Nurse Report please answer

You get done what you can do. Prioritize to make sure that the sickest patients are getting their interventions the quickest. Let the in-coming nurse know what was done and what needs to be done. Some folks are always peeved about starting the shift with several things to do, but that's just how things go in nursing sometimes.

What you're asking is a prioritization question, so it will depend on each patient and each situation. So you need to think about what are the most important things to get done. In terms of meds, if it is just their nexxium they take at home and there is no acute reason to give it, you might be ok being late on that. However, if they have an infection and antibiotics have been ordered, that is going to be important to give asap. Especially if they are immunocompromized and at a higher risk for septic shock. So you need to know what is going on with them to decide what is most important. Medications are generally a pretty high priority. Remember any med not given on time is a medication error. This could be why the on-coming nurses get upset about meds not given. Hope this helps!

The most important stuff that needs to be done prior to handoff is the stuff that gets the pts the h*ll out of there. But if you're slammed, there will def be stuff that the oncoming nurse has to complete. That's why we have different shifts...bc you can't stay there all day. o_0 But I try to focus on getting urine sent off, taking pts up to their room if they're being admitted, getting abx and any IV fluids started, bc those are things that will keep the pt. there longer. Also, it's my pet peeve to have to chart stuff that the previous nurse did. CHART AS YOU GO, PLEASE!!! But it sounds to me like you're prob j dealing with a lazy nurse.

Just prioritize what really needs to be done. Do your best. For instance, if your patient is septic, then yes, you really need to hang that IV abx (b/c timing is very important), and if you don't have time to do it, then ask another nurse or your charge to hang it for you. It's hard being a new nurse...I'm there with you. I'm in the ICU, and I've never worked in the ER, so you may just want to ask the ER nurses on this forum. Best of luck to you...it will get better! Just don't be the one rolling your eyes at the new nurses when you get to be more experienced :). Next time the nurse gets indignant with you, use it as a teaching moment (regardless if she's justified in doing it or not)..say, well, what should I have done? I am doing my best, yada yada.

I agree to a certain extent with the previous poster. I would simply ask the next time what they would like you to do or what they would have done differently. It's common for new grads to think they are keeping up but they aren't and you have to gently tell them, "hey look, it's important to prioritize xyz."

There are some people who want the whole team straight when they start no matter what but if you are consistently hearing the same complaint then maybe it's time to look at your habits. And trust me, we have all been there.

Chart what you did, and do any stat ordered on your time that you have the med for. As someone who does ICU and ER, it's frustrating when someone comes up with orders, and you can't figure out if they got that Vitamin K injection, that stat order of whatever, etc. Our systems between the ER and the rest of the hospital don't talk to each other, except for lab results (and only some of those). So if it's a heart med, a bleeding med, a critical "lives with it, dies without it" kinda med, make sure the receiving nurse knows about whether it was given or not. Nothing like watching someone bottom out because a Cardizem Bolus dose was given in the ER for someone going onto a drip, yet they get to us, looks like they haven't had any because the ER nurse didn't finish charting yet, so we give the push and suddenly it's like, "Uh...where'd their SBP go?"

Speaking as a PIA ICU nurse, all i want to know is what meds you gave, what was CT scanned and how many liters of saline were given. I will figure out the rest. I'm ready when you are, roll em on up.

Hospital policy also plays a role. At my peds hospital, if a kid comes in with fever and antibiotics are ordered in the ER, those are to be given and then the pt held down there for one hour after completion before sending them up to the floor.

We have ER orders and floor orders, so its often times pretty clear who needs to do what.

Thank you very much everybody for the responses. I just want to be clear because i like to do my job as best as possible.

what I usually do if I'm not totally slammed to prepare for the change of shift is to make sure pts are d/c or moved to the floor if ready, pts in holding pattern are up to date with vital signs, meds, labs,,etc and any pt arrivals in the last 30 minutes who are stable into my section I will start their tasks etc. That stuff is the easiest to turf to the next nurse because personally, I'd rather start with a new slate of patients than finish up old because I can get to know the whole case from the beginning. Most nurses seem to be agreeable to that. Although u will find some are never satisfied. It takes a while to hit your stride with all the shifting priorities in the ER. Naturally, the emergent stuff trumps everything!

I agree with the previous posters that this is definitely a prioritization question. First things first, always go back to ABC. If any of those things are compromised, then that patient gets your attention. Do those things first. Assuming all of your patients are stable in that regard, my suggestion is to take a quick second and make a list. As a new nurse you won't be able to mentally prioritize like some of us old salty dogs can do at first. This will come! Now, the thing about the ER is we do FOCUSED assessments and FOCUSED treatments. So ask yourself, what's my pt here for? If the order treats the answer to that question DO IT! As far as abx go, it is a JCAHO national standard and core measure that abx go up on certain patients within a certain amount of time. Be mindful of that. If your pt is a GI bleed, then yes get them the nexium, protonix, etc. One thing new ED nurses have the hardest time with is asking for help and/or delegating. But the best ER nurses do this well. If you have a CP patient that you are actively treating and you know the pt next door has pna, but you don't have time to grab the blood cultures and hang the abx, tell your charge. Thats shows us as charge that you know what's important and are handling your assignment. ER nurse or not, we still only have 2 hands and can be at one place at a time. Now having said all that my other piece of advice is every day start looking at your patient and anticipate what's going to happen. For example:

89 y/o male with fever and cough. You AUTOMATICALLY know this is a septic workup. This will get easier with time and seeing more patients. To be super successful as an ER nurse you have to anticipatory and proactive and not reactive. Best of luck and hang in there!