Time Management in ER

FancypantsRN · May 15, 2011

Give yourself some time - it's probably a combo of new nurse and new ER nurse. With any floor/unit type, being a new nurse means the challenge of learning time management.

Just remember that in the ER, you continuously change priorities. Your priority one minute changes when that new ambulance rolls in. I am new to the ER myself.... don't be afraid to ask for help no matter how busy everyone else is. They would rather you ask for help then just guess with your interventions.

One thing that was difficult for me to grasp (coming from floor nursing) is that everything is stat in the ER, don't let that change your real priorities. It really tripped me up in the beginning. Just use what you have learned re: your ABC's and take it from there. Hope this helps : )

MassED, BSN, RN · May 15, 2011

Hi All,
Im on of those "Forbidden" new-grad's in the ER. I wasn't given very good training, but nonetheless learned alot during my weeks of orientation.
My concern is adjusting to the fast-pace in the ER. Im on my first few days by myself, and the challenge of learning to handle 5 patient rooms of documentation/orders/etc is overwhelming. I work with a great team, but they are all so busy too that its hard to ask them for help!
I'm just not sure if its because Im a new graduate or just new to the ER.
Any insight on this? Tips/suggestions on how to keep my head above water these first few weeks of orientation?? How long until you ER nurses became comfortable with your workload??
I just dont want to get fired because I am drowning in my workload from poor time management!!
Thanks Evereyone!

5 patients?? What acuity level are they? Hopefully not all 2's (ESI).

Most nights if I'm super busy, so is everyone else. You do the best you can, but if you have a SICK patient and need help, REALLY need help, go to your charge and tell him/her you need help with your other patients, that your sick patient is 1:1 right now. You'll get help for the others less urgent ones, or tell your other patients you have a very sick patient and will get to them as soon as you can. Some things you can delegate to help with your overall flow, such as getting water/food, or toileting - if you can have your CNA handle those, so you can deal with the other tasks. If you jot down on a sheet of paper those tasks in the order of priority, then cross them off and as your priorities shift, rewrite them. You'll get it. Just focus on the most important things first, all the time: airway, breathing, circulation. Let all other things fall to the wayside. Keep a call bell next to every patient and make sure each person is safe, then take a deep breath! And pee! And keep a snack or two in your pocket! =) Some times the days are horrific and chaotic and you want to quit... but others are great fun and flow really well. But most of your team mates will feel the same way because when we all have crappy days, at least we went through it together!

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · May 15, 2011

Like they said, prioritization keeps changing in the ER which is why people with ADD would make good ER nurses. Thankfully nobody has said "multi-tasking." True multi-tasking has been studied and found to be detrimental to the tasks at hand, and the actual limitation for the human brain seems to be two tasks at once, like charting while planning your next task.

MassED, BSN, RN · May 15, 2011

Like they said, prioritization keeps changing in the ER which is why people with ADD would make good ER nurses. Thankfully nobody has said "multi-tasking." True multi-tasking has been studied and found to be detrimental to the tasks at hand, and the actual limitation for the human brain seems to be two tasks at once, like charting while planning your next task.

well it IS a degree of multi-tasking. You are walking to the lounge to get that zillionth ginger ale, while remembering to pee, then gets meds for that patient while simultaneously trying to remember to check orders on that new abdominal pain.

That is multi-tasking. Prioritizing, whatever you want to call it. It's a million things going on simultaneously.

I don't think ADD peeps would do well, if you lack the ability to focus. I think if you're in perpetual motion and like to do many things at once, then the ER is your cup o tea.

nurseethics · May 16, 2011

I can remember the night my preceptor in a Level I trauma center seeing 150 patients a day said "give yourself six months" and I thought, God, she must think I'm stupid..but she was right. Start with the end in mind, 'in one month, I will see the system, in two months, I will work well with the system, and in three months, I will be fine"...best words from a seasoned RN..." be easy on yourself, keep your sense of humor, and stay patient focused, you won't go wrong." 30 years later, I continue to remember her words..enjoy your journey.

sassyRN73, RN · May 16, 2011

I'm feeling your pain right now...have been in the ED for 3 weeks. I like the work and the team we work with is awesome!!! However, some days I feel like I'm running on a treadmill and not getting anything accomplished. Hopefully we'll be getting the hang of the ED rythym.

Footballnut · May 16, 2011

Keep a game plan in your head (aka nursing care plan) going for each patient and work it. That way you will know if you are staying on track and moving each patient along. It works amazingly well to remain conscious of your goal for each patient. You can usually pre-plan, stay focused, and readily know what you need from other people who ask if they can help you.

For example, a goal for a patient that I have assessed to be some sort of simple gastroenteritis might be that the patient is able to tolerate po fluids by discharge. I will work to get the right diagnostics, control vomiting with anti-emetics, rehydrate the patient, assess my efforts as I go and finally have my patient trial some po fluids to ensure that my patient is ready to go home and recover.

All the best! You will only become better and get more confident as you go.

RN1980 · May 16, 2011

i too know what its like to be thrown to the wolves as a new nurse. my orientation was very limited. but i was fortunate to have a good seasoned team to work with. working in a busy er is like trying to plug a busted dam with your finger. its tough for even a seasoned nurse thats new to the er world, now multiply that factor by x and thats how hard it is for a rookie. all the nurses you are workin with should expect you to be lost and it should come as no suprise that you need assistance. dont put yourself in the position of screwing up cause you feel as if you are slowing the other team members down with their assignments by seeking help. litsen to your gut feelings, if you think you need to ask someone..then by god ask someone! time management is a killer. its something thats learned from exp. my personal theory is pretty simple..if its not emergent or urgent than it can wait. "the a-febrile kid in room 6 that needs a strep can wait a few minutes so i can finish charting on this icu admit" ive watched many a fresh nurse go through the same thing that you are going through (and the same thing i went through not long ago) and its funny and unfortunately painful at times to watch, but take comfort in the fact that there have been many a new nurse that was not near as smart or as hard working as you that have made the transition, so you can too. be on time, be available, be flexible and be humble.

Anna Flaxis, BSN, RN · May 19, 2011

I'm just not sure if its because Im a new graduate or just new to the ER.

It's probably a little of both.

It really just takes time and a lot of work. You have to keep developing your ability to prioritize, and roll with it when those priorities change. That is a skill that doesn't come naturally to everyone.

During those few moments when you don't have something that needs your attention STAT, that is a good time to be methodical and check in and re-vital each patient, check on the effectiveness of whatever drugs you've given (analgesics, antiemetics, anxiolytics) make sure they're safe, grab them that extra blanket, check your charts for new orders, etc. And don't forget to get a drink of water and pee! I know that feeling all to well of bouncing from foot to foot trying to hold it while you're hanging a med or doing a mini cath. Not fun!

MAL, RN · May 23, 2011

Its really a relief to hear everyones comments, especially that even seasoned ER nurses get frazzled. I like the analog about running on a treadmill but not getting any where!!

hiddencatRN, BSN, RN · May 24, 2011

I don't think ADD peeps would do well, if you lack the ability to focus. I think if you're in perpetual motion and like to do many things at once, then the ER is your cup o tea.

Well that's the thing about ADD- adrenaline is a great focuser! The stimulation of everything going on and needing to be done at the same time actually helps me focus because I can't get bored and zone out. I can't remember where, but I read somewhere that the reason TV and computer/video games are so entrancing to people with ADD is because the screen shots are constantly changing and that stimulation is what an ADD brain craves....so ER nursing fits in with that nicely!

To the OP, I'm a new grad in the ED too and don't be afraid to ask for help. Everyone else might be busy yes, but they still might have time to help you out. When you have slow times, offer to help them back. I'm not sure how far you are in orientation or how long you've been working, but I noticed a progressive, growing sense of being able to handle things without getting too far behind start around weeks 8-10.

I always think about what my goals are for the day at the start of my shift, things that I didn't do super well on the day before that I want to improve on (usually it's all involving keeping up, don't forget to document you put the respiratory pt on a pulse ox monitor, hurry up and wait better so that when the rush comes I'm not already behind because I got used to moving slowly during down time).

I keep hearing 6 months to a year is the golden time for feeling comfortable and not completely behind the ball.