Fast Track Nursing - page 2

by Ryan RN 2,925 Views | 16 Comments

Been in ER for 4+ years now but i dont know why i never got "promoted" to fast track (sarcasm)What do you guys think about these RNs working ONLY fast track? In all honesty, i feel that they might as well work at a clinic. Fast... Read More


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    Quote from Altra
    I've never been a fan of the attitude that ... if you're not up to your wrists in blood, or wrestling a drunk, or running multiple drips ... you're somehow less of a nurse.
    Yeah, it smacks of machismo.

    We rotate all around although they used to have a couple of "fast track only" nurses. Fast track days can be easy or hellish. But high acuity assignments can be the same.

    And I just wanted to add- even experienced nurses can make mistakes or have a sneakily ill patient slip past to fast track, so only allowing experienced nurses to triage doesn't guarantee that your fast track patients will always be fast track worthy.
    Last edit by hiddencatRN on Aug 15, '12 : Reason: adding
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    Fast Track is always a bit crazy in our dept and certainly not an easier assignment. 6 cubicles (no bedded pts allowed) and always a new pt in and out. Our pts wait in the w room, come in for treatment/eval and then go back to the w room waiting on tests, with IV's etc.
    Our ED has 6 different areas and only experienced nurses do Triage and Resus. Other areas include adult cubicles (main ed), pediatric ed, short stay adults and kids (separate areas), consult (FT), triage and resus.

    Stops you getting bored and keeps you skills up in all different areas.
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    Fast track can be a tough place to work. Is it as "exciting" as the main ER? Well, of course not. However, you're taking in high volumes, have a lot more lacerations and splints, and it requires someone who is fast on their feet and in their charting. I definitely don't look down on anyone who works fast track.
    sandypalma likes this.
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    I enjoy working fast track. It is VERY fast paced. We have 3 rooms and at times 15-20 people waiting to be seen. Some are sent back out to lobby to wait for results, so you may be juggling 7-8 patients at a time. It is actually very challenging to see how quickly you can get through the patients and make sure nothing is missed. I agree with the other posters that about every day one of the "fast track" patients turns out to be anything but. And YOU have to catch that quickly - because they may have been waiting a long time since they were not deemed urgent. I have had fast track patients go straight to ICU. One pt was listed as "sore throat" and wound up having epiglottis. Another mild off and on abdominal pain and had a massive tumor in her belly. You just don't know - they aren't going to catch it all in triage. And like I said you have to juggle many things at once - waiting for results, discharges, ordering tests, suturing, splinting, medications, etc. It can be very challenging and it is definitely fast paced. I always liked it because I had my own desk and computer and my own "area" and worked one on one with the practitioner. And all our practitioners rock, some are my really good friends and we look out for each other. I honestly wouldn't mind working in fast track all the time, but they generally put the pregnant nurses there, lol. In a 12 hour shift a fast track nurse may see 50-60 patients in my hospital, whereas a nurse in the main ED may see 20 at MOST. And of course every day there is the "most ridiculous complaint" award to be decided ;-)
    sandypalma and Altra like this.
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    Totally agree various times i had to transfer because the patient was not triaged correctly. in our er if they are swamped(which is all the time) we get criticals plus our non urgents...that burnt me out...u have ur one critical plus your 6 ft.(we use all hallway space)..hmmmmm

    Quote from ~*Stargazer*~
    I can't tell you how many times I have had people mis-triaged into Fast Track, who were NOT Fast Track patients at all! When you only have one RN, one Tech, and one MD running the zone, things can get dicey. Just as with any clinic, people can and do code. People can walk through the door with a sodium of 109, or with a complicated infection that requires hospital admission. Remember that in triage, the nurse is making a quick judgment based upon chief complaint, objective and subjective s/s, and vital signs. Severely ill people can and often do look completely fine on the surface, and it isn't until you delve deeper that you realize they're sicker than they look.

    Because of this, and because of the state of health care today, in which access to preventive health services is severely limited, and so people wait until they're really sick before seeking medical assistance, Fast Track nursing is most definitely ED nursing.

    If you want to be assigned to Fast Track, tell your charge. Maybe they haven't put you there because they don't think you want to do it.
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    Agree with Ryan RN that every nurse should rotate through all areas of the unit with the exception of the new grads who need probably 3-6 months of main ER training before they go to triage or critical care. Both areas would simply overwhelm people who aren't "in the rhythm yet" and this varies with each individual nurse.

    I think letting someone stay only in one area contributes to burn out of the entire unit staff.

    Disagree with Ryan about fast track: its part of the ER!
    sandypalma likes this.
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    I think the veteran nurse is entitled to slow it down if she wants. The other nurse.....you have no idea what deal he has made with management or if they are accommodating a disability.......a disability that no one needs to foreclose to the staff.

    I liked the treat em and street em of fast track but it can be exhausting with angry patients and angry parents for having to wait before being seen.

    I've had a shoulder injury be a heart attack, knee pain turn into septic arthritis, a guy who fell in the woods and a stick up his nose flown to the medical center because it was actually in his brain, and a guy getting stitches for a head lac after falling in the BR end up in halo traction for his broken neck.......to name a few. It's not that the triage was not done properly......it's that humans beings are unique and defacation occurs.

    OP if you want to work Fast Track/Urgent care as your charge or manager. But your co-worker may be there for other reasons than he can't hack the main room......maybe he just asked and they said OK.

    I think it takes a special skill to calm a parent with their childs frist chin lac that this is a survivable injury after a 3 hour wait.

    I wish you the best!
    Susie2310 likes this.


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