Me: You got stung by a bee?
Guy: I was at the park and I got angry.
Me: At the bee?
Guy: No I got angry at my four year old trying to throw his ball at my face and when I went to swat it away, I knocked a bee into my shirt and it stung my nipple.
So after succumbing to my tablet monitor woes, I bought myself a 22HD Cintiq for 15 hundred, then bought a DVI-A Adapter to VGA today (Too Lazy to install a new video card…working to build a computer for next year maybe). This tablet monitor is awesome except…
1. It’s consistently making this weird horizontal distortion section of my screen that skips my cursor or makes my straight lines curved on all programs (for some reason, my previous two monitors have been also been doing that (The P-active 17 inch seldomly, my Pactive 19 inch often ). sat my cintiq both on my floor and on my table, tested both pen and eraser and the results were the same.
2. It’s also making a faint but very high pitched whining noise that’s making my ears ring. WTF.
Anonymous said: Do you have any suggestions for nurses managing their time in the ED?
The only experience I have in an ED was in a really, really small ED. So small that even when they were full, they’d have less patients than I did at one time working nights at my first job. I don’t have any time management tips for that speciality. Sorry! Are there any phenomenal ED nurses out there with good time management skills!?
I do both ER and Floor nursing. The ER I work is a trauma hospital that can hold around 70 people (Including urgent care/first aid people and psych holds). Unlike your set assignment on the floors, The ED is like a game of Diner Dash on hyper mode: you’re flipping newly arrived patients like hotcakes, there are newly ordered tasks you need to stay on top of and prioritize, there are noises and distractions that come in your way, you will get into situations that will singe your comfort zone, and the routine and the flow can change unexpectedly. The ER is one overwhelmingly messed-up dangerous microcosm of humanity. Some days are super easy and other days super hard. But you will come up with the craziest stories on Thanksgiving dinner and you will make a difference to those who really need your services.
1. A report from ER nurse to ER nurse takes around 1-3 minutes depending on the acuity of the patient. Best way to say it: Patient’s name, sex, age, allergies, why are they here, important/recent health history (i.e. that right carpal tunnel surgery is irrelevant unless patient came in for right wrist swelling), important objective findings, what’s been done already, what needs to be done, what we’re waiting for, and IV site.
Don’t give or expect an extensive floor-style report - it uses up time, it annoys your coworkers, and it’s your job to assess your patient anyway. The exception to the rule is if the patient is moving to the floor in the next hour (where the ER nurse will thank you later because the receiving floor nurse will butcher him/her on the telephone for all those nice juicy details we don’t bother about).
By the way, I like saying the words “walky talky” a lot (The jargon really caught on in my ER) for someone who’s very low acuity, walks around, AAOX4, all that good stuff.
2. Prioritize your tasks. You don’t have the time to do full head to toe assessment the moment the patient lands on your gurney. Stick with the chief complaint, the vital signs and keep the person alive first. Get the EKG, the monitor, the oxygen, and the urine dip, and the allergies next if indicated. Give the treatments/meds when they’re ordered and chart your vitals and a small blurb of your observations every two hours when your shift pans out. The cozy comfort and hygiene measures, the more detailed health history and and the sob stories can be done later. If you’re drained and drowning, take that needed two minute break or you will drag the rest of your shift to the ground. And don’t sit idly unless you’re caught up with everything or have an open gurney.
3. Lay down the ER routine to patients early so they don’t feel like they’re ignored. “Labs will take a while. Xrays will take a while. CTs will take a while…because we want to make sure that everything is read thoroughly and we don’t want to miss anything.”. “We’re keeping you here for a while longer just to make sure you don’t have another seizure/chest pain before you go home.” “You can’t eat or drink anything because food can mess up your diagnostic tests or delay surgery if it’s needed.”. “The Doctor needs to see you first before he orders the proper pain medication for you, not me”. “Your nephew’s stable, but California privacy laws prohibit me from giving information over the phone unless you’re the power of attorney or you’re a visitor of the patient.” \ “So that means the Doctor doesn’t care about me?” - “He’s obligated to check back on you and your tests, but he’s hung up on a trauma code right now.”
Is all of this stuff I say above true I say? Mayyybe. But that’s the art of persuasive BS. I do it both on my patients as well as the ER docs (although the ER docs pull off persuasive BS back to me. Grrr.) Make it sound good and make it sound like their best interest.
4. Know your psych stuff. Know which patients are truly genuinely needing your help, and which ones are bullshitting you (This is an intuition you learn on the job where you pick up with your ability to read body language). There are times which you feel like you want to do more for some patients, and times where you feel like you want to not want to do anything with the patient, but ALWAYS keep your emotions in check and script your words carefully. Stick with the necessities and don’t let the person go emotionally nuts and steal valuable time that you need to take care of other people.
5. If you have that window of opportunity, you can eavesdrop on the doctor talking with the patient and use his assessment as yours. You get some good pointers on assessing patients, plus you have a good idea what the Doctor will order next.
6. Know your Medsurg stuff that lands people into the hospital. Know your ER Workups by heart (Cardiac workup. Sepsis Workup. Respiratory Workup, GI workup, etc). Keep an eye out on the results of tests and labs. Even if the complaint sounds minor, the tests and labs can warn you that the patient is going to be admitted.
7. Take advantage of your resource people. The CNAs, the ER Techs, the volunteers, the pharmacist or floor charge nurses on the phone. Get the family members proactive in the patient’s care. Also, if a family member of a stable patient needs to step out to do an errand, warn them to do it now (and get the patient’s home med list too) because it will take a while for the Doctor to run tests and figure out if the patient will be admitted or not.
8. If supplies are disappearing like hotcakes or changing locations to the point where you can’t find them anymore, I suggest finding a hiding place in the department to stash your surplus. Especially from volunteers!
9. Help your coworkers (doctors, techs, RTs, nurses) out and they WILL help you. Ask for help when you need it because there are times where you can’t do it alone. There will, however, be times when you or your coworkers will say “No, I can’t. I’m busy”. That’s okay. Things can go batshit crazy in here and we understand.
10. Always 20 gauge needles and bigger. You’ll never know if there’s a CT ordered that needs contrast.
Also for you ER veterans….
11. DO. NOT. EVER. EVER. EVER. EVER. SAY “Oh I know this patient. He/she’s here for the same thing.” You’re going to jinx it big time and before you know it, something in the CT scan lights up and now that problem patient is going to get admitted for the not-so-same-thing. With their god-knows-how many-expired-dilaudid bottles in the Walmart grocery bag.