I feel very confused....

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Specializes in Emergency.

Thanks to everyone who replied to my post "Sobering first day at work..."

Now I have finished my second week in the ED and I am having a tough time transitioning for the little experience I had doing Med/Surg. Plus I am less then impressed with my preceptors. I have 2 preceptors I follow and both are very disorganized and they tell me that is the norm in the ED. The whole department is very informal, but I do like the people who are there and see they perform great as a team.

I feel so chaotic while taking pt history. I feel like I should make some cards with specific questions to ask; chest pain, abdominal pain, fever, SOB. I just can't seem to keep it all straight in my head and the charting program we use just confuses me more. I feel like I am stumbling over my own two feet.

Will I ever get the hang of it? My wife says I was this unsure of myself my first several weeks on a med/surg floor too and then it starting clicking....

Any advise or am I where I am suppose to be? I know I sholdn't know everything, but I sometimes feel like I know NOTHING... I am told I am doing great but everything seems so foriegn to me....

Thanks for reading and for any direction.:icon_roll

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Specializes in OB, M/S, HH, Medical Imaging RN.

Every new job feels unfamilar and foregin in the beginning but you will get more and more comfortable as time passes. Just don't be afraid to ask plenty of questions. Best of Luck!

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Specializes in Cardiac, ER.

Hang in there Steve,.it does get better. I transferred to ER after 8 yrs on a Cardiac step down unit. The ER is a whole different world. I worked as an ER tech for about 5 yrs prior to nursing school,.I sort of knew what I was getting myself into,.but not really.

From a nursing point of view the ER is just very different. It drove me crazy the first few months that I didn't have time to learn everything about every pt. I can't read old H & P's, I can't sit a talk about every health issue they have, I can't learn about their family situation and do they have adequate health/medication coverage.

On the unit I took care of the new MI, and the HTN, GERD, DM, GOUT, insomnia, and chronic back pain. It was my responsibility to make sure the pt was bathed, turned, keep track of how much or little the person was eating, what their output was etc. In the ER you just can't do that and now that I've been there and learned more,...I understand that isn't the objective of the ER.

If you come to the ER for a fx arm,.I need to take care of the arm,.give adequate pain control and transfer you either to OR,.the floor or home (where your reg Doc should be taking care of all your co-morbids). The ER is for EMERGENCIES. If the ER took the time and resources to say,..change BP meds while we suture your laceration,.we would not be available for EMERGENCIES. I do understand that we are often used as a primary care provider,.but that isn't why we are there,.that isn't what we are trained to do and for the life of me I'll never understand why pts expect an ER Dr to be an expert at the long term care of HTN, DM, chronic pain etc!!

I think that with time,.you will find yourself in the mindset of EMERGENCY,.treat the emergency and transfer the pt to the next appropriate care. Hang in there,..aside from the warped sense of humor and the excessive amounts of drama, the ER is really a great place to work!

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Specializes in Med/Surge, Psych, LTC, Home Health.

See, THIS is why I think I would actually make a good ER nurse. Because I seem to work better when I'm able to, allowed to, focus on just ONE THING about a patient. My favorite patients have always been healthy adults who just had some type of surgery. I like being able to focus on and fix that one thing, and then move on.

The reason I think I would make a lousy ER nurse is because I tend to not function well in the midst of utter chaos. Utter, disorganized chaos.

I don't mind being BUSY, I don't even mind a fast pace, but it gets to a point where I can't seem to function anymore.

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Specializes in Did the job hop, now in MS. Not Bad!!!!!.

Hey Kickstart,

where in Atlanta are you? I'm in Duluth

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Specializes in Emergency.
Hey Kickstart,

where in Atlanta are you? I'm in Duluth

Loganville area, working in Athens.

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Specializes in Did the job hop, now in MS. Not Bad!!!!!.
Loganville area, working in Athens.

Are they hiring in Athens? I never considered working there. What's your commute like? You realize you and I are about 10 mins away fr each other?? LOL.

Chloe

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Specializes in Peds, ER/Trauma.

The important thing is to focus on what brought the patient to the ER. That means focused interview questions & focused assessment. If the patient is there for abdominal pain, you don't need to be checking pedal pulses or asking about their recent bunion surgery.

As a general guide, here are things to ask:

What medical problem has brought you in to the EMERGENCY room today?

Where are you having pain?

How long have you had this pain?

What does it feel like?

Any other symptoms (nausea, vomiting, diarrhea, dizziness.....)?

What other medical problems do you have (HTN, diabetes, etc....)?

What surgeries have you had before (if they have had a ton, and are there for abd pain, ask specifically about abd surgeries)?

Allergies?

Medications?

Many patients will tend to get "off track" and tell you about every medical problem they've ever had. Just steer them back on track by saying something like "Let's talk about what brought you in to the emergency room TODAY."

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Specializes in Emergency & Trauma/Adult ICU.

Your idea about making cards is a good one ... it was actually part of my orientation. Our documentation program helped too, espcially when I was a new grad. If I typed "abdomen" it came up with a menu to tab through which reminded me all the various aspects of an abdominal assessment: bowel sounds, nausea, vomiting, last BM, area of tenderness, ... you get the idea. If I typed "respiratory" it reminded me to look for accessory muscle use, dyspnea on exertion, edema, etc.

I think things will click for you -- just give it some time. If you're being told you're doing OK, I would take that as face value and use it to boost your confidence.

Good luck to you. The ER is a great place to work! :)

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Specializes in Rural Health.

I figure all medical history and/or surgical procedures to be relevant and if they aren't - the doctor can always weed those out themselves. Medication is also a great clue as to what history they have as well. If you don't know that particular med....make a mental note to look it up when you get a chance. Oh...I see you are on 5 different DM meds....does that mean you have DM? Do you also use insulin or just oral and diet meds???? It's amazing what people forget to tell you.

I find myself asking why are you here TODAY a lot - especially in the older population or in people who can't comprehend what an ER is actually used for. Yes, they like to talk about the flu like symptoms they had 6 weeks ago, but I seriously doubt that has any effect on why you are actually seeing them TODAY.

The key is focused assessments after that.

Abd pain - focus on the nipples to the knees. Food goes in the belly - what time did they eat or drink and does that make the pain better or worse. Since we are focusing on nipple to belly - ask about bowels (esp if they are older). For those gals...ask about LMP and preg. history. Listen for bowel sounds. Ask them about their urine (knees to nipples) - do they pee alot? Does it burn? How about the smell? Do you have to pee now? Good question to ask...do you have GB? Those little buggers cause a lot of uncessary abd pain. So does that pesky appy. Think what organs lie in that abd region.

Resp c/o. Are they blue...ok good they aren't. Now are they pink or are they some other shade? How fast are they breathing. What is their pulse ox without O2. Are their fingers cold to the touch and blue? How hard are they working to breath? Can they carry on a converstation with you without gasping for air? When did this c/o start? What where they doing? Does it happen often? Now listen for breath sounds because those are usually pretty important. Ask that age old question...do you smoke and if so...how much per day. Have you ever been intubated and placed on a machine to make you breathe?

If they have a suspected fracture of X body part - make sure they can still feel below the suspected site and you get some pulses (remeber those 5 P's???). If they can't - that is a problem and you need to find a doctor ASAP and get that going. It doesn't take long before that tissue down there starts to die and a whole new problem presents itself.

Chest pain. I focus on the neck the the peri area here. When did it start, how long did it last. What where you doing when this occured. Has this ever happened before? Of course start on the chest pain protocol at this point and time per your P&P. Surgeries that relate to the abd and/or chest are good at this point and time too. That pesky GB rears it's ugly head a lot during CP as well. Good to know if it's out. I like all patients to tell me what their pain feels like (burning, aching, etc.) but I REALLY like to know what CP people think their pain is like. Crushing and radiating are 2 words that gets the room buzzing pretty quickly. Meds are good here at this time too because you want to know...do they take Nitro and ASA and if so, did they BEFORE they got there?

Fever.....when did it start and what have you taken (or given the child) for it and what time. Always check the dose. Fevers are so under treated by parents.

Headache - I worry about neck up here unless something else perks my interest. When did it start, what have you done for it. Have this ever happened before. I like to know how this pain feels too. Stabbing, burning, aching. Where does the pain go to (sinus area or down the neck). If they are younger.....start thinking associated s/s of flu and temp to rule out other nasty bugs.

The list goes on and on but that's the general idea. Focus on the area that brought them to the ER first.

Once you get the focused assessment done and you get a chance, it's always great to go back and do a full body assessment, especially if you know there will be a long delay with the doctor seeing them. You'll be amazed and how many times I've had people come in with a headache only to find pitting edema in their legs that scares the crap out of me. I also like to do full assessments on older people, especially nursing home patients. You'll be amazed at what you might find when you flip the patient off their back.

My 1st ER used T-sheets and that helped with focused assessments. My new ER job uses computerized charting and it's all over the place on a good day - so I understand your frustration with that.

Cards are not a bad idea......it will help you figure out what questions to ask and when to ask them.

You're doing great and it will all click soon I promise!!!

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Specializes in Peds, ER/Trauma.

Chest pain. I focus on the neck the the peri area here.

Why would you focus on a patient's peri area when they're complaining of chest pain?!? :eek:

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Specializes in ED, ICU, PACU.

I know how overwhelmed you must feel. I think all of us that do ER nursing can recall feeling just as you. But, you have one up on most because of your Med-Surg background------you can juggle with the best of them (or what others call, having time management skills). Now, all you have to add to that skill is constant reprioritizing as things are constantly changing.

As for learning to ask the right questions: Try to listen to the docs when they do their assessment. And, if they know that you are new (and aren't a new resident, med student or holding an 'attitude problem'), many will be glad to answer questions you may have.

Annnnnnddddd..............I am still trying to figure out why the peri area for a CP :omy::grn:

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