This is not the ICU

Yes, I did "struggle" with the performance of quicker assessments. That's mostly because I am a meticulous person anyway. Over time, I've gotten more efficient with them. In the ED, assessments are focused toward the presenting problem/complaint. Thus, you spend most of your time on the involved body system(s) and then "screen" the other systems. If you detect abnormalities in the other areas, then you can go into greater depth. That said, sometimes the "presenting complaint" is nebulous and you need to delve further. So, listen to the chief complaint, but it's ALWAYS better to delve further, no matter what your manager/preceptor say. Accuracy, efficiency, and speed come with practice. As you see and do more assessments, you will become better at it. You will become better at picking up on subtle clues that help you tailor the assessment to THIS patient on THIS occasion, if that makes sense.

Practice, practice, practice.

I still do full assessments and I have my patients usually for less than 1 hour.

It is primarily focused and prioritized but there is always a way to do a full assessment, no matter what people tell you.

Practice.

This was the hardest part of transferring to the ER. It took me a long time to switch my mind to "this is the ER",....the focus is to keep our pts alive until we can get them to OR, ICU etc. Our ER always has many in the waiting room and the longer I spend with a pt the longer someone sits in the waiting room not being seen at all. It was difficult to stay focused on only the c/o and to understand that the fx needs to go to the OR, the blood glucose of 480 will be handled later.

You will get there. It probably took me 6 months to really feel good about the care of I was giving and to fully understand that this is the ER,..we are here for EMERGENCIES,...all the other stuff is handled elsewhere. Best of luck to you!

I took a cue from the doctors I work with. If it is a resp or cardaic complaint, they listen to the lungs and the heart. If it is an abd issue, they listen to bowel sounds as well. If its a gyn complaint....well you get where this is going :)

Focus on the complaint. I don't listen to bowel sounds if the complaint is a sore throat. It will come. Give yourself 6 months minimum!

PAERRN20 gives good advice. Watch your Doctors and PA/NP's. Focused assessments are not only expected they are survival in busy high volume ED's. Which is not to say you ignore everything else. The doorway assessment as you walk in the room, how they talk act, respond, move etc....tells you a great deal before you do a formal assessment.

I've been in the Er for like 9 months now, and at first, I tried to go in with the docs when they did their assessments. At least this gives you an idea of what to investigate. Basically, I just do a focused assessment based on their complaint. It comes with time. I got the same "you take too long to do your assessment" lecture a few times too, BUT always go with your gut during assessments and its ALWAYS better to be thourough (sp)