Struggling

russianbear · May 18, 2016

I'm doing. I've cut things out of my assessment. I'm reading TNCC manual and Fast facts for ER nurse. Giving me an idea of what to anticipate, etc. any advice from you guys on what to focus on is always appreciated.

Lev, MSN, RN, NP · May 18, 2016

Your initial focus is the chief complaint. Once your assessment is complete then you will have a better idea of what the "real" problem is. The biggest problem becomes your priority.

Ask every patient if they have had any "discomfort" in their chest or trouble breathing. I say "discomfort" because some people say "I've had a little tightness but no pain."

When a patient comes back to the room attach the BP cuff and pulse ox and cycle your vitals.

If they come in with any chest discomfort/reflux (especially if middle aged and above), abdominal pain (if middle aged and above), shortness of breath/trouble breathing, confusion, High/low BP, low SpO2, Low/high HR, palpitations, syncope, neuro complaints (seizure, stroke symptoms), lightheadedness, dizziness, drug overdose/withdrawal, etoh intoxication/withdrawal, or if they just don't look right they need an EKG and should be put on the monitor. This is a task that can be delegated. They will also need labs 98% of the time.

Always eyeball your new patient even if you are not ready to go into the room.

Also, try to fill your rooms as quickly as possible. Once you get your rooms filled you can catch up.

Every patient who goes to the bathroom gets a urine cup.

Every confused, elderly, demented, change in mental status, psych, drug overdose, etoh, and sick looking patient gets chux on their beds.

Scrubs_n_sirens, MSN, RN · May 18, 2016

Don't let a bad review get you down. Think of it as a new opportunity for growth!

Hone in on what you need to improve. I always found taking online classes and con ed really helped me understand things better.

I recommend TNCC!! It helps a lot!

russianbear · May 18, 2016

Don't let a bad review get you down. Think of it as a new opportunity for growth!
Hone in on what you need to improve. I always found taking online classes and con ed really helped me understand things better.
I recommend TNCC!! It helps a lot!

Mom keeping my head up. This is what I want to do and where I want to be so in gonna keep busting my ass to be great at it. I've received some wise advise in this thread and appreciate it and always appreciate help.

MassED, BSN, RN · May 19, 2016

Do you have an emergency nursing book? Trauma book? I have one I got from Amazon years ago, critical care pocket reference, something like that. It gives you a bit of everything. Keep that in your pocket, reference everything, read up on meds, what you learned each shift, take notes. Look up a ton at home. I still do that. If you don't learn even day, you're either missing something or you don't care.

MassED, BSN, RN · May 19, 2016

It seems to be a matter of: get admission, look at chief complaint, proceed from there, i.e. Get EKG line and labs if chest pain. Or GI order set, etc. go in, do focused assessment, tasks, get on out.

A big help would be to talk, assess all while you start that IV, draw labs, hook up to the monitor. Gather information when it's convenient, make wise use of your time when you are in the room. You may have to go back later for more info, but hit on the most important so you can get to your next patient. I would say keep it to 10 minutes per pt, then circle back. Remember you have probably 3 to 4 other patients.

russianbear · May 19, 2016

A big help would be to talk, assess all while you start that IV, draw labs, hook up to the monitor. Gather information when it's convenient, make wise use of your time when you are in the room. You may have to go back later for more info, but hit on the most important so you can get to your next patient. I would say keep it to 10 minutes per pt, then circle back. Remember you have probably 3 to 4 other patients.

I think I'm getting the hang of it. I just want to be good at this. I love working in the ED.

russianbear · May 20, 2016

Ok. Seems pretty obvious at this point I'm not going to make it. This really sucks!

Editorial Team / Moderator · May 20, 2016

Ok. Seems pretty obvious at this point I'm not going to make it. This really sucks!

What happened? Did you have formal feedback?

russianbear · May 20, 2016

What happened? Did you have formal feedback?

Had a meeting. I just feel lost and like no matter what I do I'm not going to ever get it.

pockunit, ADN, RN · May 20, 2016

It seems to be a matter of: get admission, look at chief complaint, proceed from there, i.e. Get EKG line and labs if chest pain. Or GI order set, etc. go in, do focused assessment, tasks, get on out.

Pretty accurate.

ER is not the place to deal with all the things in a person's history. It's the place to deal with THE REASON THEY'RE IN THE ER and the other floors can handle the things downstream.

pockunit, ADN, RN · May 20, 2016

I worked on the floor for six months before getting into the ED, so I would agree that I'm a new grad. I'm very green.
I worked previously on a cardiac floor so I had EKG class then. Yes, I do have TNCC book, Sheehy's, etc. I'm trying to learn. I do ultimately wish to become an NP, but I'd like to stay in the ED once I do that and this ED hires NPs.

Dude. You have SO MUCH to learn in the ED. Put school on hold. It will be there next year or the year after. Do the thing you wanted to do, which was get into the ED. Learn it well. Then do the next thing. Don't spread yourself so thin.