As an ER nurse, one of my most valuable skills is my ability to go with the flow and be flexible. I found this meme on Facebook and I felt it in my BONES people!
As an ER nurse, I say bring ’em on down!
I feel like this is a skill that is overlooked. ER nurses have the ability to adapt and change their course of action as patient conditions get more critical or census gets higher. Whatever comes our way, we will make it work.
Often times, I hear other nurses say, “I could never work in ER because I don’t know what comes in next!” That’s what I love about it. Navigating my way through a full lobby of sick patients, all of our beds full, and the ambulance bringing in a critical patient tests my critical thinking, triage skills and flexibility. I’m confident in knowing I can make just about anything work and I can handle it.
This is a learned skill and if you’re used to working in a pretty steady and even paced environment, chaos comes with a lot of fear leaving many nurses at their witts end screaming “I CAN’T TAKE THIS ANYMORE!” But YOU CAN!
The next time you feel like you can’t handle anything else and the patient load gets piled on thick, critically think! Here are a few tips I have:
First of all, is this safe? Is this a safe patient load? Don’t get this confused with “I don’t want to take another patient” but really think about it: is it safe for me to take another patient? Can I give all of my patients the attention they need?
Second of all, you’re never alone. Know your team’s strengths and weaknesses and use them to your advantage.
Delegate. Delegate. Delegate. If you are swamped you should NOT be completing TASKS. Tasks include getting vitals, starting an IV, helping someone to the restroom, fetching things, etc. You focus on assessments and documentation – things you cannot delegate.
Believe in yourself. Shake off the mindset of “I’m drowning” and jump into “I’m handling this like a BOSS!” The power of positive thinking is incredible.
What resources do I have? Could I request a float nurse? Is someone on call that can come in? Is another department slow? Could someone come in early? Could this admission wait?
Don’t let anyone go unseen. Triage people in your lobby. Get in and get a set of vitals on your new admission. Lay eyes on your patient as soon as you are able to get a good baseline assessment. If you don’t and things go south while you’re away, well, that’s bad.
Hang up the phone! So many times I’m getting pulled out of a patient’s room for a phone call or spending my time on hold. No one ever tells you how much of nursing is just waiting on the other end of a parked call. Either ask someone to hold for you, ask them to take a message, ask to call them back, or just transfer it to someone who can help them. So many times we get calls from people wondering “Should I come in?” or “Can I take this medication for a headache?”or “I was seen there earlier and have a question..” While I would love to take these calls in my downtime, I have to take care of the people who are here and under MY care right now.
Ask for help. Recognize signs that you are behind or that you’re not doing well. If you’re distracted and unable to focus on your medication pass, you need to ask for help. If you’re catching yourself almost making a mistake because your mind is so overwhelmed, you need to ask for help. If you feel your patient load is unsafe, you. need. to. ask. for. help.
Make a list of things that need to be done and prioritize – back to AIRWAY BREATHING AND CIRCULATION. Treat PAIN. Make a schedule. When you enter a room think to yourself: I can allow 15 minutes to complete this med pass. I have to be out of the room by 4:45 – even consider setting a silent alarm on your watch if time management is becoming a problem for you.
Often times when I feel overwhelmed and I feel like I have so much to do but once I actually sit down and think about what needs to be done, I’m doing just fine. Give yourself a reality check. Take a deep breath. And press on. A good way to consider this is, “If I had someone to delegate to, what needs to be done right this second.” Usually, I can’t think of much.
Finally, when the department is bogged down, LET YOUR PATIENTS KNOW. I have a few different scripts I like to use to explain delays:
“We have a critical patient who just came in” or “We are experiencing an unusually high ER census at the moment and we are doing our best to take care of critical patients.”
“I don’t want you to feel like I’m not paying attention to you. I will be back as soon as I can be but in the meantime I brought you a glass of water and a warm blanket. If you have any questions or concerns, the best way to get a hold of me is to push this call light button because I may be tied up for a bit before I can come back in here. Please let me know if you need anything at all – especially if you start to feel worse.”
People are usually very understanding if they know there is a delay and how to reach you if they need you. Tell them where the bathroom is. Thank them for their patience. Get them a warm blanket. Offer a glass of water. Give them a time estimate if you can.
This is a great example of when I love my iWatch. I will tell the patient: “I’m going to set an alarm on my watch to come check on you in 15 minutes to see how you’re doing” or “The pain medication should be kicking in in about 20 minutes. I’m going to try and be back in here at 2:20 to see how you’re doing.” and then set an alarm. This has helped me keep up on my documentation as well.
That’s all folks! I’d love to hear some other time management tips from the nurses reading this! Leave a comment below or on my Facebook!