Working with MLPs in the ER

[DayDreamin ER CRNP]

I'm transitioning from an RN role into an NP role in a different ER from where I got my RN experience. We have successfully used MLPs for as long as I've been there. They have had several evolutions of the job but they have always been very involved. I love having a MLP to help with patient care and love that they seem to be more accessible / available than the MDs sometimes. The new ER is similar but they do have a more active role in a quick track area.

What do you wish your MLPs would or wouldn't do in your ER? I do like that the MLP comes in with the RN when checking the patient in for the first time. I think it kills two birds with one stone most of the time and the patient only has to tell his/her story once vs multiple times.

What what makes you LoVE or hate working with your NPs?

[JKL33]

I appreciate that they (NPs in particular) were the ones who kind of started a trend in my place toward things like obtaining samples themselves in obvious situations. For example, something that was technically fine but always annoying was when the docs would go in and work with a kid (say an infant) to check the back of his/her throat, then walk out an put in an order for a throat swab. BTW, the swabs have always been right next to the tongue depressors. NPs in particular seem to have realized that it makes a great deal of sense to look at the throat and swab it on the same occasion, or at the very least grab a nurse to come in and get the sample during the provider exam.

That said, personally if I had to choose I would prefer providers focus on functioning at the provider level. It's unsettling when we have all the RN things to do and then have a lot of issues with inappropriate/incomplete provider assessments and/or orders to worry about - which, I have seen a little more with the NPs (and PAs) than the docs. It makes it hard not to second-guess everything and things just seem more chaotic. Does that make sense? I guess my ideal situation would be for me to do my role the best I can, you do yours the best you can, and whenever we can coordinate/work together/help each other - great.

Congrats and good luck with your new position!

[Armygirl7]

"...then walk out an put in an order for a throat swab. BTW, the swabs have always been right next to the tongue depressors."

OMG this kind of stuff drives me bonkers in Fast Track - because we have SO many patients to see quickly and so few nurses. We have a PA who does stuff like this all the time. Once she walked out of a pt's exam curtain and said (after having already logged in at the bedside computer to check for triage vitals, and after examining the patient etc.), "There's no temp on this patient!" Ummmmmm ok the thermometer is 18 inches from where the patient is lying on the stretcher! You could have gotten a temp and documented it and saved us all time. She drives us all nuts.

In Fast Track I just like really clear and timely communication from MLPs, yes, I am checking the computer every chance I get, but it is really helpful if the Provider just says out loud to the nurses, "I'm putting in orders for spot 18" or whatever, so that we can direct our priorities or bundle our care etc.

Good luck- I love working with the NPs in our Fast Track, we only have a couple, our Fast Track is staffed by mostly PAs and Residents, NPs who had any kind of nursing practice before they became NPs are usually awesome!

[canoehead, BSN, RN]

My pet peeve is using equipment, and putting the garbage down on the table for the nurse to clean up. There's a garbage can at every bedside, dumb-buns.

[DayDreamin ER CRNP]

My pet peeve is using equipment, and putting the garbage down on the table for the nurse to clean up. There's a garbage can at every bedside, dumb-buns.

I couldn't stand that either! There was one particular NP that I used to work with and he would leave a trail of trash in every room. He used to try to help start IVs and such on newly landed patients and he'd leave every speck of trash lying about and blood on the bed or cart....it was maddening!

I used to fuss at the residents when they would leave instruments and sharps and stuff at the BS. I would tell them, "I'm a nurse, not your personal housekeeper. It is YOUR responsibility to clean up your messes." One resident tried to tattle and she ended up getting in trouble with her attending. She hated me that whole year. I didn't care.

[DayDreamin ER CRNP]

"...then walk out an put in an order for a throat swab. BTW, the swabs have always been right next to the tongue depressors."

OMG this kind of stuff drives me bonkers in Fast Track - because we have SO many patients to see quickly and so few nurses. We have a PA who does stuff like this all the time. Once she walked out of a pt's exam curtain and said (after having already logged in at the bedside computer to check for triage vitals, and after examining the patient etc.), "There's no temp on this patient!" Ummmmmm ok the thermometer is 18 inches from where the patient is lying on the stretcher! You could have gotten a temp and documented it and saved us all time. She drives us all nuts.

OMG! I followed a different NP on orientation and he did this exact thing. I was like, we still have RN in our title and the C and the P doesn't mean we can't still be nurses. Come to find out, this guy wasn't really ever a nurse. 'Splains a lot, sometimes.

[AnnieOaklyRN, BSN, RN, EMT-P]

It all depends on the hospital and the culture too, if that is acceptable behavior they do it.

I have been to many many ERs working on the boo boo bus and there is a mix. Some MLP think it is beneath them to do a temp or throat culture and others realize that it is in their benefit to just do it. I also believe that if your facility allows nurses should have the foresight when they room the patient to do certain things that they know will need doing, like a throat culture if your patient has a sore throat, fever, and swollen tonsils.

Annie