Hello and welcome back ☺
This week post is going to be about tips for the ER nurse. Working in the ER has got to be amongst my top three favorite things to do. But listen, sometimes things can get a little hectic and chaotic. Good chaos of course, but chaos nonetheless. One thing I pride myself on being as an ER nurse is efficient. It is so important to be efficient, because otherwise you can find yourself falling behind, really quickly. To be efficient, means to maximize productivity with minimum wasted time. In order to be efficient, one must know a thing….or two. So, I am here today to give you ER nurses some tips and hacks to assist in that 12 hour ER shift ☺
♥ Know what you have to do before you go in
→ I know we’ve been told since nursing school to cluster care. But working in the ER you really have to do just that because time is limited! You cant afford to go into your patients room 5 times in 15 minutes. So after I receive report, I look over the chart really quickly, see what medications, labs, or tasks are outstanding, make a note of it in my head or write it down, grab the portable vital sign machine then go in. Introduce myself, vitalize the patient, and then do what I have to do. I always ask the patient if they have any questions before I go(to prevent having to go back in) and then onto the next patient it is. After I’m all caught up and up to date, I go back and re-round.
♥ How many takes does it take to place that foley?
→ Sometimes it is really hard to insert a foley catheter into males. For starters getting that plastic catheter into the small urethra is not only painful for a man (as you may imagine) but they get real anxious about it. They clench up, they wont sit still, and even sometimes they have prostate issues that we have to take into account which could stop the catheter from even going in smoothly in the first place. But lets just say for arguments sake, this is a normal catheter insertion with a normal prostate. Not only will it save you time, but your patients will thank you if you could get an order from your doctor for some viscous lidocaine. Viscous lidocaine is a local anesthetic that can be used to treat pain. In this case you would take the lidocaine put whatever is ordered in a piston syringe, put the tip of the piston syringe just at the opening of the urethra and instill the lidocaine. No only will this slightly numb the area, but it can also aide as lubrication for the actual procedure. Once that’s done begin advancing the foley. Now, if you don’t get urine returned right away don’t fret! Sometimes you have to work a little for it lol. Nothing in life comes easy right? Put the patient in Trendelenburg position to allow gravity to work for you, give a little push on the lower abdomen/pelvic area and ask that young man to point his toes downward and unless they’re septic, have acute kidney injury or some bizarre medical diagnoses you should have some nice yellow urine in no time ☺
♥ Oh no blood pressure low!
→ Nothing normal ever happens in the ER. I mean if that were the case would people ever be there? Haha, they probably still would, but anyways when patients come in they either have a really low blood pressure or a really high blood pressure. So in the instance that they have really low blood pressure, almost 9 times out of 10 your provider is going to order a bolus of some sort of fluid. And sometimes you just can’t get that bolus in fast enough. Now if you're lucky enough to work at a facility that has pressure bags, great, but if not use your blood pressure cuff. Not only will it allow you to be efficient by saving you time, and allowing you to run more fluids, faster, but it also helps the patient. So grab the bag, put it on the pole, grab a manual blood pressure cuff, wrap it around the bag pump it up to about 100 and bada bing bada boom, fluids dripping at a million drops per minute !
♥ Come out, come out, wherever you are
→ As an ER nurse we draw blood and place IV’s a thousand times a day. Sometimes this is quick, sometimes it's not. For starters go into your patient room with a standard gauge needle (20G), one bigger (18G) and one smaller (22G), that way if you miss the vein you have options. If you know your patient is going to be a hard stick, bring a few extra tourniquets in with you as well as a butterfly needle and a hot pack. The extra tourniquets and the hot pack forces venous dilation, which allows for easier visualization of the vein and therefore placement of the IV. The butterfly needle is for the rare instance that you just can’t get that line. Don’t walk out of the room empty handed! At least get the blood, send that off to the lab then go to your physician or fellow nurse for assistance with the IV placement. (sometimes two eyes are better than one)
♥ Return of spontaneous circulation (ROSC)
→ During a code so much is going on and a lot of the times there are residents there to learn , doctors there to teach and nurses just trying to get in where they fit in and keep the whole thing together. A patient in cardiac arrest can be quick, run a code for 10-15 minutes, perform post mortem care and essentially you’re done, but when the patient gets ROSC (return of spontaneous circulation) things get a little tricky because now you have to move fast. You have to maintain that patients pulse, and get them to the ICU. One thing you can do to be efficient is watch the doctor as he intubates the patient, once he starts call x-ray and tell them you need a STAT portable x-ray on that patient. If your physician has experience intubation should be done in 3 minutes. Then, you slyly go behind the doctor and place the OG tube. Run it directly alongside the ET tube and secure it. By the time x-ray gets there, you can now verify placement of both tubes at once, versus having to call x-ray back delaying transport to the ICU. (yes you could aspirate or auscultate for placement but were talking about being efficient here!)
♥ Oh no, he's peeing!
→ You can’t just walk up to a 4 month old and say “hey can give me some urine, the doctor wants to see if you have any infections”. Best thing to do to save you time and maximize productivity in the infant patient, is get a pediatric urine collection bag. It should have a sticky part to it that you're able to press firmly around the infants genital area. After doing so, close the pamper and start drawing your blood. The needle alone, will startle the infant so much that they urinate. And not into the pamper, or on the sheets but right into that bag that you placed. Now you have your urine and your blood. ☺
Moral of the story , there is so much that could be done to allow you to be as efficient as possible in the emergency department. Remember, be efficient but be safe and be kind. If you have any other hacks let me know ! Any questions? Email me . See you guys next week .
p.s if you create an account (i know super annoying), you're able to leave comments for us to interact. If you'd rather not, catch me @__thewallflower on instagram
Love Memi <3
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