Time Management in the ED HELP!!!!!!

[mbrason]

i was wondering if anyone can help me with my time management. i have finished my internship and will be on my own. during my internship i was getting very high marks from my preceptors as well from other staff rn however, my preceptor tells me that i am taking a long time in the pt room and i just cannot figure out what i am doing. she says that i am listening too much what the pt is telling me and that i just need to get the facts however i believe that some of the facts and concerns the pt are asking me are important but my preceptor said just redirect the pt to the reason why they were here and leave it at that. now that i will be on my own i have some concerns about if i will get too behind and not be able to carry the pt load by myself since i will not have my preceptor redirecting me or telling me to go do this and that. i do feel that i understand the flow of things but i am just slow in their eyes. my preceptor is very helpful and just tells me that in time i will get better. it has only been 16 weeks but now that i will be on my own i am a bit nervous but am hopeful and up to the challenge. thus far i will say that i am learning a lot and have enjoyed my experiences. this is my only big concern at this time. how long did any of you finally get your time management down? also please give me any pointers.

thanks in advance:)

[LLLLiiiFFEsaveer]

I like the preceptors comment about re-directing them during your assessments!

Hopefully, You will be able to develop a system that works for you over time. One that balances that "one-on-one" care, with that "emergency department" nurse mentality.

[Lunah, MSN, RN]

Sometimes it's tough to interrupt or redirect a pt as he/she recites their litany of complaints, but you'll get used to helping the pt focus on the reason for his/her visit. It'll be a matter of your survival/sanity as an ED RN on your own, so you WILL do it. :) I often explain to patients who say things like, "I need to know why I've had this XYZ problem x 5 months" that what we do in the ED is rule out the life threats, then refer pts to primary care or specialists as necessary.

[gardengal1, ASN, RN]

First, don't ask them about their entire health history, the triage nurse has gotten most of that information for you already. Zero in on their presenting complaint ONLY and the symptoms associated with that complaint. As soon as you have the current "picture", use any excuse to leave the room - "I am going to go get IV supplies or I am going to get supplies to draw your blood", etc. It stops the conversation about their entire health problems and allows you to get out of the room in a reasonable length of time. You need to practice this until you are able to go smoothly from each of your patient's rooms, checking on them frequently but not giving them the opportunity to go into personal details about their lives (I live alone, my children never come and help me, I have no money for these meds, and so on) which then ties up your time and doesn't allow you to keep up with the ebb and flow of incoming patients and being able to keep track of their labs, x-rays, meds, etc. This will get better the more experience that you have but you need to push yourself right now to figure out ways to extricate yourself out of the patient room as quickly as possible so your preceptor can see your progress. Good luck

[JStyles1]

i agree with all of the above. in the ER you have to focus on the main complaint/reason why they are there. that is what functioning in the ER is all about, treating the main complaint. on the discharge information in another ER i worked at, part of the information the patient had to sign made them acknowledge they were seen and treated for their presenting problem only and to follow up with their primary for other complaints

[Jennifer, RN]

Focused assessments. Of course, there will be patients that need a head to toe assessment, but all others, focus on the complaint. If you have time to chit chat, great. If you are busy, get out of the room as quickly as possible. Walk in, greet the patient, talk and assess at the same time. You can get PMH and current complaints while tasking ivs or labs, or hooking the cardiac monitor. Work as you talk. Consolidate all actions. Start timing yourself. Get a watch that beeps, set it for 5 minutes. Time goes by quickly sometime in an ER (and other times, very, very slow) and you may not even realize how much time you are spending in a room with a patient.

[AndyLyn]

Some patients are just time suckers. Don't let guilt tie you to their bedside, unless you've got the time. Otherwise, do what you need to do with a big ole' smile on your face, then move along. If you need to interrupt a litany of complaints, do it. If you need to stop them and ask another specific question, do it. If you need to get out of the room, back out, turn, and go. It's the only way you'll get your work done.

I'm constantly asking myself "what do I need to do next." Your priorities change moment to moment in ER. Go with it. What was most important one minute can fall way down on your list the next. That's the way it goes. That'll become second nature before long, it's what makes or breaks a good ER nurse. Good luck!