What do you do first, besides "ABC"?

[BSNbeauty, BSN, RN]

My biggest challenge in the ED is prioritizing. I always use the ABC as a rule of thumb, however I still feel overwhelmed with the other tasks such as discharging, admitting, and receiving patients.

For an example: When I have a patient to discharge and a new patient to see which one comes first?

Should I finish my discharge,then see the new stable patient? Or should I assess the new patient then discharge?

I guess it'll take time.... sigh.

[Larry77, RN]

I was a charge nurse for years so my answer would be DC, DC, DC! In that order :-)

You answered your own question though when you said "stable" patient. Unstable patients come first of course.

[SionainnRN]

It all depends on what the new pt is in for. My triage nurse usually lets me know what they've put in the room, if it's an unstable pt they usually bring them back into the room first and start triaging them back there so they can start doing interventions. If you have a new pt and dc at the same time grab your dc stuff, stop by the new pt room pop your head in so you can see them and make sure they are stable, let them know you'll be right with them and go do your dc. In the ER it's all about moving the meat, but you want to make sure the meat is still alive.

[BSNbeauty, BSN, RN]

Thank you both! I got it now. My first instinct when a new patient comes back is to drop everything and assess. I'm learning that not every patient that comes to my room need an assessment right away. I can finish up a discharge or documentation before seeing the patient.

I love the move the meat analogy. Totally makes since.

[sesaad123]

move the meat

[SionainnRN]

Thank you both! I got it now. My first instinct when a new patient comes back is to drop everything and assess. I'm learning that not every patient that comes to my room need an assessment right away. I can finish up a discharge or documentation before seeing the patient.

I love the move the meat analogy. Totally makes since.

Honestly sometimes the doc beats me into the pts room, especially when I'm busy with sicker peeps. Hang in there, you'll get the rhythm.

[whichone'spink, BSN, RN]

Thank you both! I got it now. My first instinct when a new patient comes back is to drop everything and assess. I'm learning that not every patient that comes to my room need an assessment right away. I can finish up a discharge or documentation before seeing the patient. I love the move the meat analogy. Totally makes since.

Another thing you can do is ask your pod buddies, if they're not busy, to either triage your new patient or d/c your other patient. And yes, not every patient needs to be seen right away.

[BSNbeauty, BSN, RN]

Thanks. I'm an over achiever. Sometimes I hate asking for someone to help but I know I have to. Thanks for the advice.

Another thing you can do is ask your pod buddies if they're not busy, to either triage your new patient or d/c your other patient. And yes, not every patient needs to be seen right away.[/quote']

[JessiekRN]

Learning to balance is one of the toughest things to figure out. My apologies to the charge nurses lol- but look at it this way- if you discharge your patient first, then go see your new one- you will have two new patients before you know it. And that "stable" patient might not be as stable as they appear- sometimes it's not that clear cut. I think better to see the new one first. (Unless the discharged patient suddenly decides they need to leave NOW and they're standing in the hallway making threats. Just give them their papers. It happens)

[lagalanurse]

I actually prefer it when the doc beats me to the room, if the patient is stable. Then I can go in there and assess and implement orders. Saves me time. When I'm trying to assess and the doc walks in, then it takes foreverrrrr. Most of the time I have to step out and come back.

[Susie2310]

Learning to balance is one of the toughest things to figure out. My apologies to the charge nurses lol- but look at it this way- if you discharge your patient first, then go see your new one- you will have two new patients before you know it. And that "stable" patient might not be as stable as they appear- sometimes it's not that clear cut. I think better to see the new one first. (Unless the discharged patient suddenly decides they need to leave NOW and they're standing in the hallway making threats. Just give them their papers. It happens)

I completely agree with seeing the new patient first. Sticking your head in the room and just taking a quick look without gathering more information from the patient, and at least taking vital signs/doing a brief assessment, is a good way to miss some unstable patients. They may have an airway, may be breathing, and may not have fallen on the floor, but don't assume that they are not very unstable. People can be deteriorating right before your eyes and still say they're ok when you stick your head in the door. Some emergencies have a narrow time window for treatment i.e. sepsis. You wouldn't want to leave a patient waiting who needed urgent fluid resuscitation and IV antibiotics, would you?

[BSNbeauty, BSN, RN]

That is my original thoughts. However, at work it seems as though my preceptor and other nurses just finish what they are going then greet the new patient. I think I'll stick with the nursing process, assess first than everything else will fall into place. I don't want to miss out on critical patients.

I completely agree with seeing the new patient first. Sticking your head in the room and just taking a quick look without gathering more information from the patient, and at least taking vital signs/doing a brief assessment, is a good way to miss some unstable patients. They may have an airway, may be breathing, and may not have fallen on the floor, but don't assume that they are not very unstable. People can be deteriorating right before your eyes and still say they're ok when you stick your head in the door. Some emergencies have a narrow time window for treatment i.e. sepsis. You wouldn't want to leave a patient waiting who needed urgent fluid resuscitation and IV antibiotics, would you?