chansen

The concept of multi-tasking is flawed. It takes away mental or physical energy from whatever task is most important. Forget the word multi-tasking exists. It can impair performance. Have a mental routine before your shift. If you're religious, pray. If you meditate, meditate. If you have a song that pumps you up, listen to it. Think about what a shift normally entails where you work, focus on what you're going to do to have a strong day. Switch your brain into "I'm at work mode." Always deal with your critical patients first and foremost, which goes without saying, but otherwise, do time-limiting or tasks you hate first. Can't stand accessing a PowerPort and you have a patient with one? Go do it first. Someone needs a straight cath for a urine specimen and they're here for an abdominal complaint? Just get it done. Thinking about the things that you have to do that you don't like to do will give you anxiety and take away your ability to completely focus on the task at hand. Cluster every single thing you can. If you are going into a room, take everything you're going to need, get them situated, get vitals cycling, address anything you can while you're available, because you don't know what's coming through the door next and you don't know when you're going to be back in that room. It's easier to say, "can you peak in on Mr. Jones in 22 and just make sure he's still breathing and his cuff and pulse-oximeter are still hooked up?" to a tech, then it is to realize you haven't been in the room in two hours and you have no vitals and no idea how he's doing. Learn what's important to chart, and what isn't. Some folks chart everything down to "tucked blanket around patient's feet for comfort." I'm not that guy. Same with assessments on non-critical folks. If you use a 5-level ESI system, anyone who isn't a 1 or a 2 gets 1-2 systems covered with an assessment. ESI 1s get every system. ESI 2s get multi based on complaint and linked concerns. When you have a dirty room, or an empty room, make sure your essential equipment and supplies are ready. Nobody wants to be That Guyâ„¢ that has a sick patient and there's no ambu bag, or the suction isn't working, or there's no christmas tree on your O2 regulator. It's good habit anytime you're in a room to look around at the critical equipment and fix that problem anytime you come back to that room. Lastly, learn to let things go. You want to feel like you can do everything. All at once. For all your patients, and those of your peers. But you can't. Remember this mantra: You can't control what happens to you, but you can control how you react to it. Additional reading re: multitasking. Multitasking and the neuroethics of distraction by William P. Cheshire from Ethics & Medicine: An International Journal of Bioethics, March 1, 2015. Stop multitasking: Doing it all accomplishes nothing by Catherine M. Seeber from Journal of Financial Planning, May 1, 2015. Choice in multitasking: How delays in the primary task turn a rational into an irrational multitasker by Ioanna Katidioti and Niels A. Taatgen from Human Factors, June 1, 2014.

If they are department beneficial, try and make the department pay for them. If you work in a place that is not willing to help improve the work environment, morale, and flow with cost-effective, thought-out solutions, and expect the employees to pay for it themselves, then there may be a culture problem at your facility. Some things we've paid for out of pocket, but for any project that we've created within our group, we push it through management to get it funded first and foremost.

The ED has been and always will be the scapegoat for too many hospital problems. Unless they've worked in an ED before, they won't get it. Sure, it may be that nurse's second admission of the day, but you may have 40-deep in the lobby and have to keep flow moving. ED flow is an entire hospital problem.

Or a rhesus monkey.

I've paired down quite a bit. Used to carry full sets of IV start kits, but our nurse-servers in each ED room carry a good many things. - stethoscope - hemostats with a tape roll on them clipped to my scrub top with my shears down through the tape. - small memo book notepad in breast pocket. - 4 color click pen. - iphone with related apps - flushes and alcohol wipes - chloraprep - ammonia capsule taped to back of my badge

The sheer number of young female "abdominal pains" that arrive by medic and then elope when their urine HCG comes back positive never ceases to amaze me. Hooray for 911 pregnancy tests they never have any intention paying. And people complain that a more socialized healthcare insurance system would cost tax payers too much. If only they knew how many people are abusing the ED on a daily basis. . .

Similar to what was said before, the ED is so much more task oriented than other places, and the biggest thing you need to do to provide the safest care to your patients is continuously reassess what tasks need to be done and place them into three basic categories. 1) Life saving interventions that cannot wait. 2) Important things that must be done soon. 3) Tasks that can wait, be easily delegated, or are not time sensitive. Experience will help you place tasks into these categories, and from there things begin to feel more organized. It's easy to start working in the ED thinking you need to make every patient the most important person because you want to excel and you want to be a good nurse. Some times there are going to be people that no matter what you do, they are not going to appreciate what you are doing for them, the time you are spending on them, and the customer service you are attempting to provide. The sooner you understand that, the better. While customer service is an important facet in today's world of healthcare, your number one priority still needs to be focused on providing the best outcomes for all your patients. So, as time goes on, you start to develop your gut list for where each task belongs in those categories. You aren't always going to have a number 1 at any given point in the day. In fact, you may go an entire shift or more without having a number 1 task. So how do you sort the giant stack of number 2s you have? I personally like to do it by who I haven't seen in the longest amount of time. This way I can cluster care and try to keep seeing my entire patient load as often as possible. Reassess pain medication or past interventions, provide interventions required for new diagnostic testing or medications, get any charting caught up (the ED isn't a friendly place to catch up on charting at the end of the shift - staying on top of your charting will come easier over time but is pretty crucial), vitals, etc. Barring all those things, you can never go wrong seeing the person with the highest acuity first in the scheme of things. Look at your patient load and mentally assess which one is "the sickest" and make sure they get just a bit more of your attention (at the least). Lastly, communicate with your fellow ED nurses. This is a team sport, and an ED team that works together is a much better work environment. You may not feel like you're organized enough early on to help the other nurses in your area, but when you do have some down time, make sure you're asking if they need help with anything, try to make yourself available to help assess and check in patients arriving by medic, and don't be afraid to ask for help. Sometimes one or two basic tasks (even number 3-type tasks) being done are enough to get you over a hump where you feel like you're falling behind.

There are definitely a few instructors who I think are just burnt out from their support at the school (or lack thereof) and the swap to semesters is definitely a large source of that anxiety. There are also instructors who very much care about the education you receive while in the program and want you to succeed in the nursing field. Grades are not the end-all, be-all for the fellowship. The biggest things you need in order to get into the fellowship are a stellar application packet and solid interview skills. The application packet is somewhat arduous, which you'd think would limit the number of applications, but I know for our group there was 300ish applications for the 24 spots. It requires several essays, several clinical instructor recommendation letters, your transcript, and more. Early on, especially if you have a clinical instructor with which you connect, ask about a future recommendation, and try and get additional contact info from them if they are adjunct. I had a difficult time getting a hold of adjunct clinical instructors once I was no longer a student of theirs, and it made it difficult to complete both my final quarter preceptorship packet as well as the critical care fellowship packet. Making the cut from packet to interview is the biggest hurdle. If your packet is excellent with great recommendations and solid essays, that's the best bet. The interview is with critical care nurses as well as the person who runs the fellowship from the educational and organization side of things. You need to have developing critical thinking skills and a customer service driven attitude in your answers. There will be a number of questions regarding how you've handled situations in the past, prioritization questions, application of knowledge questions regarding common critical care setting scenarios, as well as the generalized interview questions anyone should be prepared for.

December graduate, in the OhioHealth critical care fellowship right now. What we learned in terms of clinical application was on par or beyond that of the other area schools with BSNs or ADNs. Skills are one thing, and as previously mentioned, any monkey can be taught a skill, but applying your knowledge base to a clinical setting is something that other school grads are envious of with CSCC students. The OSU grads in our program specifically mentioned their jealousy of CSCCs reputation within the clinical setting for central Ohio hospitals. Disorganized? Yes, absolutely. Being there when the focus was on the swap to semesters was definitely noticeable, but some of the disorganization cannot be helped. Clinical schedules and placements were always a hot topic, but you're at the mercy of the hospitals and units where previous rapport has been made (or perhaps destroyed by a bad group of students), and the hospitals have a LOT of students from a LOT of schools as well as tying to teach new hires, fellows, interns, and residents. Finding a place where a gaggle of students can disrupt the normal flow of a unit (for better or for worse) is difficult, let alone finding a dozen of them for each quarter of students. It was easy to find things wrong with the program while I was a student there, but looking back on my experience I learned specific things from many of the instructors that greatly influence how I practice now. What you learn in school is a small portion of what you use to function as a practicing nurse. No matter the school where you received your diploma, everyone takes the same state boards. I'll go ahead and plug the fellowship while I'm here - it's a fantastic, albeit competitive to get into, program that I highly suggest applying for if you have any interest in advance practice, critical care, or ED/trauma. It's a 21 week program with 4 clinical rotations and lecture, simulator, and ACLS classes between. It's a great onramp to the critical care setting and is well received on the critical care units. At the end of the program, you interview with various critical care units (likely the ones through which you rotated, but there's some flexibility) and find a new home where critical thinking and autonomy shine.

You need to really start developing those critical thinking skills. It's not enough in an ICU setting to just memorize things like, "if my patient has low blood pressure, put them on a pressor." You need to know what that's doing, why it's increasing the blood pressure, what difficulties is it causing by doing so, and if it's even safe to administer it (What is your patient's fluid volume status? What is going to happen if you're titrating a vasopressor to someone who is hypovolemic?). Example two: why are you recommending to the physician to order albumin on someone that isn't voiding with lasix? How long will the albumin shift fluid to the vasculature before it's moved out to interstitial space? What is something else you could use instead? How much of each liter of an isotonic crystalloid remains in the vasculature after a few hours? Basic information like lab values, drip rates, common critical care drugs (class, moa, uses, contraindications, adverse effects, off label uses) and things that are on your pre-printed order sets are great to have memorized or handy in a notebook. However, nothing will replace your experience and critical thinking when it comes to the outcome of your patient. The icufaqs.org site is a great start, though depending on where you work, the information can be dated at times (CVP monitoring is mostly out the window anymore, for example). Beyond that, check out books like "Hemodynamic Monitoring made Incredibly Visual," listen to podcasts like ICU Rounds or EMCrit (geared towards physicians primarily, but the information is still invaluable), and most importantly, use the educator of your unit and the experienced nurses around you. ICU nursing is a team sport. Just don't make the team do everything - come to them and say, "here's the situation with my patient and I'm thinking X might be happening, and we could treat it with Y, what does your experience say?" People are much more receptive to someone putting forth the effort compared to someone who just expects an answer (not that you're this type of person!). Best of luck in the ICU.

Dyslexia in physicians is always easy to diagnose.

As a new grad you have an easy and effective "weakness" you can list if the question comes up. Delegation. "As someone who has been in a position of learning until this point in my life, I've had less experience delegating tasks. I'm not in a position where I feel comfortable delegating even the more menial tasks because I won't know the people around me or how they do things compared to how I was taught. It's something I'll have to work into once people know what they can expect from me as well as what I can expect from them."

I love cargo uniforms, because I'm a walking boy scout in the ED. I don't like to have to leave the room for additional supplies for IVs or gather up extras for med admin when making a trip to the pyxis. Stethoscope around the neck, small flip pad to jot things down in my breast pocket with two 4-color pens. Left pant pocket is 18 and 20 gauge angiocaths, right pant pocket is iphone and my leatherman squirt (the pliers come in handy for stuck IV tubing, swapping out tubing to ours when a patient comes from an OLH or by squad), left cargo inside pocket are tourniquets,left cargo outside pocket are wrapped 5 ml flushes, right inside pocket are wrapped 10 ml syringes, filter needles, and blunt fill needles, and right outside cargo pocket is filled with alcohol wipes, chloroprep, and tegaderms. Hemostats are clipped to my scrub top with paper, plastic, and fabric tape rolls threaded on top, with my trauma shears dropped down through the tape. The diet coke stays back at the station inside our drink box!

20' and above tends to be the height at which falls get ugly. Had a construction worker fall 60' off a roof, landing feet first on the hood of a car. L1 and up on the CT were pristine. Some minor damage to L2-L4 (never found out if there was cord involvement), no pelvic damage, and some lower limb breaks. Medical hx received in report? Past trauma history of pedestrian vs. train and pedestrian vs. car. I honestly wondered if he fell from the building or jumped. . .

I think I'm in the minority that go the minimalist route with shoes. I wear new balance minimus to get a near-barefoot feeling.