keeping up with the pace and acuity?

[amzyRN]

I started my orientation about 4 weeks ago and it has been both challenging and extremely difficult. It has been much more difficult than working on the floor (partly because thinking like and ER nurse is new to me). I get the priority part, always stabilizing the sickest patient first (the one that will die the quickest), but what if there are two or three at the same time that start to tank? I know ask for help, but then my more stable patients are discharged by another nurse and a new patient is put in my room who I am responsible for.

I have been working with a great preceptor who has helped guide me in the right direction but in the next 4 to 6 weeks I would like to be able to be somewhat functional on my own. I know I'll hopefully never be on "my own"-with teamwork and all, but nevertheless, I'd like to feel confident that I can have a handle on things.

Any tips to deal with this kind of thing? What goes through your mind when you are working? For those of you who are quick and efficient what's your process for keeping the patients moving quickly?

[Lunah, MSN, RN]

Your scenario illustrates a big challenge in the ED — prioritization in the face of competing priorities. You literally have to go by the ABCs, as in airway-breathing-circulation. If you have multiple patients crumping, it's up to the charge nurse to help spread the love evenly. Just keep communication open with whoever is directing flow, and let them know if you're drowning! It always drove me nuts to have two drain-circlers at the same time, and then charge is all like, "hey, I just put a new chest pain in Room X." Gee, thanks! But a good charge would continue, "EKG done, not a STEMI, so-and-so is getting labs, looks stable." Teamwork, I love it. Good luck!!

[MedicFireRN]

I would say one thing to be sure you do is to help your co-workers when you aren't drowning and they are; makes them more apt to help you because they won't think of you as someone who only does their own work and is on the lazy spectrum.

Your tracking board is your road map. I always badge in to the computer in the room, even if I'm not needing it to chart so that I can keep an eye on what's going on in my other rooms. Set your monitors up to take your BPs and such however often they're needed for each of your patients. I put those vitals in the EHR whenever I go update the patient on their plan of care, and before I leave a room I always assess what I need to do when I leave. To me it's pointless to walk out of a room, to the nurses station, then badge into a computer there, wait for the tracking board to load, then figure out what I'm doing... I make a game plan before I leave the room. If I see I have a new patient in a room, I go assess them. If not, I see what needs to be done in my other rooms.... meds? labs? the key here is to cluster care; make a plan and be sure you have everything you're going to need for the tasks you need to do when you walk into the room. If we are super busy I will go into a room and make a basic nursing note on a patient (I'm a fast typer) instead of doing my head to toe/focused assessment documentations right then. I put just enough for me to remember what I need to elaborate later and chart that assessment. Typically, if I'm that busy it's because I got 4 patients within 5 minutes of each other, which means in about 45 minutes I'm going to be in a holding pattern waiting on labs so I will have time to catch up my charting then. Remember, we do the essentials to keep people alive in the ED. Sometimes because of the acuity of my other patients, the only notes some patients get are "patient continues to come out of room to nurse's station complaining of 8/10 pain, texting on phone when in room, NAD/VSS."

also, urine is like gold. If it's a female of CBA I automatically ask for a urine upon first meeting them. Typically I give them about an hour to produce a sample before they get straight cathed. Not having a urine when it's needed kills your flow.