I graduated in May and will be starting my first job as an ED nurse next week. I was wondering if any of you experienced ED nurses could share with me initial assessments that you have found to prove helpful over the years. I had the opportunity to shadow a RN before I accepted the position and he had a really good flow with his questions that he asked his patients. After 6 years in the ED, he made it look like it was as simple as putting on your pants in the morning.
Any advice you could give me would be greatly appreciated!
Sep 3, '12
A bunch of random things:
My most difficult thing coming from ICU was getting to the point where I wasn't anal retentive and obsessive about every detail. Nursing school makes you obsess over details. In the real world and especially the ER, details are great if they are relevant... but many people provide lots of info that has nothing to do with what you are concerned with. (E.g. in triage, "What brings you in today?" can start off a story like, "Well I was at my uncle bob's a couple of months ago and he had a sandwich and I like blue posters and....[ten years later, talking but still no answer]." Ok... so, again... why are you here today?)
Consider your chief complaint and ask yourself... is this detail important? Do I need to follow up on this? Redirect the patient if they get off track and focus on the NOW. Your focus in the ER is NOW. You don't need to be rude, but cultivate the art of turning the conversation towards the issues at hand. You deal with chief complaint and potentially life threatening issues. If they come in complaining of a stubbed toe or jock itch but their BP is 220/125 or 82/40... which is your priority, the CC or the BP? If they come in saying they want a refill of their clonazepam, and can you do a pregnancy test, and can you check their BG because they're peeing a lot and last time this happened they ended up in ICU, which is your priority? You will have patients where your major concerns are not even on the patient's radar, and vice versa..
You will develop assessment skills as time goes on. I used (and still use) our charting system's templates for each variety of chief complaint as a cue to remind me what to ask. Know your body systems, especially neuro, cardiovascular, and respiratory. Problems with these systems can make your patients crash very quickly if not caught soon enough.
Review how to do a basic neuro exam. Review signs/symptoms and treatment of common but potentially life threatening conditions that should always be in your differential depending on chief complaint (off the top of my head, especially MI, COPD, PE, pneumothorax, A-fib, CVA, renal failure, status epilepticus, aortic dissection).
See your sickest patients first. Put the patient on the monitor if you think the issue is serious; treat the patient and not the monitor, but the monitor is a great thing to have sometimes and has saved or alerted me many times (it has also irritated the hell out of me for no reason an equal number of times.)
For psych patients, you need to do a medical screening but also remember that the environment can provide lots of life-threatening utensils if they are really suicidal. Patients can try to kill themselves and/or staff with monitor cables, bedsheets, trashbags, metal forks. Always assess your environment (takes no time but frequently ignored).
Your hospital should put you through a critical care course to help you review info about patho diagnosis and management as well as assessment.
Last edit by apocatastasis on Sep 3, '12