Fast Track Nursing

Altra, BSN, RN · Aug 14, 2012

I've never been a fan of the attitude that ... if you're not up to your wrists in blood, or wrestling a drunk, or running multiple drips ... you're somehow less of a nurse. There's a great deal of patient education that goes on with many "fast track" patients ... something that a nurse who only deals with the combative and the unconscious might not deal with too well.

And when you've been an ER nurse double or triple or quadruple the length of your current tenure, you may see that skills and talents ebb and flow over the course of a typical 40-year career.

emtb2rn, BSN, RN, EMT-B · Aug 14, 2012

We have 1 rn who works only fast track. She's been an er rn for over 30 years. She doesn't want to work the main er anymore. She's awesome and is an incredible resource. Our boss was smart to make the fast track only deal and hang on to this rn.

Fast track is just that. Fast. Nope, they're not all real sick but sometimes some of them are. On sunday, monday & tuesday, fast track can be the toughest assignment drawn as the volumes are huge and the line of pts never ends.

Maybe your manager doesn't think you're ready.

Ryan RN · Aug 14, 2012

One of my coworkers only does fast track. Been in the ER about the same amount of time i have been. He cannot handle the main ER but handles fast track just fine.If you can do the main without any problems, fast track is a piece of cake. Dont think it works the same the other way around. Maybe its just me.I just think that everybody should be rotated. Its all one big unit. I can kind of understand somebody whos been doing it for like 100 years but if youre one of the youngest in the ER and all you do is fast track, there isnsomething wrong

Anna Flaxis, BSN, RN · Aug 14, 2012

I can't tell you how many times I have had people mis-triaged into Fast Track, who were NOT Fast Track patients at all! When you only have one RN, one Tech, and one MD running the zone, things can get dicey. Just as with any clinic, people can and do code. People can walk through the door with a sodium of 109, or with a complicated infection that requires hospital admission. Remember that in triage, the nurse is making a quick judgment based upon chief complaint, objective and subjective s/s, and vital signs. Severely ill people can and often do look completely fine on the surface, and it isn't until you delve deeper that you realize they're sicker than they look.

Because of this, and because of the state of health care today, in which access to preventive health services is severely limited, and so people wait until they're really sick before seeking medical assistance, Fast Track nursing is most definitely ED nursing.

If you want to be assigned to Fast Track, tell your charge. Maybe they haven't put you there because they don't think you want to do it.

Altra, BSN, RN · Aug 14, 2012

fast track is a piece of cake.

Are you sure about that?

Low acuity patients from the waiting room have typically waited 1 - 6 hours before being seen where I work ... they're already ticked off before you even say hello. Fast track is also the land of "I'm going out to smoke" and they x-ray tech coming to tell you that "Room 18 won't go to xray - he says he wants more pain meds" ... and a million other difficulties that are far less likely with your main ED patient who is lying on a stretcher hooked up to a monitor.

Something to think about.

But I agree wholeheartedly with ~Stargazer~ -- if you want to be assigned to fast track -- say so.

PS -- I've worked in an ER where there were a few dedicated minor care nurses. Believe me when I say it was not because "something was wrong" with either of them. They had all been paramedics and critical care nurses prior to coming to the ER.

rangerlil · Aug 15, 2012

In the ER I work at, all new grads and new hires start in the fast track/minor areas as well as the medicine holding area.

I once came on shift and was told "oh that patient in the chair is just waiting for the results of her abdo CT, her pain is better now". So, I went to assess another patient first and came out of the room to find a whole bunch of my coworkers rushing around with shocked looks on their faces - the radiologist had called and the patient had an abdominal aortic aneurysm that required immediate surgery to prevent rupturing.

At least in the higher acuity areas you know the patients are sick but the fast track patients can be really deceiving..... I think fast track nursing is a good test of assessment and critical thinking skills, especially because of the volume and complaining:)

Anna Flaxis, BSN, RN · Aug 15, 2012

PS -- I've worked in an ER where there were a few dedicated minor care nurses. Believe me when I say it was not because "something was wrong" with either of them. They had all been paramedics and critical care nurses prior to coming to the ER.

I believe it. I kind of liked working FT every once in a while, because it gave me a break from the Acuity 3s. Give me a 1, 2, or 4 any day. The 3s are the ones who are just sick enough to be legit, but not too sick to pester you for sandwiches and blankets. In FT, we don't even gown em. ;p

Unfortunately, I tend to be a poop magnet, so when I worked FT, I often ended up with a lot of mis-triages, or with ambulances because all the other beds were full. I remember the kid who came in through the lobby for arm pain s/p fall from tractor. The triage nurse must not have even looked at the arm, because the kid still had his coat on. When I had him take it off, the deformity was mind-bogglingly obvious. We ended up doing a peds conscious sedation in Fast Track. A guy came in for I don't remember what, but it was some kind of hangnail type thing, and he turned out to be septic. Another time I got an ambulance that was supposedly just a mild fender bender, but it turned out to be a wheelchair bound medically complex child, and the accident was a head on car vs. telephone pole at 50MPH.

You just never know what's going to come through the door, even in Fast Track!

Ryan RN · Aug 15, 2012

I believe triage is one of the more challenging section of the ED. Do it properly and everybody moves smoothly, in and out. Do it poorly and you risk putting bs patients into the main while leaving the real patients waiting in the waiting room. I understand that triage is supposed to be a quick process, but that extra minute or 2 can save a patient an hr or 2 wait when in the wrong dept.

Anna Flaxis, BSN, RN · Aug 15, 2012

That's why they don't let nurses triage in my ED until they have a year experience and have taken a course.

hiddencatRN, BSN, RN · Aug 15, 2012

I've never been a fan of the attitude that ... if you're not up to your wrists in blood, or wrestling a drunk, or running multiple drips ... you're somehow less of a nurse.

Yeah, it smacks of machismo.

We rotate all around although they used to have a couple of "fast track only" nurses. Fast track days can be easy or hellish. But high acuity assignments can be the same.

And I just wanted to add- even experienced nurses can make mistakes or have a sneakily ill patient slip past to fast track, so only allowing experienced nurses to triage doesn't guarantee that your fast track patients will always be fast track worthy.

Hagabel · Aug 16, 2012

Fast Track is always a bit crazy in our dept and certainly not an easier assignment. 6 cubicles (no bedded pts allowed) and always a new pt in and out. Our pts wait in the w room, come in for treatment/eval and then go back to the w room waiting on tests, with IV's etc.

Our ED has 6 different areas and only experienced nurses do Triage and Resus. Other areas include adult cubicles (main ed), pediatric ed, short stay adults and kids (separate areas), consult (FT), triage and resus.

Stops you getting bored and keeps you skills up in all different areas.