81 | New panel | Charge RN advice | Physician efficiency tips | Developing Confidence

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 reall

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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.