How do I prioritize in the ED and More tips please?

This topic contains 1 reply, has 2 voices, and was last updated by Vera Vera 1 year, 1 month ago.

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  • #71134 Reply
    Lincoln Lover
    Lincoln Lover


    I am glad to be a part of this great group. I’m not a new nurse, but I am new to the ED, after working 4 years in med-surg. I love the ED team here at the facility where I work.

    I quickly learned that the ED is a completely different world. Some nights it’s like being in the Twilight Zone.

    I consider myself to be a good nurse, but every nurse has things to learn. I am hoping that one day I will get used to this environment, but for now, it’s just a weird and wonderful world. Though I know how to be a nurse, being an ER nurse is a whole new world to me… different processes, different resources, and different expectations. These things are stressing me a little bit… I hope that I eventually adjust to the process… like what is expected and when…

    Anyway, Yesterday I had a patient that

    Last night in the last 30 mins of my shift, I had a stable MI that needed to be transferred upstairs to a bed in the ICU

    I also had two patients that I was trying to triage at the same time. One patient had pneumonia and the other had a broken bone. No sooner had I gotten them all triaged, 2 ambulances came in with patients who were in a minor MVA.  OMG

    Now I am feeling pretty overwhelmed and I am really wondering how to prioritize because obviously, I am not very good at it. How do I deal with all these things going on at the same time, when they are all important.

    What time frame should I give myself to get used to this? I knew it would be rough, but my gosh. It was crazy.

    I also realize that this can take time, but is there anything I can do to help this? I felt completely defeated when I left this morning.

    Can you please offer me any suggestions or constructive criticism to make my life a little easier? Please and thank you!

    Oh, great group btw

  • #71135 Reply

    Well, welcome to the ER and to this group. We are a pretty tight-knit community here and the Admin rocks.

    Unfortunately, it just takes a lot of time to feel like you know what you’re doing in the ER. It’s a very fast-paced environment and you need to have everything in order to get things done as proficiently as possible.

    The thing about the ER is that everything is an emergency, that’s why it’s called the emergency room.

    One thing that helps me is to get orders, vitals and meds into the charting system right away, then you can move on. All the other stuff in the chart can wait till later. As long as the physician knows the patient’s vitals, medications PMH and C/C that will be what they need to know to the patient seen.

    Make sure that you try to follow the same process. So much so that you can do it in your sleep. Getting the monitor ready and bringing the gown in the room so the patient will at least have those things ready. The gather all your IV supplies and get ready for report.

    Don’t panic, it can be your worst enemy. Work on staying calm and working steadily.  If you had a patient that had an MI, but has been stabilized then it sounds like they were okay to go to be transferred. If you have two nonminor MVAs then just get the rooms ready for those patients and be ready to take report on those.

    The patient with pneumonia is your priority until the others come into the ER. So deal with that one. Especially since they are in respiratory distress. Remember “airway, breathing and circulation.” in that order. You know you’ll need a monitor, abx, 02 and blood cultures right off the bat. You’ll also need a chest Xray and some type of antipyretics.

    If you can just remember to critically think then you’ll be okay. Think and think some more. Pretty soon, you won’t need to do as much thinking or as much running around. You will get the hang of it and you will know that if a patient comes in with “X” then they’ll need “XYZ” to take care of them. It will become as natural as driving a car.


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