1. Staying on Task
The first few months of working as an intern, I found myself just running around with my head cut off with no sense of direction. I have (mostly) learned the art of writing things down and setting alarms on my watch. I no longer hesitate to delegate to our awesome, amazing, wonderful tech’s. I can methodically organize tasks by patient priority. It feels less chaotic for me! I try to go through four “steps” for each patient:
- Initial assessment/ABC’s/Intake
- Maintenance/Repeat Labs/Comfort
I like to write the word “comfort” near the middle of my chicken scratch report sheet. Although not a priority in the emergency room, sometimes getting that patient an extra warm blanket can ease them up and give you time to handle another patient.
2. Using SBAR to Talk to Doctors
Before this job, I had never actually done this. They teach it to us all the time in school but I have always been afraid to do it. My tip? I write down my talking points. Each phone call has gotten smoother, and I usually get what I need for my patients!
An example of my talking points:
S- Mr. X, the 80 y/o male in room 16 who is here for respiratory distress now has an O2 sat of 87% 30 min after the breathing treatment
B- He has a history of HTN and type 2 diabetes
A- BP 142/88, RR 30, HR 94, SpO2 87% on 6LNC, no temp. bibasilar crackles
R- I recommend another breathing treatment and a stat chest x-ray
In school, I felt like they teach us to include everything in our SBAR. There are a lot of situations that would warrant a more thorough SBAR (like giving report to the floor nurse). But when something is needed very quickly in the emergency department, you have to just grab the basics (ABC’s) and run with it.
3. Hospice/Palliative care.
Some of you might be wondering why this is happening in the emergency department. Well you know what. The situation warranted it. We are often on saturation, which means no where else for this family to go for several hours to days. I’ve cried with the families that are waiting for a room somewhere else. I sat with them and ignored the noise and chaos down the hall. I took extra time with the extremely uncomfortable patient to make sure the bed was made perfectly, all trash was picked up, and that the family always had fresh ice water.
When that family makes a decision for their loved one to be DNR, and we cannot get them a room upstairs, the emergency department becomes the place where the family must start the process of grieving.
4. Confidently Asking for Help
Instead of saying, “I don’t know what I’m doing,” or, “I’m really sucking today,” I say, “Hey, it’s time for morphine, could you pull that for me please?” and “Could you please page respiratory?” My preceptor knows my limits, and I am finally feeling like a real nurse.
Negative self-talk can really hinder your day. I don’t know what I’m doing all the time. But I already know that and I don’t need to bring myself down because of it. I also use statements like, “Could we review this process? I think I misunderstood something.”
ALL. NURSES. NEED. HELP.
If your preceptor says they never ask for help, they are doing their job wrong.
5. Targeted Patient Education.
How often have I ever stopped to thoroughly explain something to a patient? Never in my clinicals, honestly. My preceptor usually does it. And in the ED, it isn’t at the top of the priority list. Patient education does not have to be some crazy 30 minute presentation! I can explain insulin and blood sugar during times of illness. I can explain a sliding scale. And I can do it in about three minutes. So yes, that sounds so simple, but I’ve always been afraid to take that initiative!
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