[alkaleidi]

I'm on orientation and things are coming much better than I thought. Picking up the more focused assessment, brief admission info, and procedural stuff (lots of IVs, blood draws, etc) is going fine. One thing that I'm struggling with:

When and how to cut someone off when they want to go on and on and on about their issue, no matter how minor or severe. When you have other patients, it's important to know the really important details, but to know that a little old lady's husband started to feel dizzy right about when the big storm was starting to come through, and the sky was all dark and they had heard about hail on the radio earlier... where 'bouts do you live? Did you guys get a lot of rain? Our crops are really doing well this year... yadda yadda yadda...

I love to talk to my patients, and I'll talk about anything if they want to, and I have time, but in the ER that is not the case... I've worked on just politely moving on, changing the subject, continuing with my questioning, or giving them a quick answer to whatever non-medical thing they're talking about, but it seems I keep getting the chatty folks. LOL!

How do you keep fluff conversation at a minimum? I have honestly considered being less nicey-nice and more drill-sgt-nurse just to avoid this, but I don't think I could pull it off... :P

Any suggestions? Hints/help? Thanks in advance!

[angelwingsamy]

thanks for this post! im a nursing student and will probably run into this soon and i would love to see the response to this!

[bill4745]

Sometimes you need to be blunt: "Sir, I really need to focus on exactly why you are here right now, and any major medical problems you may have, so that we can decide how to begin your treatment. We will get all the details later". This usually works for me.

[traumaRUs]

I'm with Bill. I usually say: "why did you come to the ER tonight?" If they get too long-winded or meandering, then I reiterate what's the one symptom or problem that made you decide to come to the ER?" That often helps direct things to what is "different" about the problem tonight.

[CatintheER]

It is very hard to not be rude, as you get more experience you will learn how to read people and at what point you need to cut them off.

Im not very good at it but getting better.

Cat

[biker nurse]

I slowly back out the door and say I 'll be back in a little while, i've got to check something!!!

[emtb2rn]

Run into the same problem pre-hospital. My standard approach is to introduce myself, ask their name and "why did you call 911?". Of course, unresponsive pts are so much easier....

[DiannaK]

Originally Posted by traumaRUs

I'm with Bill. I usually say: "why did you come to the ER tonight?" If they get too long-winded or meandering, then I reiterate what's the one symptom or problem that made you decide to come to the ER?" That often helps direct things to what is "different" about the problem tonight.

I say something very similar to this .....
I also may add, to the pt's who don't want to answer questions, because they are in too much pain, etc, etc ....
"The quicker we get through this process (triage history), the quicker you will be seen by a doctor."

[Anagray]

I am new to the ER and I know how you feel! What I've com to realize is that yes, sometimes it is hard to break conversation, but most people are there to get their problem addressed fairly fast, so I say : I'm sorry, but I have to .....go send your blood, order an x-ray, check your urine, etc... so I can help you as fast as possible. Then they get the message.

as far as obtaining history - I am VERY detail oriented and ER is not the place for that. I know that MD will come in in a few minutes and will interview the patient again, so the only thing I want to really know besides ABCs is relating to their meds, allergies, major illnesses and risk factors.
For example: if a syncopal 45 year old with only 3 medications on his list comes in on a hot day I know even without talking to him that if his VS are good, he is awake and feeling OK he is probably still going to get EKG,monitor, bloods, X-ray and fluid. You would do exact same thing for a person that is 85, but expect this person to be admitted and give meds. Most of the important info usually comes from triage as well.
I try to collect more history when I have time, but I was told very clearly that i am there to stabilize the patient and send them off either home or to the higher level of care.
Another thing that helped me is using resources other than me. For example if i see that an elderly person lives alone, appears dirty and doesn't know their meds I get social work involved.

good luck!
Nat