Things I've learned about getting stuff done in the ER

There are a lot of new folks at work---either new ER nurses or just new to us, so either way there are new ways of doing things everywhere. This has made me realize I have developed my own stash of Ways to Get Things Done Expediently Without Being Meanly Rude to Patients. I had nothing at first. I spent way too much time explaining too much about the situation and trying to get patients to wholeheartedly agree with my methods, and you can't DO that in an ER. It takes too long and hardly ever works.

  • "Today we'll be doing it this way." Response to "but my own doctor's office always...." This is direct, but I use it in situations when I don't have time to argue about the differences between an emergency and a primary care checkup.
  • Deadpan: "I've started a few IVs now, and I've stopped passing out at the sight of blood, so I think I'll do OK." Must be used very carefully, for patients very anxious about IV starts because they've been stuck 12 times on previous visits or something like that. Have had spectacular success with this. A previously nervous patient will be all smiles in 30 seconds, after my carefully timed grin or wink.
  • "Have you decided that you do not want treatment, then?" A stopgap response to "I don't want an IV/monitor/x-ray/CT scan/C-collar...." Our physicians prescribe treatments according to presumably emergent conditions. Patients don't want treatment? I'll try to talk them out of the decision, but I won't argue for long if they're adults of sound mind. Response returns power to a patient who probably feels powerless at the barrage of interventions going on. If they then opt for treatment they feel they've actively chosen it.
  • "I need to redirect you." Priceless especially in triage. Stops conversations that begin with "Well, 16 years ago I had a car wreck, and then a few years after that I had two surgeries...." or "Well, yesterday my pain was an 8-and-a-half, and this morning it was probably a 4, 4-and-a-half...." Can be followed with "I need to know why you are here now, at 4 AM, and what we can do for you today." It's not that I'm not interested. I just need to make sure a long story isn't going to end up 10 minutes later with "and 20 minutes ago I woke up in a cold sweat with sharp chest pain radiating into my left arm, jaw, and shoulder blades"!
  • "It is not reasonable to expect to be totally pain free." People don't know this. If they have fractures or kidney stones, they sometimes need to be told that they're going to feel bad for a while. We can help, but that stuff hurts. Providing accurate expectations is a merciful service, even if it's not an immediately popular one.
  • "We need to investigate a way to consolidate your requests." Used only for patients who time call lights for when I'm at the maximum possible trajectory from the room every few minutes because they forgot something. Response tells patient I am not going to ignore requests and invites collaboration from them on finding a solution. Works surprisingly well.
  • The magic popsicle cocktail, revisited because it's worth revisiting. Just last night I told a coworker about this one, and he thought the child was too old to fall for the "magic popsicle drink" schtick, but she tossed it back. Half a double popsicle (red is best if possible), microwaved 10 seconds and broken off the stick. Splash of apple juice. Whatever med the kid has refused to take and/or spit all over you. Stir. Present to child as "here is your MAGIC popsicle drink!" May not be magic for the child, but it prevents a lot of rodeos.