RNSurf

Yes, I'd really like to hear more details about the flow ... thanks!

We are focusing on trying to move patients back to rooms faster and decrease wait times. Our current system consists of having a patient walk in and fill out a card with name, birthdate, and chief complaint. Our Triage nurse registers the patient in the computer system and then calls the patient back to do vital signs plus a computer history questionaire including current medications. This takes approximately 10 minutes per patient on average. If a room is available and time permits the patient is taken straight back however all too often we end up with a bottleneck of patients waiting in the lobby when more than 3 patients show up at a time because it's at least 20 minutes before the 3rd one is initially seen by the Triage nurse. Adding staff is not an option so pulling a nurse from the back would mean less rooms available. One idea was to have patient complete a written history questionaire while waiting similar to forms handed out while waiting in a physician's office. Another idea was to have the Triage nurse do a "mini" by inputting vital signs and chief complaint only ... then have the primary nurse complete all other information such as weight, medical hx., PCP, allergies, meds, etc. Perhaps she could do this off the written form given to the patient but I have to wonder if that would just transfer the bottleneck back to the rooms. Of course it doesn't make it any better that one hospital in our state of Florida now advertises ED wait times on an electronic billboard located on the interstate. Last time I drove to Miami it was flashing 14 minutes. Any suggestions would be appreciated as I'm sure we all face the same challenges. Our ED sees approximately 100 patients per day and starts with a CCN, 4 floor nurses accomodating 16 patients total, a Triage nurse, a secretary, and two ED techs who perform EKG's, wound care, ortho, and assist with procedures. We add one nurse at 11am and two at 3 pm. We currently do not staff with medics or phlebotomists so perform all IV starts.

Thank you so much. I think the suggestions are great and will work for me ... after all I do want to be part of the team not an outsider looking in. I happen to have brownies in the oven as we speak because I'm scheduled to work tomorrow; they're the really good ones with marshmallow creme and drizzled fudge for topping. I'm better one on one than with group dynamics so plan to pick a new person each night to strike up a conversation with over the next 30 days. I do need to start jumping in there with the codes. Maybe I'll even bring a few photos to pin up on my locker. This forum is great and so are all of you ... I know it will just take time for me to feel more comfortable.

Well ... some of you may find this amusing. I am a new nurse beginning a second career in the ED. I just got off 90-day orientation as a GN and now am on 90-day orientation as a new RN. I was told at my review that I need to "socialize" more at work especially with the nightshift so that I can build bonds and be able to function with them as a team. I can honestly say in all of my work career, I have never been told to socialize at work more. Some of those night people in the ED can be pretty intimidating so I've just been trying to keep my mouth shut, MYOB, and take care of my patients. Now I'm being told it doesn't work that way in the ED. Of course, I have less of a problem with the day shift and mid-shift personnel because I oriented as a GN on days with a preceptor, but the night shift has worked together for a long time and I'm feeling it's not easy to fit in. Apparently they think my not talking or socializing very much is a road block to building trust. The Charge Nurse at night thinks I am focusing a little too much on my patients and not enough on team dynamics. I responded that I am very focused on learning to do my job at this time ... on how to do the tasks correctly; I'm just trying to get comfortable as a new nurse. I guess the nightshift personnel think I'm stand-offish. What I really feel is that I am still scared of a lot of things right now, I don't feel like I totally fit in, some people seem like they are a little grumpy, and I try to stay out of everyone's way. So ... help me out a little with some advice. What do I need to do? It's a problem to drink on the job and besides I don't drink at all so I can't very well loosen up with a few shots of Tequila before I go to work (ha!ha!). Should I start baking some goodies to bring in? No one has the same hobbies or sports interest as I do so I don't want to drive them crazy talking about it. I guess I could take some pictures to show of my family or something but how boring is that for other people? I had Dale Carnagie's book once on "How to Win Friends and Influence People" but must have sold it in a garage sale ... obviously it didn't work for me anyhow. From what I remember it was just a lot about remembering people's names and acting like you liked someone even if you didn't. Don't get me wrong ... I still have work to do on fine tuning assessment skills, time management, prioritizing, and critical thinking as a new nurse but those are things I have a clue about how to handle. I can picture all of you chuckling at this point but before you get carried away with the belly-laughs throw me a bone or two if you have some insight. Somebody shoot me.

I cringe at ER docs and nurses wanting to drop a HR of 140 in a septic patient. Can you say "cardiac output?? " I'm a new nurse wanting to more fully understand the rationale behind the above comment. Please elaborate ... I need to learn. Thanks!

Yes, I have plans to join ENA as soon as finances are available so appreciate the recommendation. I've been to their website to look into the information about CEN certification because my hospital provides a salary incentive. I'm just a little concerned about how much experience I need behind me before attempting the test. There is so much to accomplish it makes my head spin. I graduated in January, began work in the ED in February, passed NCLEX in March. Since that time I've completed Basic Dys and ACLS; PALS is next month. In the meantime I'm trying to adjust to a new job and work group. Sometimes because of my lack of skill and slowness combined with my endless questions I feel that I am no help at all! I thought if I could get a good reference book and self-study at home it might help with the learning curve. I just want to make sure I invest money and time wisely with the book I choose so thought this was good place to ask. It seems that Sheehys Principals and Practice is the "gold standard". There's apparently a newer book entitled Sheeyhs Manual of Emergency Care. I'm not sure how they compare. Since I plan to take my CEN I want to also make sure that I get something that will facilitate that process as well. Being a new nurse is certainly tough I've been told for the 1st year and at this point I'm in absolute agreement. But, I couldn't be happier with my choice of emergency nursing.

I feel like such a fish out of water working in the ER right after graduation and thought a good textbook might help with the learning process. Any recommendations? I'm still recovering from nursing school and didn't want to waste money on books that may not be worth it.