Organizational skills

bill4745, RN · Aug 27, 2006

I had 10 years of ICU, now in the ED for 2 years. It takes time. You are constantly setting and resetting priorities. The hard thing to get used to is that some things (and patients) just have to wait. You always need to be thinking of what needs to be done next, in the event that someone else has time to help. And don't forget to help others when you are caught up. You often need to politely explain to a patient, family, or doctor that your patient in the Room 4 has a heart rate of 30, and that the tylenol for the headache in Room 6 make take some time. Every visitor feels that their friend/loved one comes first, and you must politely explain to them why delays occur.

Jennifer, RN · Sep 1, 2006

Prioritize, prioritize, prioritize. It takes time. Remember, focused assessments, try to chart immediately after procedures if possible. Like bill4745 said, try to think ahead. Abd pain will always need a urine. Old people will always need a urine. I put IV sites in almost everybody, draw blood from the iv site and hang NS kvo. Saves time if the doctor wants a bolus. It was hard for me coming from the floor to the ED. It took a little while to figure out that I am not going to give my pts in the ED the same care that I would if I still worked on the floor. I will always do the basics, making sure my pts aren't covered in bodily secretions, making sure they are warm and dry, making sure orders are followed, and making sure they are fed if they are allowed to eat and drink. I usually do not have time for a lot of small talk, mouth care, bathing, turning q2hrs, etc.... I carry note cards in my pocket to write down times and procedures if I don't have time to chart. That way I don't have to waist time wondering when I put in that foley or gave that med. I put everyone on the monitor or at least the bp cuff and pulse ox. That way, all I have to do is look at the monitor and see my vitals q15 minutes. I also try to chart on my pts that may be admitted first. Usually you have a good idea who will be admitted and I try to keep their charting as up to date as possible in case someone has to call report for me (in case I get a trauma). I have also learned how to chart quick. All of our charting is on the computer, so I have learned how to type really, really well.

A lot of times, though, I am charting my pt's assessment and procedures as I am discharging the pt out of the computer or calling report to the floor. It happens to us all. The key is trying to remember what happened.

nuangel1, BSN, RN · Sep 1, 2006

i agree with bill and jennifer it comes with time.remember the setting in er is different then in icu .i have 12 yrs icu exp.4 yr er experience.both settings are busy stressful but can be very rewarding .prioritizing ,organizing,quick documenting ,asking for help and not letting yourself get overwhelmed are a must.good luck and be patient with yourself.

Pedi-ER-RN, RN · Sep 6, 2006

Bill and Jennifer said almost exactly what I would've said. I am always one step ahead of the doctor. If I get a patient with a Lac that needs suturing, I assess the pt, go draw up the Lidocaine, get the Lac tray& some Neosporin. All the MD has to do is choose sutures and grab his/her gloves. Most MD's are predictable and if you work with them long enough, you are already going to know what that MD is going to do for that type pt. I am not saying go ahead and order labs, x-rays, etc...just anticipate what you will need to do. I try to chart right after I do something or I attach a yellow sticky note the the nurses note with the time, etc... I think you are on the right track for success in the ED. Good luck to you.

There will always be days where none of this will apply, it will just be crazy!! The ED is a constatly changing environment.