What do you do first, besides "ABC"? - page 3

by prnqday

4,235 Views | 25 Comments

My biggest challenge in the ED is prioritizing. I always use the ABC as a rule of thumb, however I still feel overwhelmed with the other tasks such as discharging, admitting, and receiving patients. For an example: When I... Read More


  1. 1
    So you guys are answering specifically to a situation without specifics. Is the new patient unstable? We don't know. Has the new patient been seen by an RN? We don't know. Is the discharge ready to go (ie dressed)? We don't know. Is the department slammed and the CN desperate for rooms? We don't know. Is there a pod buddy that could discharge your patient real quick? We don't know.

    My concern and the reason for the "ugh" was what sounded like bad practice to me and you are defending it using specifics we don't know. Should you always wait for the MD to see the patient...you agree no right? Should you always wait to discharge so not to receive a new patient...you agree no right? That was my point, not that in this specific example without the needed details is it the right thing to do...we don't know.

    I hope this makes a little more sense and in no way was I trying to offend anyone...
    Altra likes this.
  2. 2
    Okay- I agree with you completely. You're right in the sense that prioritization is not clear cut and entirely dependent on the situation. But I think the OP is aware of that. Patient in respiratory distress, or discharge? It's clear cut. I think OP was asking for help in the situations that are not so black and white. And so maybe I should have been clearer. It's the "in between" patients where I think new ER RNs can get lost. And so- when in a situation where you're facing the known (discharged patient) vs the unknown (patient either triaged or not- but you yourself have not seen)- I always go with seeing the unknown first. Triage helps, sure. But not every nurse does a great job at triaging. Vitals only tell you so much. The triage could be three hours old. Abdominal pain could be a ruptured app or a bellyache. You see where I'm going. In a case where you simply don't know what you're going to walk into- that comes first. I think when I started in the ED I had a tendency to take things for granted. Triage note looks good- patient can wait. But I've learned the hard way that things in the ED are not always what they seem. And that things can change on you in a millisecond. So Larry I apologize and we can agree that learning ER judgement is something that comes with time and experience. Until then, the OP needs to err on the side of caution. Which means discharging your patient, while maybe the charge nurses first priority, is not and should not be the primary nurses priority. Obv there are exceptions. Asthma attack and not a single room in the ED? Get em out. But I think u get my point.
    prnqday and Larry77 like this.
  3. 0
    Again agree with Larry77 ... this "new patient" scenario/fear is too vague for meaningful discussion and meaningful guidance for the OP. If this new patient has come through triage -- unless your ED is horribly dysfunctional and unsafe, you will be given a heads up if the patient is presenting with something potentially unstable or has an immediate need. Otherwise, they can likely wait.

    On the other hand, is the new patient arriving via EMS and EMS is standing there waiting so that they can give you report and hand off the patient? It is a priority to get report from them and get them back out into service.

    The OP needs specific guidance on how to refine her thought processes.
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    so I've been a nurse for a year and a half.. first year spent at a small hospital, and I've been at a huge level 1 trauma center for 6 months now. I still feel like a new grad most of the time. .. One good approach that I think works well is when a patient gets put in your room, if you have something else you have to do, go introduce yourself, give them a hospital gown and tell them to change. This give you a chance to do a quick "across the room" assessment and to figure out why they are there. then tell them you'll be back in.

    Moving the meat is right, as terrible as it sounds. in one way, because most EDs track how long it takes you to d/c your patients, and secondly, where I work, the charge nurses put your next patient outside your room within 10 minutes of your patient being up for discharge. There isn't time to dilly-dally around.
    I still try to pay attention to get tips on prioritization and just keeping up wtih a massive, fast load, but I figure being with my sickest patient that needs me the most can't fail me.
    prnqday likes this.
  5. 0
    Never underestimate the power of a quick look. If there is a new pt, you can introduce yourself, ask how they are feeling, maybe even listen to lung and heart sounds in like 60 sec. You can use that give you idea of what you need to prioritize. Give a little quick look...ok they are stable...d/c the other pt.
  6. 0
    Everyone is giving such great ideas. Thanks!!!!


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