New panel! Lucas (ER physician), Kendra (Charge RN, NP student), Ben (paramedic and educator)
Kendra talks about her advice for new charge RN’s
Have some ER experience first. She says it was difficult starting as a charge when she was so new to ER. Have a good set foundation.
You need to be able to have difficult conversations with people in a tactful way to address problems
Getting to know the providers on a more personal level also allows you to better counteract interpersonal conflicts
Lucas talks about how a good charge nurse is a problem solver. He doesn’t view himself as the captain of the ship as an ER physician. He views the charge nurse as the problem solver and it’s their job to make sure every patient is managed in the department
The progression from EMT to paramedic is a similar advancement as RN to charge RN. Thinking outside the box instead of just task-oriented work
Paramedics must learn to allocate resources appropriately rather than do the tasks themselves
Simulation based training has help new paramedics learn to lead calls and see the time it takes for tasks to get completed
Paramedics do tend to have chips on their shoulders, a lot of this has to do with the difficulty of the job and how it is fairly new by comparison and the history of EMS is often us trying to prove ourselves
Lucas discusses efficiency tips in the ED
Chart with the same basic structure regardless of the chief complaint
The physical exam can be very basic and general with a very detailed focused physical exam based on the complaint
Sometimes documenting a physical exam that is too thorough can bite you later when you have to answer why you did a cranial nerve exam on an abdominal pain patient
Document what was done and do what you document
More is not always better
Document twice as much as you think you need to on the relevant components
When you are new as a physician or APP you should be ordering more and documenting more
Try to batch tasks. When you get up go see multiple patients rather than one at a time
It’s better to do the right tests rather than use a shot gun approach every time
You should be able to answer what you are looking for with a given test
On most patients, you should be able to form a plan after getting the HPI and physical exam
We should seek to avoid stacking orders, sometimes it’s inevitable when unexpected results pop up
Stacking orders really affects the nurse’s ability to be efficient as well
Do complicated procedures the same way every time
We teach this with intubation was well- have everything set up the same way every time with all your back ups, so you increase your chances of success
Confidence comes with time, but it is something you should be working on as well. Not arrogance.
Second guessing will make you less efficient
Plan on a negative work up because a positive result will usually dictate the plan
Think one step ahead. After you see a patient have an idea of what you are going to do.
Pre-discharge patients when you have a chance. Write the scripts, put in the follow up. Give the discharge instructions.
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Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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