Quote from JustKeepSmiling
1. Slow with tasking IV/labs/cath/EKG while simultaneously going through the questions for the chief complaint. I can dart in a 18g, draw my labs, 12lead, in & out cath and get monitoring on in less than 15minutes but I just don't "know" all the things for each different variety chief complaint to ask and when I have enough data for EM needs.
*for this I would be eternally grateful if anyone has chief complaint quick reference guides or example order sets*
2. Wrapping up charting. So the software is horrible and archaeic and just bad. I'm adjusting, I type 70-80wpm, just remembering where and what ******* F key does what. Learned the enter key on the numeric pad is evil and not equal to the other enter key in terms of functionality and mistakenly deleting entire sections of my charting. I really hate charting at the bedside. I'd rather chart at the desk. Thoughts?
3. Speaking of charting- if I did a damn neuro exam but charted under neuro reassess and not the abbreviated mini NIH tab (which is way less info but the SAME as in other too) I got a nastygram for it. Bc surveyors might miss it under that other title. SPARE ME PENCIL PUSHER.
Honestly, it sounds like you're developing a better handle on things than you give yourself credit for.
1. As far as everything that needs to be done right away - - I feel your pain. I really can't imagine doing it in a timely manner without techs. Some of these people take 10 minutes to sit on the dang stretcher and get the gown on. However, you will learn to multitask and ask pertinent questions while getting the important tasks done quickly.
Regarding "quick reference guides" - - I agree with the text mentioned above. My personal preference in mentoring nurses new to the ED, though, is to focus on the thinking behind what we're doing. I understand the desire for some sort of guide i.e. what to do for "chest pain", "abdominal pain", etc. The problem is, that isn't foolproof, and isn't as good at helping develop the ED version of critical thinking. I encourage you to aim for developing into a ED RN who is a "thinker and do-er" rather than a "task-er", if that makes sense. I've seen places where they give out big binders with pages for each condition which contains a list of "what to do" - - the problem is, for someone without ED experience, how do you know if you should pick the "diverticulitis" page or the "incarcerated hernia" page or the "UTI" page or the "nephrolithiasis" page or the "leaking AAA" page?? Some of the initial steps related to these things might be similar, but there's a lot of knowledge involved in knowing which way to head first. We do new ED nurses a disservice by not aiming to help them broaden their knowledge base first and foremost. You have a lot of experience to draw from so you're in a great position. I believe that better care is ultimately rendered by those who choose to learn how to think in the environment in which they're working (so long as they can also get things done in a timely manner).
2. Unless I am involved in a situation that requires 1:1 care or doing meds/allergies and PMH, etc., I don't chart too much at the bedside. Personal preference. I find it too distracting (esp patient/visitor conversations/TV/phones/kids running around, etc) and prefer to be focused on the patient or else not in the room.
3. Agree. And I do not double chart anything. It's against my religion. Over time you will learn the preferred area for charting various things and will get better at putting it where they want it, but I usually chart it in the most sensible/accessible/convenient area and leave it at that. Sometimes I will go to an area that I know is being tracked and make a note that says "see neuro exam." Simply because it's the principle of it. I've already charted it somewhere else that I was told I needed to chart it. Done.
As to your ultimate question - what is most important to me? Critical thinking. My recommendation related to this would be to get a good text like the one mentioned or the CEN book and study @ home. Take even ½ hr each day and review the conditions you encountered that day at work.
Best of luck!! And I DO think you will do just fine!