ER Prioritizing/communication help please!

[cmarn]

Hi folks! I am a 6yr nurse who recently transitioned to the ER. I am a perfectionist, like to have a plan, and believe communication is an essential part of medical care. (some of you are probably laughing...knowing where I am headed with this). I am hoping that some of you have some helpful tips. My biggest concerns are:

Communication

1. When I am with an acute patient providing care, other patients are being put in my rooms, my name being put in the computer as the patient's nurse, and no assessment is done. I am not told that I have a new patient. Now...I know it's my responsibilty to keep track of these things BUT sometimes if I am with chest pain protocol, a tough IV, etc. it could be a while before I can check my other rooms. I have started making notes on these charts stating "assessment completed upon my knowledge of patient placement in room".

2. Admissions. Patients are being admitted and assigned rooms and I am never told. There is a lot to do to prep the patient for the floor and we take them up ourselves. I just feel like I need to be made aware and other nurses who might not be as busy could put meds in the computer, update vitals, etc. Again, I try to keep up but if I'm busy it might be a while.

3. Teamwork. If I am slammed and a chart is put in the rack with orders...why do other nurses sit at the desk talking and snacking? I don't understand. Shouldn't the charge nurse encourage others to help if another nurse is busy? It would be ideal if the charge or secretary could page us when we have new orders/admissions. Also, how to get the CNA's to help with updating vitals, getting urine specimens, EKGs, etc.

4. Organization. I could just use some general tips in how to be more efficient with my time...save a few steps. Are there things I can do to feel like I have a better handle on all of my rooms at once?

Thanks for helping!

[cmarn]

Murphyle

Great response! I do think that a lot of this will come with time. I've also realized that I spend a lot of time resisting the system in my mind because I can see its faults. That probably keeps me from thinking clearly at times so I need to let it go for now.

I feel like I spend a lot of time trying to figure out who has the chart, does my patient have new orders, has the doc been in...etc. It is a huge communication issue. We all carry hospital issued cells so I'm not sure why it is so difficult. We have face to face report from ED to floor so I am not sure why we don't do that when a patient is brought from triage. Some people will put a patient in and assess them. Others drop them off and disappear.

I just feel lost a lot of the time.

Quick example of useless chaos....

Had 2 critical paitents/1 treat and street. I'm in with one of the new rescues(critical, very critical) working her up, starting an IV, drawing labs, etc. My phone rings and its the front desk saying "room 8 is calling out..(the non critical)" I tell her to let charge know I can't go right now. Five minutes later...my phone rings and it's charge "room 8 is calling out"..So, I take a sec and check on room 8. He wants to know when he is going to be discharged! Go to the desk and let them know again that I'm with a critical patient and room 8 doesn't have any orders yet. Back to my new critical patient...Phone rings again. Room 8....Are you serious??? I step out and room 8 says...when am I going home. I explain that I am with a critical patient and he needs to limit use of the call bell to emergencies.

Now, in my mind the charge knew about my rescue (she's the one that told me the patient was coming to my room), the front desk knew I was busy. Where is the teamwork? I've just gotta find the right recipe for prioritizing and time management. I felt like I wasted a lot of time with a non critical patient and that I didn't have the support I needed from coworkers. I'll figure this out eventually. Maybe one day I'll be able to give someone else advice :)

[Hagabel]

CMARN,

You have the same frustrations that I have as a nurse with 20 years experience and 8 years in the ER!!

If you are not getting any luck with the other nurses or charge assisting you with your other pts when you have a really sick/busy pt then you may have to approach the next person in the chain of command. That may be your unit supervisor or manager.

You appropriately explained to your other pt appropriate use of the call bell but really someone else should be answering that for you and obviously your secratary or whoever answers the call bell was not communicating effectively with you or the charge nurse.

Hang in there.

:)