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HOW TO PRIORITIZEA Professional Growth Module:

YOUR WORK©1998-2014

May be copied for use within each physicallocation that purchases this inservice.

We hope you enjoy this

inservice, prepared by

registered nurses

especially

for nursing assistants

like you!

After finishing this inservice, you will be

able to:

State at least two reasons why prioritizing your work

is important.

Outline Maslow’s Hierarchy of Needs theory and explain

how you can use it to prioritize your work.

Explain how prioritizing can help you deal with a

difficult client.

Discuss how setting goals and creating “to do” lists

can help you prioritize your work.

Develop your own flexible, prioritized daily work

schedule that is unique to your working environment.

If you are studying the inservice on your own, please do the following:

Read through all the material. You may find it useful to have a highlighting marker nearby as you read. Highlight any information that is new to you or that you feel is especially important.

If you have questions about anything you read, please ask _________________________.

Take the quiz. Think about each statement and pick the best answer.

Check with your supervisor for the right answers. You need 8 correct to pass!

Print your name, write in the date, and then sign your name.

Keep the inservice information for yourself and turn in the quiz page to _____________________________ no later than _______________. Show your Inservice Club Membership Card to ___________________ so that it can be initialed.

Email In the Know at [email protected] with your comments and/or suggestions for improving this inservice.

THANK YOU!

Instructions for the Learner

A Professional Growth Module:

HOW TO PRIORITIZE YOUR WORK

Developing Top-Notch CNAs, One Inservice at a Time

A Professional Growth Module:

How to Prioritize Your Work

FOLLOW THE YELLOW BRICK ROAD!

Inside This Inservice:

Why are Priorities Important?

2

How Do You Know What Is Important?

3

Focus on Physical Needs 4

Focus on VS, I/O & Weight 6

Focus on Difficult Clients 7

Time Management and

Goal Setting

8

How to Focus and Stay on

Task

9

Final Tips 10

Focus on Safety Needs 5

© 201 In the Know, Inc. www.knowingmore.com

May be copied for use within each physical location that

purchases this inservice from In the Know. All other copying

or distribution is strictly prohibited.


In the Wizard of Oz, Dorothy finds herself in a strange environment (Munchkin Land) with a huge task ahead of her (getting to Oz). When she turns to Glinda to ask for directions, the good witch replies,

"It's always best to start at the beginning."

Then, she directs Dorothy to the Yellow Brick Road.

Well, this is good advice for just about everything in life. It is best to start at the beginning, take baby steps until you are comfortable, then just keep going until you reach the end.

Unfortunately, it's not always that simple for people who work in health care.

Your day doesn't start out with a perfectly paved yellow brick road surrounded by happy munchkins cheering you on!

Some days you may have so much to do, you can't see the beginning or the end. This is when it becomes important to know how to set priorities.

When you plan your day by setting clear and appropriate priorities, you are paving your own yellow brick road!

Of course, even the best brick road can have potholes or lead to a wrong turn, but as long as you keep your priorities in mind, you will get back on the path and soon reach your destination.

Keep reading to learn how you can get everything done during your day by setting priorities.

And, learn how setting and following a list of priorities will help you reduce stress, provide better care, and allow you to meet your client’s physical and safety needs with compassion and dignity.

Being able to prioritize means you know how to schedule your day so that the most important thing (at the time) gets your full attention.

It’s not enough to just react to situations as they arise. This will leave you feeling stressed out! You must be able to look ahead and predict what may happen and be ready to head off problems before they occur.

IT’S GOOD CUSTOMER SERVICE Organizing your day with clear priorities not only makes your day better, but it brings calmness and predictability to your client’s day.

It can be difficult and frustrating for your clients to have to rely on you to do things for them. Combine this with the uncertainty of not knowing where you are or when you will be back. This frustration and uncertainty can make even the nicest person feel a little edgy.

When you can give your client a clear idea of how the day will go, you can relieve some of that edginess. Your clients will stop ringing the call bell or making excessive demands when they can trust that they will have your undivided attention at certain times throughout the day.

SAFETY SHOULD ALWAYS BE ON YOUR RADAR There will always be safety issues that demand your attention but they don’t have to consume your day and ruin your planned schedule.

Remember, by planning ahead, you can head off many safety issues before they ever happen.

WHY ARE PRIORITIES IMPORTANT?

A Professional Growth Module: How to Prioritize Your Work © 201 In the Know, Inc. Page 2

WORK SMARTER, NOT HARDER Prioritizing safety will make your whole day run much more smoothly. For example, if you know Mrs. Jones is a sundowner, (a person who becomes agitated in the afternoon or evening) then plan your day so that you can feed, bathe, massage, and play soft music for her before she becomes agitated and disruptive. This may keep an unsafe episode from ever occurring.

GET THE WHOLE PICTURE Whether you work in a facility with many clients or in the home with just one client, it’s important to take a few minutes at the beginning of each shift to assess what has happened during the previous shift . . . and what needs to happen on your shift.

Get report from the outgoing shift or read over the chart. Even if you have worked with the client before, take the time to find out if there has been any change in status.

For example, Mr. Smith may have seemed fine when you worked with him two days ago . . . but now he is on restraints after becoming combative several times yesterday.

You will need to prioritize his physical and safety needs now

in a way that is different from when you worked with him

two days ago. You’ll need to plan to check on him every two hours and make sure he is fed, toileted and cleaned, since he is now unable to do these things on his own.

Grab your favorite highlighter! As you read through this inservice, highlight five things you learn that you didn’t know before. Share this new information with your supervisor and co-workers!

© 201 In the Know, Inc. Page 3 A Professional Growth Module: How to Prioritize Your Work

While each individual person will have different needs at different points in life, there are a few things that remain constant for every human. These constant needs, common to all humans, are best described in Maslow’s Hierarchy of Needs theory.

Take a look at the pyramid above. Notice that the most basic physical needs are the biggest portion of the triangle—at the base. Oxygen, water and food are needed to sustain life. These needs must be met before anything else matters. Now, work your way up the pyramid. Next, you will find the need for safety.

Physical and safety needs are the most important priorities for your clients. If you are not prioritizing these two

basic needs . . . there will be NO client to care for!

HOW DO YOU KNOW WHAT IS IMPORTANT?

To be the most effective caregiver you can be—you have to be able to meet your own Hierarchy of Needs!

List two things in each category that YOU do for yourself that meet your own needs:

Physical Needs:

_____________________________

_____________________________

Safety Needs:

_____________________________

_____________________________

Need for Love:

_____________________________

_____________________________

Self Esteem Needs:

_____________________________

_____________________________

Self Actualization Needs:

_____________________________

_____________________________

PHYSICAL NEEDS:

Oxygen, water, food, elimination, activity and rest.

SAFETY AND SECURITY NEEDS:

Shelter, clothing, and protection from harm.

NEED FOR LOVE:

Feeling love, acceptance and belonging.

SELF ESTEEM NEEDS:

Achievement, belief in one’s own worth and value.

The need to learn, create and achieve

one’s own potential.

SELF ACTUALIZATION NEEDS:

MASLOW’S HIERARCHY OF NEEDS


You may have recognized from Maslow’s chart that the physical needs include ones that must be met in order to sustain life. They include:

OXYGEN: This may seem obvious, but humans must have oxygen to be alive. This means we have to be able to breathe!

If your client is unable to breathe because of disease or obstruction—nothing else matters—this is your only priority!

WATER: Humans are over 61 percent water. Water is essential to maintain life. Water becomes even more important in the elderly and ill and those who are on certain medications, or undergoing therapy. Without water the body becomes dehydrated.

Signs and symptoms of dehydration may include: decreased urine output, dry mouth, sunken eyes, low blood pressure, rapid heart rate, and an elevated temperature.

If you notice any signs or symptoms of dehydration, make it your priority to inform the nurse, document strict intake and output, and follow any orders put in place to correct the situation.

FOOD: Without food, starvation occurs. Muscle wasting, weakness, irritability, confusion, and low blood sugar are all signs of starvation.

Most people eat 2-3 meals and a couple of small snacks throughout the day. Clients who can feed themselves may simply need access to food and gentle reminders to eat. Clients who cannot feed themselves will need you to prioritize a consistent and predicable feeding schedule.

Report any changes in intake, difficulty chewing or swallowing, vomiting or refusal to eat immediately.

ELIMINATION: No other physical need creates more trouble for clients than the need to eliminate! Those who are incontinent face the embarrassment of soiled clothing and bed linens. Those who are physically impaired and cannot get to the bathroom independently must rely on YOU to help when the need arises.

A call for help from the client to get to the bathroom is a priority! If you can’t get to it, find someone who can. Falls, broken bones, and even head injuries can result when a client attempts to get to the bathroom in a hurry because the wait for help was too long.

FOCUS ON MEETING PHYSICAL NEEDS

Chances are, your clients are under your care because they need help with Activities of Daily Living (ADL’s).

Some clients need total care while others may be in the process of rehabilitation and only need your assistance to help themselves.

Compare a total care client with a client who is working toward a higher level of functioning.

Discuss how you would prioritize each of the following ADL’s differently for these two clients:

Bathing

Dressing

Grooming

Oral Care

Toileting

Walking

Discuss the differences with your supervisor and co-workers. Find out

how they prioritize these items.

Eating

Shopping

Cooking

Housework

Doing Laundry

Driving

“Time is more valuable than money. You can get more money,

but you cannot get more time.”

~ Jim Rohn

©201 In the Know, Inc. Page 5 A Professional Growth Module: How to Prioritize Your Work

FOCUS ON MEETING SAFETY NEEDS

Maslow lists safety as the second most important need. This is true for most humans. However, in healthcare, safety needs must be met at the same time as physical needs.

IN FACILITIES: To prioritize safety in a facility with many clients, you should:

1. Get report or read the charts: You need to know if your clients are on fall precautions, restraints, if they are wanderers, if and how much assistance is needed for ambulation and eating, and if any special orders are in place.

2. Do a quick safety check: Take a moment to walk the halls, peek in rooms and make sure everyone is breathing and in a safe position.

3. Remove obstacles: Move or remove anything that may cause a client to fall, such as extra equipment, shoes, clothing or linens on the floor, or spilled food or fluids.

4. Check equipment: Make sure all wheelchairs, walkers, beds or any other assistive equipment is in good working order before using.

IN THE HOME: If you work in the home environment with just one client at a time, you will do all of the above, and:

1. Perform a Safety Inspection: Routinely check for dangers such as frayed wires on appliances, space heaters that are too close to furniture or curtains, problems with ventilation, and any other structural problems that could cause harm.

2. Recommend Assistive Devices: If you see your client has trouble getting around the bathroom, you could recommend having safety bars installed, or using a raised toilet seat. There are many assistive devices available to make things safe in the home. Talk to your supervisor about your safety concerns. There is likely a solution to the problem.

3. Adapt and Change: Help your client re-organize things such as kitchen cabinets or linen closets so that items are easily reached without needing a step stool.

4. Poison Control: Make sure all cleaning supplies or dangerous chemicals are clearly labeled in their original containers.

HOW DO YOU CREATE STRUCTURE IN YOUR DAY?

A. Show up and do whatever needs to be done.

B. Arrive on time and follow the same routine you follow every day.

C. Arrive a few minutes early to get report and note any changes in your client(s), then make changes to your routine based on this report.

There is no right or wrong answer to this question. But, ask around. Find out what your co-workers are doing. And then, notice the difference in the stress level and reports of job satisfaction between the three types.

Those who answer “C” are likely to be the least stressed and report the highest level of job satisfaction!

“The key is not to prioritize what's on your schedule,

but to schedule your priorities.”

~ Stephen R. Covey


VITAL SIGNS

You should start every shift by assessing your client’s vital signs. This gives you a baseline to start from. That way, if something seems odd later on in the shift, you can always refer back to the baseline vitals to see how much has changed.

Some medication doses are adjusted daily based on blood pressure results taken by you. Be sure to get accurate and timely BP readings. Other medications can affect pulse rate. Record accurate pulse rates with each blood pressure reading and report abnormal results to the nurse.

Clients who are sick and immobile have an increased risk of developing pneumonia. Pay close attention to respiratory rates in your immobile clients. Any respiratory rate that falls outside the normal range of 12-20 should be reported immediately.

INTAKE AND OUTPUT

Be sure you know if any of your clients are on strict I&O. This will mean you will have to prioritize keeping close tabs on everything that goes in and everything that comes out! You can prepare in advance by being sure your client has access to a urinal, bedpan, or a collection hat that sits over the commode.

Also pay close attention to clients on fluid restrictions and those who have orders to push fluids.

Fluid balance is extremely vital information for clients with certain disorders like congestive heart failure, brain injury, and metabolic disorders.

DAILY WEIGHTS

Many clients will need to be weighed every day. This is usually done to be sure the client is not retaining fluids.

Some medications may need to be adjusted if your client’s weight is suddenly too high or too low. So, an accurate weight is very important!

Plan ahead to weigh your clients on the same scale, at the same time of day, and wearing the same amount of clothing.

FOCUS ON VITAL SIGNS, I’S & O’S AND WEIGHTS

NEW AIDES: When you are a new nursing assistant, your workload can become overwhelming and become unmanageable pretty quickly.

Look around at the way your co-workers manage their workload. If you see someone who seems to have it all together, ask:

“How do you prioritize your tasks?”

“How do you get all your work done so effortlessly?”

“Do you have any pointers for me to better structure my time and get the most important things done first?”

OLD PRO’S: Are you experienced, organized and confident in your abilities? Then, share your secret! If you see someone struggling to

keep it all together, ask:

“I see you are having a hard time. Is there anything I can do to help you run things more smoothly?”

“I remember feeling the way you are feeling right now. Here’s what I do to prioritize my tasks and get it all done . . .”

WORST THINGS FIRST! It’s human nature to avoid things that may be hard or uncomfortable. This is no different in the medical field when dealing with difficult clients. You want to do your best and give all of your clients the care they need and deserve . . . but there is always that one client that makes giving care feel like a cruel and unusual punishment!

Avoiding your difficult client is the worst thing you could do. Putting difficult clients off only prolongs your anxiety and theirs. It’s best to take care of these clients first! Here’s how:

Identify "High Need" or Difficult Clients

There is usually one (or more) on every shift! Be prepared, in advance, to budget and spend more time with this client.

Go above and beyond! Be sure you have done everything you can do for this client before leaving the room. This will keep him from pushing the call light or making excessive demands throughout your shift!

Ask your client, "What else can I do for YOU before I leave your room?" This is a good way to make sure you've done everything you need to do and gives your clients (or their family) a feeling of security knowing you want to make sure all their needs are met.

Having to depend on others for care can make people feel as if they are not in control of their own lives. Difficult clients (or family members) may be acting out as a way of gaining control.

Give your client some control by allowing him to make some decisions about when and how you will care for him. When your client regains a sense of control, he will stop making difficult

demands!

Heap on Kindness!

It’s okay to spoil your clients (a little)! Try to remember what your difficult client likes and dislikes. This will let him know you see him as an individual . . . and not just one of the many patients you care for. Always maintain a kind and compassionate spirit . . . even if the feeling is not returned!


FOCUS ON DIFFICULT CLIENTS

Working with clients in the home often requires coming up with creative

solutions to uncommon problems.

THE PROBLEM: You are caring for a 78 year old woman who is recovering from a broken ankle (the result of a fall).

You arrive at the house with an agenda . . . . but the weather report shows a big storm coming, so your client has a few requests for you, as well. She would like you to do a load of laundry, mop the bathroom floor, fix the rubber stopper on her walker, and make sure she is prepared for a power outage with a flashlight and bottled water, etc.

WHAT YOU KNOW: This client lives alone and is having trouble walking with her casted ankle. Her requests are not out of the ordinary, and you’d like to do everything she needs. But, there is just not enough time!

GET CREATIVE: How would you prioritize these needs to make sure your client gets what she wants and needs?

TALK ABOUT IT: Share your ideas with your co-workers and supervisor and find out how they would solve the problem.


Time management and setting priorities go hand-in-hand. When you manage your time well, you will handle all your priorities . . . and, when you know your priorities, you will manage your time well!

There are several ways you can use time management skills to prioritize your work. Here are a few:

Make a daily “To Do” list . . . then, take it a step further and number the items on your list in order of importance. This will tell you what your priorities are for the day!

Take care of the items on your list in order of importance, checking them off as you go along. This can be a very satisfying way of making sure you are doing what needs to be done and not wasting time on things that are unimportant.

Set goals for yourself each day . . . but be realistic! Each day at the top of your “to do” list set one goal for yourself, such as, “arrive to work ten minutes early to avoid feeling rushed,” or “keep up with charting so I don’t have to stay late to finish.”

If you get off track because of an emergency . . . just pick up where you left off and keep moving. Taking time to dwell on the fact that you are out of your routine will just waste more time.

If you get to the end of your day and find there are still items on your “to do” list . . . don’t just ignore them, you’ll have to make some decisions about what to do.

1. If the item on your list can wait until tomorrow, start tomorrow’s list right away and put that item at the top.

2. If the item can’t wait until tomorrow, you may need to stay late to complete it. Be sure to ask your supervisor for permission to stay late. Some companies have policies regarding overtime.

3. The final alternative, if the item on your list can’t wait . . . and you can’t stay late . . . you will have to notify your supervisor and pass the task to the next shift. Use this option as a last resort because when you add your work onto your co-worker’s “to do” list, you put their schedule behind.

TIME MANAGEMENT / GOAL SETTING

Now, it’s time for you to develop your own flexible, prioritized daily work schedule that is unique to your working environment.

Think about your typical workday. Do you work in a facility with many clients, in a home with just one client, or do you travel from home to home visiting several clients?

1. Take a minute or two to make a quick list of all the things you have to do on a typical day.

2. Next, place numbers next to the tasks to arrange the list in order of importance.

3. Now give each task a time frame. For instance, estimate how long it takes you to measure, record and report vital signs on your clients.

4. Finally, chart it out! There are no rules here! Just do what works for you!, Make it your own. You

are the only one who has to read it!

5. HINT: Write in pencil so you can make changes if needed!

“Set priorities for your goals. A major part of successful living lies in the ability to put first things first. Indeed, the reason most

major goals are not achieved is that we spend our time doing second things first.” ~ Author Unknown

TO-DO TO

DAY!

1.

2.

3.

4.

5.


BAN ELECTRONIC COMMUNICATION DEVICES

We live, work and play in a very fast-paced world. We have computers, internet, email, cell phones, iPhones, iPods, and ear pieces. We stay continuously connected though our electronic devices via texting, MySpace, FaceBook, and YouTube. By the time you read this inservice, all these things may be “old fashioned” and the next big thing will have come along!

The point is, these things are fun and sometimes even functional. But, they can also be distracting . . . and distractions in healthcare can lead to deadly mistakes.

If your workplace does not already have a policy in place regarding electronic devices, enforce your own! If you must keep a cell phone so your children can reach you, then use it for that purpose only.

The only thing answering calls or texts, or updating your FaceBook profile during work is doing for you is putting you behind. It's taking your focus away from your clients. And, it could potentially be a HIPAA violation.

There have been instances recently of healthcare personnel updating their FaceBook status with comments about the clients they are caring for. This is not only a big time waster . . . but a huge, possibly criminal, violation of privacy.

The bottom line is this: when you are at work . . . you are being paid to give your clients your full attention. Unless it is an emergency, keep your electronic communications for when you are on a break or at lunch.

STEER CLEAR OF THE GOSSIP

Another focus killer is gossip! Stay out of the gossip circles by not participating when you see it happening. Remove yourself from any conversation that targets a co-worker. If the gossip is malicious or harmful, report it.

Gossip distracts you from the task at hand, has no purpose, and can really bring down morale.

HOW TO FOCUS AND STAY ON TASK

1. Being able to prioritize means you know how to schedule your day so that the most important thing (at the time) gets your full attention.

2. It’s not enough to just react to situations as they arise. Prioritizing helps you to look ahead and predict what may happen and be ready to head off problems before they occur.

3. Organizing your day with clear priorities will not only make

your day better, but it will bring calmness and predictability to your client’s day.

4. Physical and safety needs are the most important priorities for your clients. If you are not prioritizing these two basic needs . . . there will be NO client to care for!

5. Setting priorities does not have to be a time consuming chore! Once you get the hang of it, it should only take you a few minutes each day!


THE KEY TO PRIORITIZING YOUR DAY LIES IN: Knowing what is important, and why,

Understanding how long it takes to do the things you need to do,

Responding to emergencies and interruptions without being knocked off track,

Keeping a “to do” list with tasks numbered in order of importance, and

Eliminating things like phone calls, texts, and gossip circles that take your focus off your priorities!

AND, SOME FURTHER SUGGESTIONS:

When trying to schedule your time and set priorities, follow your workplace guidelines first. Your employer will likely have a rough routine for you to follow that dictates what needs to be done and when.

For further guidance, look to Maslow’s Hierarchy of Needs. Remember physical and safety needs should be your top priorities and should be met first.

Try to arrive at work about ten minutes early each day. This will keep you from feeling rushed, and will give you time to sit down and plan out your day according to the needs of your particular clients on that particular day.

Remember, your clients’ needs may change from day to day. So the first thing you should always do is get report or read the charts to find out what has changed. This will give you the starting point for deciding what is most important.

There will be days when you just can’t get everything done that is on your list. Be sure to let your supervisor know what is being left, and if it is something that MUST be done, be sure to pass it on to the next shift.

Making your “to do” list and prioritizing your day should not be an exercise that makes more work for you. Once you get the hang of it, you should be able to sketch out a rough schedule in a few minutes!

Planning your day with clear priorities will leave you feeling more productive and less stressed throughout your day! In addition, your clients will benefit from your new organizational skills as well!

FINAL TIPS FOR PRIORITIZING YOUR DAY

Now that you‘ve read this inservice on prioritizing, take a moment to jot down a couple of things you learned that you

didn’t know before.

Are you “In the Know” about prioritizing your work? Circle the best choice. Then check your answers with your supervisor!

1. True or False To “prioritize” means to arrange things in order of importance. 2. True or False Maslow’s Hierarchy of Needs shows the need for self-esteem to be the most important priority for all humans. 3. True or False Elimination is an example of a physical need. 4. True or False Prioritizing safety means you prevent problems instead of just reacting to emergencies as they happen. 5. Your client has an order for “Daily Weights.” You cannot get to it before the end of your shift because another client had an emergency. You should: A. Try to remember to do it first thing the next day. B. Let your supervisor know so the weight can be checked on the next shift. C. Chart the previous day’s weight —not much would have changed anyway. D. Ignore the order, it’s not a priority. 6. True or False Taking vital signs is not really a priority. You should just do it whenever you have time to get to it. 7. True or False When you work with the same clients every day, there is no need to get report or read the chart. 8. True or False Making a “to do” list can help you feel more organized and productive.

9. True or False It’s best to deal with a difficult client last. That way you won’t get behind.

10. Fill in the Blanks Difficult clients (or family members) may be acting out as a way of gaining

_____________________.

Inservice Credit:

Self Study 1 hour

Group Study 1 hour

File completed test in employee’s personnel file.

EMPLOYEE NAME (Please print):

________________________

DATE: __________________

I understand the information presented in this inservice.

I have completed this inservice and answered at least eight of the test questions correctly.

EMPLOYEE SIGNATURE:

________________________

SUPERVISOR SIGNATURE:

________________________

A Professional Growth Module: How to Prioritize Your Work


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