Organizational skills

[pumpkin]

Hi all,

I recently started in an ER after working on a floor for a year. I really like it in the ER, but I'm having some problem regarding organization. On the floor, I was so used to carrying around a clipboard with all my patients' information on it. I'd have the same patients most of the day, then give a written report to the next nurse. It is not so in the ER. We're constantly moving patients from triage into rooms, from rooms into the hall, and to the floors. I'm having trouble keeping track of who's who, and who's where. There's no time to write down info about the patient, and when I give an oral report to the next nurse, my preceptor has to keep interjecting info about the patients that I've missed. So many patients come in with the same complaint (i.e. chest pain), that I'm mixing them up. When a doctor asks me about a patient, it takes me a few moments to wrack my brain about who they're talking about.

My preceptor doesn't seem to understand why I'm having difficulty with this, so it's making me a little concerned that perhaps I don't have the memory capabilities to be an ER nurse. Will this come with time?

Thanks.

[PedsERRN]

How do you track your patients? We have a tracking system in the computer which makes it easier to keep track of your patients. If you have signed in as the nurse, you stay with them no matter where they go. If you don't have this, many nurses keep a piece of paper with a registration sticker for each pt in their pocket and write down vital info, such as dx and plan. This also helps with charting-you can cross off the pt when you are done with the chart, and then you know what charts you need to find at the end of the shift.

Learning to track many pts in a busy ED is definately a learned skill that may come with time, however, some nurses can never make the change from a floor nursing mentality.

Hope this helps! :)

[erjulie]

you get to the point where the stuff you keep track of is only the absolutely necessary...and only for as long as you have to remember it. A huge part of the problem in ER is the "chaos factor". It is so active, so noisy, so distracting, that it really does take a while to hone it down to manageable bits. You're interrupted three hundred times, it's no wonder you can't remember stuff! It honestly took me about a year to really get the filters going well, I was so sure that I'd miss something that I was totally over-loaded. It gets easier, stick with it. Then something else comes along...that's the beauty of ER nursing! :rotfl:

[Havin' A Party!, ASN, RN]

Just a student here... but what's wrong with carrying a cheat sheet on the folks you're caring for?

[suzanne4, RN]

In the ER, you could spend too much time on trying to update a cheat sheet.

At the most, try just a pat. sticker with a brief diagnosis, etc. But remember to not lose that sheet. It has confidential info on it. With time, you will get your skills in place. But for the ER, you definitely have to be able to multi-task.

Hope that this helps.

[snowfreeze, BSN, RN]

Paramedics have developed many quick assessment papers that are pocket sized

ask one of them for theirs, it might help you refine your notation.

[erjulie]

Just a student here... but what's wrong with carrying a cheat sheet on the folks you're caring for?

It's a great idea, I just always lose the paper. I am the original 53 y/o disorganization queen! However, for a long time I carried notes with me with info like assessment stuff, drip mixes, etc on a little tiny notebook like you kept your assignments in during grammar school. My pockets started to get heavy and hurt my neck, so now I carry a PDA for that stuff. It's just a learned thing, what to remember and what not to bother with.

my cohorts have various means for memory aids, too. Whatever works best for you!

[Dixielee, BSN, RN]

I guess it depends on how your system is set up, but I keep all my nurses notes on a clipboard. If not, it goes with the main chart that can be most anywhere and I can't keep up with my charting. I keep a paper on top so no one can see the patient info, but when I give report, I give it from my flowsheets. We have a tracking board that tells when patients go to x-ray, CT, etc., and I can add that to my notes. When you give report from your notes, you don't have to remember when you gave the morphine, or what arm the IV is in, it is on your sheet. Plus, when I receive report, I only want the highlights, not like on the floor. I don't care where the IV is, as long as it is patent. I don't care what the I and O is, just that they are voiding (if that is even pertinent). I want to know why they came in, what we have done to find out what is wrong with them, and what is left for me to do before I can send them home, to the floor, surgery, etc.

If you have computer charting, then give report in front of a terminal that has all your patient info.

I don't care about their personal life (unless it is an issue I must deal with), their indepth assessment (I can read yours, and will do my own anyway), exactly when they got what med (I can read that), but I do want to know if it was effective. I don't really care exactly what their vitals signs were if they were essetially normal, just say normal vitals.

What I do want when I take report is a chart that has been stamped or labeled, so things don't get lost, I want you to make sure all the things you were supposed to do were either done or passed on to me, so I am not finding things 2 hours into the shift that should have been done 2 hours before I arrived.

You may want to try bedside reports as well. When you actually see the patient a lot of things come back to you. You may not remember them by name, but you will remember what you have done for them.

Don't let this worry you TOO much, you will find ways to cope. ER is a different bird. Your organizational skills do have to be different, but you will develop your own coping mechanism.