SC Nurse in ER... love it but drowning... ANY tips would be helpful

pittnurse24, BSN, RN · Apr 26, 2015

May I ask what part of SC you work in? I'm currently living in Charleston and as a RN with my BSN I've had the worst time finding a job surprisingly. I'm about to schedule an interview at a hospital about an hour away this week because I've had no luck with in Charleston, specifically at MUSC.

JulesVincent · Apr 26, 2015

Hi,

A lot of what you speak of is going to come with experience, and trial & error. When I began ER nursing almost 3 years ago, I was fresh out of school and didn't even know how to use a butterfly.

Regarding finishing charting before seeing the next pt, you want to always check on your new patient. Sometimes if it is super busy you may have to chart when they get discharged!

Pain seekers should be treated like any other sick person because they are really sick in their own way. That's the way I look at it.

Giving bedside report. Start from head to toe, right? BSAP. I frequently look at the ed doc's H&P so as to not confuse myself which pt I am reporting on.

Sepsis? Temp, breathing fast, high pulse, the way they look.

How to not sound completely dumb when speaking to docs? I think that will come with experience and acquired confidence. Otherwise just be honest and say you're new or don't know what they are talking about.

Again, a lot of it takes time. I was intimidated by all of the same things you mention. Iv pumps, priming tubing, heck I dodged accessing mediports for at least a year, not to mention catheters!

EdwardsRN89 · Apr 27, 2015

Thank you. You have eased my fears a ton! I have asked alot of my experienced peers that i respect and they have essentially said what you did... but i kept thinking they were just being kind. My manager and supervisor have both came to me on multiple occassions statimg other nurses have reported to them how well im doing and that im a good team player. But again i just assumed they were being kind. The only thing they have seemed concerned about is how long it takes to finish my charts at the end of shift. But thank you very much guess im just worrying too much. Thanks again!!!

EdwardsRN89 · Apr 27, 2015

Small world... im originally from Charleston, born and raised. I live in Beaufort now but i work at colleton medical center. And i absolutely love it! They are often hiring so id look online thats how there hiring process goes.

Editorial Team / Moderator · Apr 27, 2015

As far as triage categories, are you using ESI? There is a free handbook available online, and you can even order training DVDs at no cost. How long have you been working in the ED?

Emergency Severity Index (ESI): A Triage Tool for Emergency Department | Agency for Healthcare Research & Quality (AHRQ)

bebbercorn · Apr 27, 2015

Toddlers respond well to distraction... attempt to distract to get an accurate respiratory and heart rate, then do the more distressing part (rectal temp). Show them something shiny. Sometimes parents WANT to help but don't know how. I include them by giving simple directions, or letting them know what to expect. It doesn't help to explain an IV to an 18 month old, but Mom knows inherently that the kid is going to fight more from being held down than from getting poked (hopefully, once). Direct mom to talk to jr., it will keep her distracted, too, so you don't feel like she's watching your every move (which she is, but a good mental block sure can't help). Good luck to you!

Nonyvole, BSN, RN · Apr 28, 2015

Getting air bubbles out of pump tubing, especially that stretchy sort, is something that people will always have trouble with. (At my facility, it feels like it depends on the phase of the moon, the time of day, which doctor is working, and if we've made the appropriate sacrifice to the pump module)

I'm guessing that you're using Alaris pumps? What I do to prime the line is to clamp the line, spike the bag, fill the drip chamber, and then angle things so that when I open the line, fluid isn't running down straight from the bag to the line but onto the side of the drip chamber. This will also angle the line itself so that there is a slight upwards angle. I keep it running slowly until I see that the fluid has passed the part that goes into the pump, then I clamp it again, check for bubbles, and then finish priming the line. I'll let it run faster then. Before putting it into the pump, I'll do another visual check for air bubbles.

The Alaris pumps can usually handle small bubbles. If you continually get air in line alarms and there aren't any bubbles to be seen? Replace the module.

With kids, I don't visibly focus too much on them. I'll have a parent hold them or stay within reach, and then I get down on the floor. Yes, I sit on the floor if I have to! (I usually crouch) It puts me at their level or lower, which does help the child's peace of mind. I smile at them, and the first place I touch? Their feet. If they're old enough to understand, I show them what I'm going to do before I do it and say if it's going to hurt or not, and I'll also reframe my words. I don't "take their blood pressure" (will they get it back?) I "give their arm a hug." I put a sticker on their finger, not check their pulse-ox. Usually that creates a "huh. What is this and do I like it?" mode that lasts long enough for me to get a pulse and SpO2. We have temporal thermometers and I'll run it along my hand, their arm, and then their forehead to show them my machine that goes "beep." Once I'm done getting vitals, I then tell them that as the patient, I have one very big rule in my ER. They get to hold the remote, and as soon as they're allowed to eat, I raid the EMS room for them. So slushies, popsicles, juice, pudding...

If they're sick and need a better distraction? IPad! I have a few games and Netflix on mine, and I'll load up a movie or TV show for them. It doesn't leave the room, however, and they have to give it back before discharge. (Yes, I'm playing with fire here, but it's a first generation iPad and looks very used. They're welcome to try to take it and sell it...won't make them much!)

Anna Flaxis, BSN, RN · Apr 28, 2015

That's a lot of territory to cover in your post. I will say that Meditech has got to be one of The.Least.Intuitive.Programs out there. I don't envy you having to use it. It's horrible. All I can say about it is that you just have to get more time and experience with it, and you'll get better at using it.

I can say the same for the rest. You just need more time and experience to get your feet under you.

ParalyticAgent · Apr 28, 2015

It will all come with time. It took me a year to not feel like I was drowning. It took another year to actually feel confident.

ALWAYS lay eyes on your patients as soon as possible. I've had "level fours" intubated within minutes of my assessment. Once that patient is in your room, they are your responsibility, and you are their advocate. You can do a quick assessment in seconds by just observing your patient: what's their general appearance? work of breathing?

As a new ED nurse, you should not be in triage. Anyone who tells you otherwise is lying.

Be patient with yourself. Ask questions.

nursemel326 · Apr 28, 2015

First of all, the fact that you are able to organize all your "issues" into a list of questions is a good thing! It shows that you are able to recognize your weaknesses and things you need to work on.

I was an ICU nurse for 11 years before becoming a NP (going on 2 yrs now) and there are two things you brought up that I wanted to comment on:

Always, always, always lay eyes on your new patients when they first come in. You don't have to start charting or asking questions right away, but at least lay eyes on them and know that they're awake, breathing, and not in distress. I can't tell you how many times this will save your butt and possibly, your pt's life. Once you get super proficient with the charting system, you may be able to whip through the questions with one pt before moving on to the next, but don't start with one pt before you've at least laid eyes on the other.

The other thing I wanted to say- when talking to doctors, remember they are people like YOU. They are not perfect (even though some may disagree with that), they make mistakes, and ultimately, they want to help you accomplish what it is you're trying to accomplish. Try to have your ducks in a row (labs, vitals, assessment findings, current orders, etc) before you approach them with a concern. Know beforehand what it is you think they should order or do and be prepared to tell them all the data that supports why you think it's necessary. This will make your life so much easier. And if they approach you and want assistance with a procedure you've never done, tell them you'd love to help, but it's your first time and ask if they can walk you through it. Sometimes time may not allow this and they will request someone experienced and that's ok, too. They will respect you more for speaking up.

purple44444 · May 3, 2015

Here are 2 thoughts that may help:

1. Doctors love it when you ask for something specific. It's hard when you're new but whenever you think you know what somebody needs go ahead and say, "Do you want me to give _____?" Or "Could I give Zofran with this charcoal so it stays down?" etc.

2. I used to hate the idea of incident reports because I felt like any situation where I needed to write one, was a situation where I didn't have the time to sit down and write for 5-10 minutes about one thing in addition to my other work! However, once I had done 3-4, I became so much quicker at it, and now I do them right away when it's fresh in my mind so I can get it done and sort of "let it go" and move on to the next challenge!