Graduate nurse: difficulty finding job.. Emergency Medical Scribe Experience - page 2

I've been reading and hearing about many graduate nurses both new and old who face a difficult time finding a job and experience for a while. I'm not sure if this may help or not, but if you feel as... Read More

  1. by   qcc2011grad
    Aniva your reply and comment was very professional and by going on and beyond to describe an example helps clarify the actual job description . I also believe that you can learn a lot , it will help you imo to be present to listen , clarify and most importantly document. This is vital in the nursing profession. I am going to look into it knowledge is power ,but more importantly it helps you the rationales will support and enhance your knowledge in pharmacology , as stated before you also become a better listener.
  2. by   qcc2011grad
    Aniva I am looking into it but my hospital doesn't seen to offer it . When I google Medical Scribe I get hiring agencies . how should I go about it should I ask the nurse manager . I would love to do medical scribe part time . Please pm me if you have time so we can chat . Thanks
  3. by   Aniva
    Yes, having emergency medical scribes is a relatively new addition to the emergency team. A lot of people have never heard of a scribe, until they've been to hospitals that have them and figure out the person tailing the attending is the scribe haha. The hospital I was in never posted the position on their "jobs available" list online. They contract with a third party, which was EMSS. I had to apply to the website and tell them where I was interested in applying to. This particular company was based in California (and there are more hospitals they contract with down there). There was one in Ohio/Michigan - where I was at, and some on the east coast. Since you live in the NY area, I think they contract with some hospitals there, but you may have to contact them to make sure.

    Join Our Team

    I saw a posting at a Johnson City, NY:

    If you can get a hold of these third party companies, I would contact them to see if there are any opportunities in the area. OR you can directly contact someone from the hospital (maybe someone in the administrative offices of the ER). They can tell you if they have scribes and who to contact (In house program director, or company manager). Play around with the search item as well. Try all the different titles: "Scribe" "Medical Scribe" "Emergency Medical Scribe" "ED scribe", etc...

    Here's an article about scribes from the Los Angeles Times:
    Medical Scribe | Scribes are doctors' tech support - Los Angeles Times

    I hope you find a position If you land a scribe job, I hope you see and learn a lot. It can also help you network for future nursing job! Good luck!
    __________________________________________________ _____________________________

    I also realized that what I previously mentioned could be an avenue for knowledge as well. The HIT/HIMS profession is exploding right now and one operational area within the department is medical transcription. You get get similar experience by "transcribing" or writing down the providers dictation/recording via phone. So in a way, you hear a good basic summary of what went on during that patient encounter. I feel this is an alternative, but not as strong as the scribing position because 1)you're not seeing the patient (VERY important in nursing/medicine), 2) the charting details may not be available (e.g. strong history taking), 3) you're stuck in an office... (although if you like this option, then that's awesome- - you may also be able to work at home if the hospital allows it..).
  4. by   Aniva
    Also, if they don't have a position open at the time, keep checking. the turn over can be quick if not annually. All scribes on my team were students. Moving around for various reason goes along with that life, so a training round may start when you least expect it...
  5. by   Aniva
  6. by   qcc2011grad
    Thank you so much .
  7. by   Esme12
    Quote from Anivia
    Here's an example of a scenario working with a provider during a patient encounter: Enjoy!

    Dr. John: Hello. How are you today? What brings you to the ER today?
    Patient (pt.): I've had this horrible cough, fever, nasal congestion, pain in my face, and runny nose. I'm miserable.
    Scribe writes: 36 y/o F c/o cough, fever, nasal congestion, facial pain, and rhinorrhea. (age and sex on the triage note)

    Dr. John: How long has this been happening?
    Pt.: About a week or so
    Scribe writes: pt. c/o cough, fever, nasal congestion, facial pain, and rhinorrhea x 1 week.

    Dr. John: Any bad headaches, vomiting, nausea, chest pain, abdominal pain, difficulty breathing?
    Pt.: No (to each)
    Scribe writes: Denies HA, V/N, Chest pain, and. pain, dyspnea.

    Dr. John: Anything make it better or worse?
    Pt.: Oh Doc, I've tried everything... Nothing works.
    Scribe writes: No modifying factors leading to improvement of sx.

    Dr. John: Have you taken anything recently?
    Pt.: Just some Motrin before coming.
    Scribe writes: Pt. took Motrin prior to arrival.

    Dr. John: Are you allergic to any medication?
    Pt.: No
    Scribe writes: NKDA

    Dr. John: Any prior medical history (e.g. asthma, COPD), surgical history, or family history?
    Pt.: I had my tonsils removed when I was young.
    Scribe writes: [under surgical hx] tonsillectomy

    Dr. John: O.k. now I'm just going to look you over and you make hear me babbling about what I find, but that's for [your name] to help me document. ...this is where you'd write down the physical exam (exactly what they tell you-usually the positives and significant negatives), an end medical management piece (which they also tell you):

    Scribe writes:
    Pt. has mild tenderness to the frontal sinuses upon palpation, nasal congestion, mildly erythematous turbinates, and clear discharge from bilateral nares. Oropharynx exam has post nasal drainage, no uvular deviation or oral petechiae. Bilateral TM clear and normal. Anterior lymphadenopathy. Lungs clear to auscultation, no wheezing, or consolidation. All vitals stable.

    No indication for XR/CT scan, labs.

    Final dx: Acute Sinusitis
    Discharge: home

    Pt. to be discharged with script for antibiotic (Dr. will do this himself).

    If sx. worsen or does not improve, return to E.R. or see PCP. Follow up with PCP in 2-3 days.
    __________________________________________________ ____
    Scribe signs and makes sure the Dr. Signs. IF the provider doesn't sign the chart or is missing something, it will be checked by someone in the HIM dept. and sent back to the provider. Sometimes when a resident is charting and they forget to sign or forget the entire physical exam/medical management, the chart is sent to the attending and they have to redo the entire chart (whether they remember the patient or not. they probably didn't take care of him/her either..). Any order are separately done by the provider (depending on the policy, you can note that or not). Consults can be charted with the medical management (e.g. at 1405, Spoke with Dr. Name in Ortho services. Dr. Name reviewed the XR and saw pt. in the ER at 1420. Dr. Name comfortable with discharging pt. and following up with him on an outpatient basis".
    I totally understand what a scribe is and I meant no offense but since when does the MD not write their own H&P. I have been a nurse for 33 years all critical care, emergency medicine, trauma flight, cath lab.....I began nursing when we gave our Chairs to the MD and "fetched" their charts for them and carried the charts for the MD on "rounds" and took notes for every patient for the busy being a part of the "team" in the patients care and able to make independent decisions for the patient's care and the thought of walking behind them AGAIN and writing down everything they say.....doesn't sit well with me. I am still cautious about the legality of having a license when the MD is sued for malpractice and you are his "scribe", secretary or personal assistant and being held legally liable as well..

    Power to whomever has this position.....I will however remain skeptical. I see how it provides you with some experience and it is a job. I am just unsure how this will play out.
  8. by   Aniva
    Duly noted
  9. by   HouTx
    I tend to agree with Esme12 - this is yet another ploy by physicians to avoid changing their practice despite the very clear evidence that patient safety improves when physicians assume responsibility for their own orders & documentation. Sheesh.

    It also adds more expense to the health care process by inserting another job into the mix - I assume these folks want to be paid, right? IMHO, this is not a 'naturally evolved' position like the 'monitor wranglers' in endoscopy... those positions came about because of the new tasks and new work that is needed to support laparoscopy. Nope - in this case, physician documentation is not new - it just changed modalities. What's next?? A "hand scrubber" to handle all that time consuming pre-op stuff so the 'busy surgeon' can use her/his time more effectively? Physicians have to become part of the team rather than simply interested bystanders. If not, they're not going to survive the reimbursement changes under value-based purchasing.

    My organization is not permitting scribes, and I am very happy about that. Physicians are expected to interact with the electronic records just like everyone else.
  10. by   Aniva
    My intention for starting this thread was not to weed out animosity towards scribes, physicians/providers, or other positions. You can always start another thread for that. This was to provide another option of experience for students or new grads and whether or not they look into it is their own agenda. Any suggestions to help them would be most welcome. Good luck to those still on the hunt
  11. by   Esme12
    I hear you........I had NEVER heard of a "scribe" before. I was taken aback. I am still unsure about a licensed person's responsibility when taking notes and the legality involved if the MD gets sued what is the "scribes" responsibility if they are licensed. I never intended to hijack the thread. Peace.
  12. by   Skyia
    Hey Aniva! I just wanted to say that I came across your posting a while ago because I was also having THE worst time finding a new graduate nursing posiiton. I did more research and applied to a position that had an opening for a scribe. I had to relocate and the pay wasn't great, but I've learned SO MUCH!! I'm so much happier now and to think I almost gave up on the medical field! Thank you so much for the information, it was a blessing for me!
  13. by   Pneumothorax
    Quote from Aniva
    I've been reading and hearing about many graduate nurses both new and old who face a difficult time finding a job and experience for a while. I'm not sure if this may help or not, but if you feel as if you've applied to the jobs in the nursing avenue (RN, CNA, etc.), there is another avenue to look into.

    The emergency medical scribe is a position where you (as a scribe) follow a provider in the emergency room and complete all the documentation (paper based or EMR). The pay is not as good as a nurses, but the experience more than makes up for it. You get to see everything the providers see without the liability. See everything, write everything, learn everything! They teach you why they do certain tests and symptoms of various pathologies (when it's not busy). Through working as a scribe, you get a very solid grasp of how things flow and more medical management. Some hospitals have these scribe programs in-house, but many hospitals contract with third party companies. (e.g. EMSS). (by the way, if you have clinical/nursing knowledge, you will have an advantage over other scribe applicants unless the program only wants medical students... but most programs hire undergrads who are going into nursing, NP programs, PA program, or medical (premed) students). If you can write down the conversation between the physician and patient, you can take a good history = you can be a great scribe.

    I understand that to some, this is not the ideal RN experience because you will never flush and IV line or administer medication (you don't get to touch the patient); however, the experience gained is powerful. The experience you gain after working as a scribe with a nursing background is a potent combination that puts you in the mindset of a provider. This is the type of "wisdom" older nurses learn through the years. After working just one or two years, you may know and see things a "seasoned" nurse knows (or more).

    After I graduated nursing school a few years ago, I had a very difficult time finding an RN position. I was applying to numerous positions that were not the most favored... When I applied to these positions, there was an internal conflict... I knew the position was experience, but I also knew it was not the best experience. It's very disheartening when you apply for many jobs and fail to catch a break. It's an absolutely horrible feeling to know you're a smart and kind hard worker, but cannot get others to see that and give you a chance. For those who are going through this, I understand how you feel and there are a lot who have felt/are feeling the same way.

    Fortunately, someone referred me to the scribe position at a local hospital. I've never heard of a medical scribe, but I figured, I'd apply. I am extremely grateful for the referral and I loved being a scribe. I was accepted into an MSN program and working my way towards being an FNP. The scribe experience has given me such an edge in the MSN clinicals and it has help me "think" like a provider. When I was scribing, I've had various residents, PA students, and NP students inquire about working as a scribe (because they've never heard of it) and they would comment on how wonderful the experience was saying, "I wish they had that when I was in school" or "I wish I had known about this..". I wouldn't hesitate to work part time as a scribe while I'm working as an NP in the future. One ER attending I really admired once told me prior to leaving, "You never stop learning and seeing new things. Even after working ## years in the ER, I'm still learning. I hope you got to see a lot during your time here and I hope you get to see so much more." This opportunity has changed my life and without it, I don't know where I would be or who I would be... I really want to extend a hand to others who have struggled to find that "golden" experience. A hand to pull you out of a spiraling vortex of the RN job search and to a different safety ground.
    excellent advice. thank you so much!