement for her for the next three nights.

Item 7To: Ms. KerrFrom: AdministratorRe: Patient complaintDate: October 23

Please investigate the following patient complaint. I would like a reporton this matter this afternoon.

Dear Sir:My mother, Gertrude Boswich, was a patient in your hospital, and I just

want to tell you that no member of my family will ever go there again.She had an operation on Monday, and no one gave her a bath for three

days. Besides that, she didn’t get anything to eat for two days, not evenwater. What kind of a hospital do you run anyway?Elmo Boswich


Item 8To: Joan KerrFrom: Nancy Newton, RN, head nurseRe: Problems with x-ray departmentDate: October 23

We have been having problems getting diagnostic x-ray procedures sched-uled for patients. Many times, patients have had to stay an extra day to getx-ray tests done. I have talked to the radiology chief several times, but thesituation hasn’t improved. Can you do something about this?

Item 9To: All department headsFrom: Store roomRe: SuppliesDate: October 23

The storeroom is out of the following items: Toilet tissue, paper clips,disposable diapers, and pencils. We are expecting a shipment next week.

Telephone Messages

Item 10Sam Surefoot, Superior Surgical Supplies, Inc., returned your call at 7:50

AM on October 27. He will be at the hospital this afternoon to talk aboutproblems with defective equipment received.

Item 11Donald Drinkley, Channel 32-TV, called at 8:10 AM on October 27 to say

he will be here at 11:30 AM to do a feature story on the open-heart unit.

Item 12Lila Green, director of nurses at St. Joan’s Hospital, called at 8:05 AM on

October 24 about a phone reference on Jane Jones, RN. Ms. Jones hasapplied for a job there. Isn’t that the one we fired last year?

Item 13Betty Brownie, Bluebird Troop 35, called at 8 AM on October 27 about

the Bluebird troop visit to patients on Halloween with trick-or-treatcandy. She will call again.

Web Links

Organizational skills: Are you ready for a change?http://www.womensmedia.com/organize-goals-0200.htmA women’s resource for organizational skills.

Personal time management for busy managershttp://www.ee.ed.ac.uk/~gerard/Management/art2.htmlThis article looks at the basics of personal time management and describes how the man-ager can assume control of this basic resource.

Leadership Skills for Professionals Desktop Workshophttp://www.consultskills.com/contents.htmPoint to and click on the underlined name of the document you wish. Documents includ-ed under subsection strategy, setting priorities, and saying no.

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• An elderly, frail patient pulls out her intravenous line. You make sixattempts, over a one-hour period, to restart the line but are unsuccess-ful. You have missed your lunch break and now must choose betweentaking time for lunch and finishing your shift on time.


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