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Discussion

Orientee too slow on EMR..now what?

Hi everyone,

 I need some tips to help my Orientee before they finish orientation and have her fly.  I feel she doesn’t have a firm grasp of the EMR and is spending a lot of time looking for stuff hence chart review and documentation takes a lot of time.   What I do at average speed will take her 3-4x as long.   The clinical skills and patient care she’s excellent.  She’s very through checks every detail.   All I can think of is have her take notes and practice navigating on a test patient between real patients 

suggestions please?  I need all the help I can get.  

 

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    How long has she been on orientation?  Some people don't grab the computer part as fast as others, especially if they are older and haven't used computers their whole life.  If she is good with other things, I'd have her do the documentation and nothing else for a couple days.  She observes the interaction, takes notes, and documents that patient while you do the hands on. Then she goes and documents. That way she has time to hunt through and become familiar without the pressure of getting to the next patient.  That may mean she sees half the patients and documents while you pick up the other half of the patients.  

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    Have you tried making a laminated (allows  cleaning) cheat sheet with the basic flow/ name of tabs/ screens to document your common tasks like admission, assessments and discharge. 

    We have used them in the past when we went live with a completely new EMRs. It significantly improved people’s speed until they had a chance to really learn the new EMR.

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    1 hour ago, kp2016 said:

    Have you tried making a laminated (allows  cleaning) cheat sheet with the basic flow/ name of tabs/ screens to document your common tasks like admission, assessments and discharge. 

    We have used them in the past when we went live with a completely new EMRs. It significantly improved people’s speed until they had a chance to really learn the new EMR.

    Came here to suggest exactly this! 

     

    Great minds and all.....

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    • Guides

    Well, hopefully, you don't shoulder the cost of the laminated cards. I would say work on the EMR more with her. I am not a bedside nurse but for us providers, EPIC for instance, has a lot of smart shortcuts and hidden tables and charts that you have to unlock and keep in your tabs for easy access.  Whenever we have a new NP in our group, I share how my EPIC is set-up so they can see my workflow and some will say it works well for them. Her taking a long time documenting? I wouldn't touch that...I know a lot of new NP's who take forever writing their notes even long after orientation.

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    Agree with the cheat sheets, big time.

    Also...

    12 hours ago, Enarra said:

    She’s very through checks every detail.

     

    12 hours ago, Enarra said:

    The clinical skills and patient care she’s excellent.

    I foresee some hard times coming her way.

    I suspect she is going to have to learn what is really really important vs. what all is competing for her time and meticulous attention.

    I would help her with cheat sheets and then also pay attention to how she is spending her charting time.

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    • Author

    Thank you everyone for commenting!  I was able to identify a few areas that taking up too much time and  Then demonstrated how I do chart review and documentation.   And that speeded things up a bit.  I’ll think about what those sheets will look like.

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    • Author

    Orientee gets flustered when I speed up so have to go at her pace otherwise she’d freeze and can’t remember how to find info she could find before.  She’s a bit older.  I’m trying to get her to be comfortable w EPIC know where to find what info.   I guess just reinforce practice and slowly up the speed

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    • Guides

    It sounds like she has some anxiety management issues along with a little bit of time management too. Pretty normal for a new grad and one of the biggest curves to learn in the first year. 

    Make sure she has a good brain sheet that helps her see how her day is laid out. I would do mine in columns - one for each patient with the paper turned landscape. Room # at the top, then down the left side every hour from 0700 - 1900 (or vice versa if on nights). Get report, then sit down with this sheet and go through each patient's eMAR and notes from report. Any time they have medications due, write "meds" under that patient in the correct time slot. Same with Blood Sugar checks. I would put "BS" around the time blood sugar/insulin was due. Same with tests (often at the very bottom due to not knowing exactly what time), checking labs, dressing changes, Vanc troughs, requested calls to family, etc.

    Doing this helps ease the mental block that can come with feeling overwhelmed. She can clearly see when her scheduled tasks are - pretty normal to be task oriented at first. It also then plainly lets her see when she has pockets of time to get her charting done. As she picks up the software and gets more secure in knowing how her days will go, she will pick up speed and confidence.

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    • Guides

    Speed comes with practice. If your orientee is technically proficient at the hands on part of the job then he/she may need to practice in real time. I have a book with all kinds of tips for navigating our EMR (Which is notoriously non-user friendly) During the last part of orientation I will have my orientee do all the charting in real time. We also have a practice lab where orientees can practice.

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