Graduate nurse: difficulty finding job.. Emergency Medical Scribe Experience

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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.

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Specializes in "Wound care - geriatric care.

Thank you Aniva. I will look into that. I graduated in 2011 and by now I've been looking for over a year. No response at all. I am volunteering at a ER/trauma center in N.Cal. I love the ER. If that does not pan out I will definitively forget about an RN job for now and look elsewhere in the health field. However I'm not sure how I could make my way back into nursing?

I think what's lacking in nursing is a more clear understanding that Nursing is a profession like any other. It takes a long time to get a job and there aren't many jobs. It's a big hype perpetuated by nursing schools and the media. At times there are more jobs but it is not the norm or a permanent situation. I think what make us new grads suffer is the wrong assumption or expectations that Nursing is a guaranteed profession and a recession proof profession. I wish people would be more outspoken about this and alert students who jump into nursing thinking they are financially safe.

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i use to dread the er because i didn't know what to expect, but after working there, i love it, too :) i also agree with you regarding the false cover that nursing is a guaranteed profession. i recently read an article on medscape ([color=#006699]nurses are talking about: jobs for new grads) and it did a very good job of detailing the frustrations of new grads, their perspective, and the perspectives of older nurses and administrations. i hope you find a position (nursing or not) that you absolutely love. :)

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Specializes in "Wound care - geriatric care.

Thank u again. Somehow the link you posted did not go through.

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I'm a scribe too, and it has helped me immensely. Best part of the job is I can work it for as long as I can while searching for a nursing position. I have another job as a CNA/unit secretary on a medical floor. I think I'd have to give that one up after I get my RN.

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Thank you so much Aniva that is extremely nice of you to inspired. I would like to know does scribing only apply to the emergency department? Although as I read more into it from your post it makes sense as the ER you get all walks of life all pathology all acute, chronic you get it all.

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hmm.. Sorry! I'm not sure why the link doesn't work... maybe it's only restricted to subscribers: but it's free :)

Whichone: That's awesome. Isn't it a sweet job! The companies I worked with was really flexible so I was able to work as much as I wanted and the hours I wanted. Since many of my coworkers were classmates, they were unable to take the day/evening shifts, so it worked out perfectly for me. (they also loved the scheduling flexibility, too). win win for all haha.

Qcc: I'm not sure if scribing extends to other specialites or areas in the hospital, but it would not hurt to find out!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Thank u again. Somehow the link you posted did not go through.

You need to register for medscape but it is free.

About the scribe thing....I need to digest it. I understand it's tough out there but I am creeped out that you are "just" (and I don't mean this in derogatory way, I really don't) a secretary and "handmaiden" to the busy doctor because he can't enter his orders in the computer. It Makes my skin crawl and makes me angry at the same time.

The whole reason for MD COE was to minimize errors and the MD claiming that was not what they said ordered and here we are right back at square one. For years we fought agaiunst following the MD around saying yes doctor and no doctor, how would you like that doctor.....and it seems we are right back there.

I don't know how I feel about this.....I don't know what legalities are involved if you are licensed in this capacity and the MD is found negligent....sholud you "know better" and correct him as a licensed professional.

I don't know, I just don't know.....:no:

I knew the MDs would find a way around putting their own orders in..:mad:

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Actually, the providers have to put in their own orders-no one should be inputting orders. The scribe is not suppose to assume anything on the documentation. If you catch a blatant error, you just bring it to his/her attention. Ultimately, you're not responsible for the documentation. The provider is. Once they sign off on the chart, they assume all responsiblity. Whether a scribe feels like he/she is "just a secretary/handmaiden" or another member of the team, it's up to to the scribe. The provider can use transcriptions services (dictation) instead of scribes, but real time documentation has its advantages. If you truely feel disturbed by such a position, don't take it. It'll provoke feelings of inferiority: which I hope no one feels. However, if you take a position like this, you will realize you learn quite a lot. there are so many pearls of wisdom each provider can give... wisdom that is very hard to find or normally undisclosed to certain health care professionals. No matter what position your in, whether your a CNA, RN, NP, Physician, or administrator, have pride in what you do. "No one can make you feel inferior without your consent"- Eleanor Roosevelt

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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, abd. 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 petechaie. 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".

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I used to be able to enter orders, but the higher ups stopped allowing it this year. So now I take care of the rest of the paperwork, such as discharge instructions and calling back patients. I also do my best to help the nurses out. The docs I work with for the most part are pretty chill. A lot of them like to teach, and I have learnt a lot. It was this job that made me decide that I want to work as an ER nurse.

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Like :) Yes, order entry by those who do not have prescriptive authority crosses over to the realm of quality assurance and liability. At my hospital, the docs entered the orders and we just copied it on the paper chart or mentioned it in the medical management piece on the computer along with the rationale for the orders.

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