ED Tech here - Tips for being the most helpful to nurses?

libran1984, ASN, RN · Dec 17, 2013

**Grab an EKG immediately when the pt presents with any of the following:

1. 65yo +

2. Dizziness (50yo +)

3. Syncope / Seizure

4. CP

5. SoB

6. suspected stroke

7. HTN with SBP 180+

8. Dialysis patients (especially if they're older like 50+)

Be proactive!!! Even if you don't have the order for it, hook them up to the monitor and wait for the order until you hit the EKG NOW button.

**Don't do a blood draw without first consulting the RN or overseeing LPN/Medic (my ER has both LPNs and Medics). It may make more sense to put in an IV rather than straight stick.

**Get urine ASAP for any of the following conditions

1) Female of child bearing age

2) Abdominal pain

3) Dysuria

4) STD check

5) Altered mental status (although a bedside commode might be preferable with someone in the room to standby)

6) Overdose / Substance abuse / alcoholism

*** If you do a straight stick for blood alcohol (and for some reason they aren't getting an IV), always use castile soap or non-alcoholic skin cleanser.

*** Make hourly rounds on XYZ patients to improve satisfaction and reduce call lights

*** Obtain Orthostatics with vertigo/dizziness

*** For any adult eye condition or injury obtain an visual acuity asap.

*** When you are finished cleaning the room, and if you by chance only use fitted sheets, put 1-2 cloth chuck pads on top in case the next pt is an incontinent elderly person or a vag bleed.

*** Grab an accucheck on the following:

1) suspected stroke

2) altered mental status

3) and all that other diabetic stuff.

*** Preemptively set up for a pelvic exam for all females complaining of discharge, lady partsl bleeding, STD check, etc.

*** If a pt has a fever, do not hand them blankets. Repeatedly Cover their hands and feet with multiple footies. This tricks the hypothalmus into thinking it has reached its new set temperature, but the body is still dispelling most of the heat from the torso, head, etc. It actually works!

*** When an ambulance is coming, get all the VS stuff set up at bedside, position and raise the bed for the medics, ENSURE CHUCK PADS ARE ON THE BED (and if it is a stroke, have your accucheck handy!)

*** Obtain Fetal Heart Tones on any pregnant woman 12+ weeks as long as they are there for a non-pregnancy related problem. So no abdominal pains, no vag bleeds, just don't do it if you think there is a chance of miscarriage. You don't want the mom to find out bad news like that. Only if they come in complaining of neck pain after an MVC or something like that.

Okay, that is all I can think of at this time. Remember to tell all ambulatory patients you walk back to get a CCMS urine specimen and to gown up!

emergency_love · Dec 17, 2013

Thank you so much for taking the time out to make this list! It was very helpful.

Just out of curiosity, is it helpful for me to say to an RN, "Hey, I updated the vitals on all your rooms, and got urine for pt X and sent it off" -- or just leave them alone and let them see it on the charting? I feel like sometimes when I do this it's like saying "HEY LOOK AT ALL THIS STUFF I DID FOR YOU! GIVE ME PRAISE!" Some RNs are like "Thanks SO much!!" and others look at me like, "cool story bro" so I don't know if I should be announcing the tasks I've completed...?

libran1984, ASN, RN · Dec 17, 2013

Thank you so much for taking the time out to make this list! It was very helpful. Just out of curiosity is it helpful for me to say to an RN, "Hey, I updated the vitals on all your rooms, and got urine for pt X and sent it off" -- or just leave them alone and let them see it on the charting? I feel like sometimes when I do this it's like saying "HEY LOOK AT ALL THIS STUFF I DID FOR YOU! GIVE ME PRAISE!" Some RNs are like "Thanks SO much!!" and others look at me like, "cool story bro" so I don't know if I should be announcing the tasks I've completed...?[/quote']
You should verbally reinforce w/e u chart for clarification as is my opinion

Nurseadam · Dec 17, 2013

do EKGs as much as possible if you're not busy, take vitals n put them in (tell me you did) I will so appreciate it. empty urinals, help patients to the bathroom or bed commodes, always ask the RNs if they need help even if you're feeling lazy that day, 8 out if 10 they'll say no. if you're not sure if u need to hook up someone to the monitor or do EKG, ASK, it's nothin wrong in asking. 99% of the time patients need IVs, if you see the RN busy; place one n send the blood off or hand it to the RN if that's in your scope of practice.

1fastRN · Dec 17, 2013

I think the first poster hit the nail on the head! Be proactive!

It comes with experience but you'll be able to "anticipate" what is needed for each patient depending on their chief complaint.

I have some great techs that I work with, it's a team effort. Then I have some that are lazy and play dumb.... they'll wait for me to ask (even on silly things) when I KNOW they know better. I hate when a new patient comes in, even on a slow night, and I have to go out of my way to ask the tech to do vitals and help change the patient. Come on, it's common sense!

Chest pain? Get ready for that EKG and placing the pt on the monitor. When a patient comes in via ambulance, get ready to get their vitals. Overhear that the patient is diabetic? Grab the glucometer! It makes the nurses job much easier and the nurses will notice you being proactive.

If you see a patient is being discharged, grab their vital signs and ask the nurse if it's okay if you pull their line. If you assist a patient with urinal or bedpan, ask the nurse if they need a urine specimen. If a female of child bearing age comes in, do a u-preg without the nurse having to ask.

Communicate with your nurses; show respect and you'll get respect. I'm always respectful to my techs... I wouldn't be able to do my job without them. Even on busy nights, don't lose your cool (this actually goes for all members of the team). I hate when I ask a tech to do something (like an EKG) and they roll their eyes at me or act passive aggressive, "ill get to it when i get to it!" Listen, I know you're busy and that's okay... but don't pull at attitude with me because I'm asking you to do your job. Or even worse when techs get irritable in front of a patient, like when a young person comes in and needs an EKG. Yeah, it's probably nothing but we still need to treat them accordingly and do that EKG. Young people can have MIs too.

That being said, I LOVE most of my techs. I work nights and we have great teamwork. I love when my tech is two steps ahead of me. Some nurses will abuse you (although I don't see that so much on nights) but don't let it get to you. Be respectful to everyone, punch in every day and be ready to work. Most importantly, respect the patients. A trip to the ER may seem like no big deal to us because we become immune to it sometimes, but keep in mind these patients are scared and vulnerable. Respect their privacy and keep them informed. Don't just fly into the room with the curtain half open and undress them to do an EKG. Communicate with them and tell them what you are doing. Some of these people think they're having a heart attack so just try to remain calm and explain what you are doing.

Sorry, if that was long winded. I'm sure you will do great! Come in each day with a positive attitude and remember the patient's come first :)

bebbercorn · Dec 17, 2013

I agree with all of the above and have only to add... I love certain aides/techs in our department who just ask "what can I help you with?" It is often the mere action of asking that makes me feel not so busy and that I have support. Way to be proactive!

turnforthenurse, MSN, NP · Dec 17, 2013

Excellent advice in this thread!

OP, what kind of charting do you use? Computer or paper? We have a tracking shell where we can see everyone who is in the ER at the time. There is a little spot where we can put comments, so we usually communicate when labs have been sent or if labs are still needed. I LOVE my techs and we really do have a great team on nights. Our techs are usually always looking at our shell to see who needs line and labs, who needs an EKG or blood sugar check, etc. And yes it's true, some nurses will abuse you and come to you for everything. Just be proactive and you'll eventually get an idea on who needs what as you continue along. Most patients do need an IV and I know you said you cannot place them, but for any blood draw I always draw a rainbow even if the provider only ends up ordering a couple of things. It's better than having to have the patient get re-stuck and if the provider decides to add on some labs later, everything will already be done and you'll just have to wait for the lab to result everything.

Also grab an accucheck on anyone presenting with seizures.

WAheartnurse · Dec 18, 2013

I have never heard a tech ask me if I want help with anything- I would love that. Many techs want to focus on the cool stuff- ekgs, wound care, splinting, etc and get resentful if I ask for urine to be dipped or to bring a bedside commode to a room and help someone produce a urine sample. Heaven forbid if I ask them to enter a set of vitals. Most of the experienced techs work very independently- not necessarily as team facilitators.

The list of tips that libran provided was excellent. I think another tip would just be to notify me if you are going on break or have been pulled to be a sitter. I won't bother you if you are busy or unavailable- and if you don't tell me - don't get huffy if I call you for something while you were on break - I had no idea.

Also, don't get mad if you see me sitting- the only way I can look to see new orders/meds is if I check into my computer frequently and look for them. I also have a lot of charting to do. If I can delegate some tasks, I can pull another patient from the waiting room and get the process going- yes I can and will collect my own urines and toilet my patients but that means I don't have as much time for educating at DC or time to juggle an extra patient.

So a big thank you for trying to be so helpful and looking ahead to make sure we can work together as efficiently as possible. I love working with techs like that and it is the nurses that will work hard to make sure you get hired when you are done with school.

thelema13 · Dec 18, 2013

Just don't be lazy, and don't take any crap from other lazy staff, whether it is a CNA, tech, medic, LPN, RN, etc.

Talk to the ED director now about becoming a staff nurse. Let them know you are interested, enthusiastic and easily trainable. Do the normal HR stuff but personally hand your resume to the manager/director and shake their hand, let them know you are ready to hit the ground running.

And techs aren't the only staff that can do an EKG. I hate seeing a nurse sitting and watching a chest pain roll by, and expecting the tech to do the line, labs, monitor, undressing, EKG and oxygen. I'm sorry, I just, very plainly, do not like lazy.

And, of course, thanks for all that you and all the other techs do!

emergency_love · Dec 18, 2013

I have never heard a tech ask me if I want help with anything

Are you for real? I ask the nurses that so much each shift, I feel as if I'm being annoying like a waiter or waitress that checks on a table too often. Our nurse manager is sort of fierce about having a lot of techs staffed around the clock in the ED, though. There is usually at least one available to help for anything at any given time (shhh, don't tell the higher-ups that we're adequately staffed...). There is a lot of teamwork. We as techs get "room assignments" but I never even look at my assignment. I help out any of the nurses for any of the rooms.

emergency_love · Dec 18, 2013

Excellent advice in this thread!
OP, what kind of charting do you use? Computer or paper? We have a tracking shell where we can see everyone who is in the ER at the time. There is a little spot where we can put comments, so we usually communicate when labs have been sent or if labs are still needed. I LOVE my techs and we really do have a great team on nights. Our techs are usually always looking at our shell to see who needs line and labs, who needs an EKG or blood sugar check, etc.

We have a similar computer system, although with the orders for labs/urine etc. we usually rely on the paper chart to tell us and computer chart when it is complete. I usually stand in front of where the paper charts are and look at what rooms need urine. For rooms that need labs I ask the RN if they are getting it off the IV or if I can do a draw (I always draw a rainbow even if only 1 or 2 are ordered). Any blood cultures, I usually go ahead and grab the first set since the other set will likely be from the IV (unless the IV was started by EMS). I try to stay on top of the EKGs esp those with a 10 minute window for CP. I am slowly getting better at anticipating the needs of the RN and trying not to be asking things constantly.

Just out of curiosity - can your techs start IVs? Is that what you mean when you say "line"? I've never heard of NA's starting IVs before.