ERjunkie81

The ER that I work at could be a model for others... Our average DOOR to MD time is about 12 minutes. There are very few days that a patient has to wait 2 hours to see a doc, especially a MR patient with SOB w/hx of pneumonia. So first, the ER and docs should work on their wait times. This is completely out of your control. With the knowledge that our average wait time is 12 minutes, understand that the doctor alot of times makes it to the room before the nurse does. However, when he doesn't I still start IVs, hang fluids if called for, obtain EKGs, etc. Is it good nursing? ABSOLUTELY. Being newer to the ER, you may not have the knowledge or experience to make accurate calls on what needs to be done, but once you do, if you initiate care, then that can help streamline getting labs quicker, blood cultures done sooner, and subsequently ANTIBIOTICS. Think about it, would you wait on the doctor to place a patient on o2 that needs it? Honestly, how many patients do you start IVs on, WITH AN ORDER, that don't need one? So if YOU think that they need one, then it's probably safe to initiate it. Now, naturally you can't give meds, order labs, or start fluids without an order or protocol, but if YOU feel that they need it, then you'd better be asking an MD! JMHO

I think it's great for medsurg nurses to come to the ER! I have precepted former medsurg nurses, and in my experience, there are struggling points that are common among them: - IVs. On any given day, I may start anywhere from 4 to 15 (I'm not exaggerating!) IVs. From what I understand, medsurg nurses do not start very many IVs and don't perform peripheral blood draws. My advice is to do AS MANY as you possibly can while you are orienting. Don't ask techs to draw all of your blood. Do alot of your own blood draws. THIS WILL HELP YOU! - In and out times. I've never worked medsurg, so I can not attest to what the common practice is on the floor... But former m/s nurses tend to spend too much time in each room in the ER. Now, everyone please don't stone me yet!!! I'm not saying that you shouldn't spend time, listen to, or care for your patients. What I'm saying is that TIME MANAGEMENT is everything! When you work in a "fast track" type area, treat it like fast track! If you have 6-7 other patients that need IVs, labs, meds, vitals, then don't spend 30 minutes in a room talking to your 25 year old patient about his penile discharge. Get in, do what you have to do, and get out. Do your FOCUSED ASSESSMENT, educate quickly, and move on! There are no scheduled meds, bed baths, or meal times in ER. Everything happens quickly and the quicker that you can turn over your patients, the quicker you can see the next one! PRIORITIZATION and TIME MANAGEMENT! ****EDIT: I work in a VERY busy ER. If you work in a 10 bed ER that sees 30 patient's a day, you may be able to spend more time. That's just my experience at this ER.**** - Last but certainly not least- EMOTIONS! There is no right, wrong, or easy way to handle this. You WILL see patients die on a regular basis. You will have a patient die under your care. Do whatever you need to deal with it. I'm a dude's dude, so I don't particularly do this, but if you need to, walk to the bathroom and ball your eyes out. It is OK to hug a patient's family member or pray with them (if they want to). Be careful not to become calloused. We had a 50 year old person that came in with a ICH, and when the MD told the family that she would not make it, they did not take it well. I told some one that night, "I hope I never completely get used to that!." They said, "Then you wouldn't be human." These are just my observations of some struggling points of m/s nurses. Get in there, soak up the knowledge, and HAVE FUN! I DO! JMHO

YES! IF he is truly unresponsive with shallow respirations.