Organizing Yourself in the ER
The Emergency Room is a crazy place. Since I can remember I wanted to do emergency room nursing. It is a lot though. If you are an A Type of personality that thrives on chaos, then it is probably for you.
Staying organized in the ER is critical to your success. Make checklists for complicated patients AND take notes for legal reasons. In the land of boarding patients, where we are expected to be floor nurses and ER nurses, the expectations have changed.
Strategy
Have a strategy when you start. My strategy is to prioritize the patients from sickest to least sickest and if I have two or three "sickest" patients, organize them by stable and unstable. Someone may be really sick but be stable. In the ER you can not just visit one at a time and in a row. You need to be able to critically think through your patients.
Routine
Starting with my sickest patient, I list out everything that is due right now or past due. I always update vitals, whether they are due or not and do my assessment. Vital signs in the ER are due every two hours, and more for some patients depending on the condition. By starting my vitals at the beginning of my shift, I know exactly when they are due based on patient acuity and I do not need to guess or keep checking EPIC. Also, be flexible, because the best laid plans will change in a second.
Time Management
Organize medications together. Giving all your meds at once is a time-saving strategy. Make sure all the medications are ordered. Above all, do the checks to make sure the order and medication are right. Know your medication and if you don't, look it up EVERY TIME. One thing I always vowed I would do is to check my medications according to the rights of medication administration. Providers in the ER (whilst we love them) constantly get pulled away to do other things (like save people's lives), sometimes they start an order and can not finish the entire order set. Make sure all the orders are in unless it's critical, you need to be able to make judgment calls all the time.
Tasks
The same goes for tasks. I organize all my medications and tasks for a visit to them. I get as much done as possible. If I know I need to draw a troponin, I see what else is due before I go in and just knock it out.
Updates
Check your results prior. Almost every patient I have ever had asks "what is going on", by preparing I can not only give them an update, but I can give myself an update. I can figure out what orders need to change. If a patient's hemoglobin has dropped by 3 points, I probably need to order another CBC, follow up with the provider, and make sure the patient is not symptomatic. If the x-ray comes back positive for a broken hip, I need to address toileting if I haven't already. I put anyone with a broken anything on a purewick or condom cath if they can not get out of bed. it is non-evasive, helps the patient feel better, and allows them to sleep unencumbered.
Do Not Procrastinate
Do not put things off. First of all, everyone hates following the nurse that doesn't have everything done. Not that it's always purposeful because there are times that it is completely out of your control. However, that just means may need to be better at delegating. If you need help, don't just call and say "I need help', give a list of what you need to be done specifically. Techs are busy.
Attitude is Everything
Check your attitude at the door. ER nursing is hard. Helping your coworkers is part of your job description and honestly, I've always hated the statement "that isn't my patient", even though I do say it sometimes for very different reasons. Never ever get the attitude that you are better than the veteran nurse who has been an ER nurse for 30 years or that the nursing student doesn't understand a particular condition better than you do. We are in this ship together, and if one of us goes down, we all do.
Pleasantries Aside
Know that you will be faced with things that aren't pleasant. Your patient may be swimming in a river of poop or projectile vomiting. They are not doing it to ruin your day. They can not help it most of the time. You are literally there to help save their lives. If you have an aversion to all things gross, do yourself a favor and do outpatient nursing.
Teaching
Don't forget to teach your patients. This is a critical time for them. They are scared and they are not wanting to go through this again. It is the perfect time to lay seeds about changing their behavior. Choose your words and timing carefully. During a code, is not the time to be teaching them about smoking.
Hope you enjoyed these tips. 💕🩺💕🩺💕
Read more
What is up with toxic nursing?
When I first got into nursing, I did not believe the gossip. ICU and the ER are always fighting. The floor does not take report. The ER lies in report and they NEVER check the patient's skin. ...
Read more
Critical Care
Landing a job in the ICU as a new grad
Let me guess… all your nursing instructors told you that Med-Surg is the only type of nursing you should be doing when you first graduate nursing school. Don’t get me wrong, I know a lot of people ...
Read more
Leave a comment
This site is protected by hCaptcha and the hCaptcha Privacy Policy and Terms of Service apply.