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too slow to work in ER?

Emergency   (4,314 Views 8 Comments)
by dec 123 dec 123 (New) New

1,532 Profile Views; 8 Posts

So I just recently transferred from medsurg to the ER and my preceptors are telling me that I am not doing well with time management and prioritizing correctly however I did fine with these on medsurg units. It just is a whole nother ball game it seems down in the ER. I am really struggling. I am feeling like a new grad all over again. Any tips tricks or advice appreciated. Save any negativity please.

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Altra is a BSN, RN and specializes in Emergency & Trauma/Adult ICU.

6,255 Posts; 40,399 Profile Views

It is absolutely a completely different environment with completely different priorities. I have precepted some nurses who have come to the ED from other specialties. Some suggestions:

Focus your assessments on the chief complaint. If it's an ambulatory asthmatic having an exacerbation, it's not important what their feet or their backside look like ... just CXR, steroids, neb tx ... disposition.

You can assess & get history & screening questions while starting a line & getting labs.

Food & drinks are now optional and only for those patients who have a diagnosis, disposition, and are not NPO ... so take that out of your vocabulary.

Never waste an opportunity to obtain bodily fluids, ha ha. Ambulatory patient asks where the rest room is? "Here, let me give you a cup just in case we need a urine specimen at some point."

It takes a little time to adjust from the "this is my team of patients for the day" mindset to the revolving door of the ED.

And ask your preceptor(s) for specifics on areas in which you can improve -- this demonstrates your willingness to accept constructive feedback and ensures that they have an opportunity to meaningfully contribute to your progress.

Welcome to the dark side ... keep us updated on how you're doing! :)

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I agree with the previous poster. I establish a baseline for my patient when my shift starts and yes focus assessment based on the chief complaint. Speak to the CC and the outcomes of your interventions. Always collect bodily fluids when possible. Be a forward thinker. If you have a chest pain pt you know they need a line, labs, EKG, 02 and put on the monitor. A nausea, vomiting pt your focus is gonna be GI. The pt will be NPO and need fluids. A female of childbearing age will need a urine pregnancy test (ALWAYS). If you can anticipate the needs it will make your life a little easier. When you know a pt is being admitted start on what needs to be done before the patient goes to the floor. MRSA swab, med rec or whatever your hospital protocol is. I have been a nurse for 1.5 years and I came from a med-surg/stepdown unit to the ER. Time management was a struggle for me as well initially but with time it will get better trust me. Best wishes!!

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Good comments from Altra.

You need to be very proactive in the ED. Never put off doing something that you have time for just because you don't have an order. Learn to anticipate what orders will be given on your pts and get them started before the pt even sees the doc. For instance, you get an abd pain, chances are you need line, labs, urine, fluids and CT, so at least get the line in, blood drawn, upreg if female, and fluids hanging (unless contraindicated) so you can roll faster when you do have orders. Also maybe get a verbal order for nausea and pain meds if appropriate.

If you can do this, you can avoid getting backed up so badly when you get ambulances back to back or that STEMI rolls through the door. Good luck!

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I have worked a total of 2 shifts on the floor, and got my butt kicked both times- and that was with ICU experience.

It is a totally different ball game with a different skill set. Why anybody thought I could manage 6 tele pt's is beyond me.

Ask to tag on with your preceptors as they manage pt's to see where they are saving time.

Also, consider not just priorities, but what takes the most time. For example, a respiratory complaint that looks and sounds like a pneumonia. On the surface, it might appear that the CXR is most important. But- CXR results are immediately available, and labs take a while to cook. Labs first, CXR second.

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SionainnRN has 5 years experience and specializes in Emergency Room, Trauma ICU.

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I started in the ER two months ago after doing 2 years in a Trauma ICU and 1 yr on Surgical Acute and time management was hard for me also. Now I've gotten a good pattern down. Biggest thing is cluster care. As soon as the pt gets into the room, help them get into a gown and on monitor if they need it and get your assessment done. If you know they are going to need a line put one in while drawing labs. Always tell them to pee in a cup, it's much easier to throw away unneeded pee than to try to squeeze a few drops later. My hardest problem what chatting with the pt, in ICU I was used to having just the two patients, sometimes for months, so you get to know them. In the ER you have to learn to chat to get the real story but to also make a quick exit, sometimes it's hard because there are some very lonely people. Good luck and hang in there!

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15 Posts; 945 Profile Views

It is absolutely a completely different environment with completely different priorities. I have precepted some nurses who have come to the ED from other specialties. Some suggestions:

Focus your assessments on the chief complaint. If it's an ambulatory asthmatic having an exacerbation, it's not important what their feet or their backside look like ... just CXR, steroids, neb tx ... disposition.

You can assess & get history & screening questions while starting a line & getting labs.

Food & drinks are now optional and only for those patients who have a diagnosis, disposition, and are not NPO ... so take that out of your vocabulary.

Never waste an opportunity to obtain bodily fluids, ha ha. Ambulatory patient asks where the rest room is? "Here, let me give you a cup just in case we need a urine specimen at some point."

It takes a little time to adjust from the "this is my team of patients for the day" mindset to the revolving door of the ED.

And ask your preceptor(s) for specifics on areas in which you can improve -- this demonstrates your willingness to accept constructive feedback and ensures that they have an opportunity to meaningfully contribute to your progress.

Welcome to the dark side ... keep us updated on how you're doing! :)

Perfect tips!!!

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