How organized...

jensdandy · Nov 1, 2005

Have you worked in an ER before? Maybe as a tech or CNA? I have been working in the ER 4 years as a tech and just passed my boards a month ago. The nurses I have worked with as a tech sure made it look easy....I thought I had the hard job as a tech. Now working there as a nurse I am constantly on the go but I know where everything is. Turnover is quick, acuity is sometimes high, and it gets tough. But...things are organized. I can't imagine working in an ER like the one you describe here. If it is truly that bad I think I would be looking elsewhere too. I too get told that I am the nicest nurse there since I tend to take time to listen to my patients...I don't want to change. I also know there are some very rude and at time unprofessional nurses....but they know how to take care of any patient during an emergency. I strive to be like them without the rudeness and unprofessionalism. I hope you find a place that you are happy. I love my job and wouldn't trade it for the world! :)

MIA-RN1, RN · Nov 2, 2005

I think you should utilize your techs. When I was a tech in the ER, it was my job to stock exam rooms, keep all the supplies for the IV/blood draws stocked, order supplies if they are low, find linens etc for the nurses etc. Can you speak with your techs or their supervisor?

scrmblr · Nov 3, 2005

I'm a new grad in the ER too. It has been hard to get the hang of things. But, luckily, I am doing much better!

Some things that have helped me...Know what you can do without the dr's order. In the ER life is a little different. We can order stuff without the MD. For example if someone comes in with n/v/d and looks dehydrated I can start the IV and draw labs at the same time. I may not be able to order anything, but at least I am a step ahead. If someone comes in with an ankle injury...don't waste your time listening to lung sounds...they aren't here for lungs:p throw an ice pack on them and either let the doc know or order Xrays.

My ER is small and sometimes more like a clinic. But, I have learned to move very fast. Don't waste time looking for things. At the begining of your shift check your rooms. And, you have to use your ER techs. That is what they get payed to do!

And, you may want to think about another area...I have never heard of an ER being so disorganized. I have been in a few and it seems like they have a place for everything...You just have to figure out where:rolleyes: I have a friend who started in the ER. She moved to ICU, it was still exciting, but the pace was slower. She could take the time to listen to lungs, check pedal pulses and do a full assessment on all of her patients. She was a wreck in the ER, it drove her nuts not to fully assess all of her patients. She is well loved in the ICU.

Jerico, BSN, RN · Nov 4, 2005

Thanks for the input.

I spoke with my supervisor about my preceptor (who has been in the ER for over 16 years) and also found out other new RNs to the department have been precepted by her. They say she is hyper-critical by nature. And YES it is disorganized ER.

NOW I know why at my interview they said: "We like you because you seem organized and can bring some maturity....to the department..."

Yikes! I had no clue! I have been looking elsewhere, but am going to give it couple more months - and perhaps ask for a payraise to make it more tolerable.

vampireslayer · Nov 5, 2005

I also work in an ER, and I can tell you, you're not alone! We are also frequently disorganized, and the thing about not being able to find the supplies, or the normal place for something has changed...well it happens in our ER too!

I also had a preceptor that harped on me over & over to get faster, faster, faster. Get in, get the story, assess, get out. Faster, faster, faster. But of course, you have to hook them all up on their cardiac monitor, get their vitals (WHY is there no BP cuffs in my room???) get their pulse ox (yep, no pulse ox sensors either), it's a chest pain, need to put them on O2 (of course, no nasal cannulas)...it just isn't that easy to get in & get out of the room.

So here's what I do, I'm still not as fast as I'd like to be but this helps. I check out their triage assessment sheet to see what the complaint is before I bring the patient in from the waiting room. So if it's a chest pain or a respiratory complaint, I know i"ll probably need a nasal cannula. I also check out the vital signs, and the time they were done. Sometimes you need to redo vitals because they've been sitting in the waiting room a while, other times they're fine. Or their BP may be sky high, so you know right away you'll put them on a cardiac monitor, even if their major complaint was toe pain. So, check out vital signs & chief complaint, to start getting a game plan.

Then, check out the room you're going to put them in first, and make sure you have a BP cuff, pulse ox, leads for your cardiac monitor, & nasal cannula. If you don't have all that stuff, stop off at all the obvious places on your way to the waiting room to get the patient...stocking carts, other rooms that have carts in them, etc...making sure you pick up all the various things you need by the time you get the patient. For me, being in there with the patient when I figure out I don't have something is what slows me down, cuz then I try to go hunt it down, come back, find out I have antoher thing I need to go find, etc.

If it's a stretcher patient, I look around for all those things while the paramedics are moving the patient onto the bed...if I'm missing something, I leave and go get it, the paramedics will wait, and it takes them awhile to get the patient moved over anyway.

Then as I walk the patient out of the waiting room into their room, I stop by the bathroom and have them go in & get me a urine sample. This way I don't have to unhook any IVs or BP cuffs or anything to get them to the bathroom, they're not hooked up to anything yet.

Then while they're in the bathroom, I stay close but gather all the IV supplies I'll need...our bathroom is close to the major cart where I can gather most of those supplies.

So they come out of the bathroom with their urine, I take them to their room & get them into a gown (I used to leave the room to give them privacy to change...not anymore, takes too much time), and hook them up on all the various monitors, pulse ox, BP, and O2. Once they're hooked up, I get their story, which determines what I'm going to assess. I almost always listen to lung sounds regardless of what the chief complaint is...my little old lady with toe pain may also have pneumonia or CHF, you know? But other than that, I stick to assessing just what's pertinent to chief complaint. I've also learned alot about assessing quickly, by listening to the docs when they do their assessments...if it's chest pain, I can ask the questions rapid fire now: where, does it radiate, is it constant, how long has it been going on, nausea/vomiting?, SOB, dizziness. Same with abd pain: where, how long, last BM, LMP, problems with urinating, lady partsl dc or whatever, n/v/d. Once you see a particular type of complaint many times, you start to know what to look for and ask about, and it goes faster.

Then you leave the room to get your IV stuff, if you didn't get it already, and for me, even if I already have the IV stuff in the room, I leave the room briefly to put the chart up for orders. I figure I want that chart out at the desk so the receptionist can order the stuff I've checked (CXR, labs, EKG, whatever) and so the doc can find it, because it might just take me a while to find a good vein.

So anyway, sorry to be so long, but my main point is gather all those things you'll need on your way, before you get your patient, otherwise you'll be going in & out of that room many times. Make an entire quick circuit throughout the ER to find the BP cuff, the pulse ox...if you move quickly, you can find those quickly even if you find 1 thing in 1 spot, another in another spot, etc...rather than entering & leaving that patient's room over & over.

Good luck, and try not to let it get to you. I think for me, once I learned what all the packaging looked like, so I could spot something, like a pulse ox, in a drawer filled with a mess of other stuff, and once I found all the possible hiding places for some of the things, so I could go to the next place, and the next place, and the next place, one right after the other, looking for something, I managed to get quicker.

VS

Jerico, BSN, RN · Nov 6, 2005

Thanks VS! I really appreciate the time you took to write all that.

Things are getting better the last ten days or so.

I am able to 8-10 beds at a time now as long as they are not the chest painers, or stroke, aneurism, CHF, liver failure, critical trauma types.

Our ER has six beds dedicated to the more critical complaints and 18 beds dedicated to everything from lady partsl bleeding, to rape, to running noses and abcesses.

Thanks again, everyone. :smokin: