Malena Fryar

"Use your critical thinking skills!”

Do any of you remember hearing that being drilled in nursing school? How many of us are actually make critical decisions for your patients or are you deferring all decisions to the providers?  Really think about this.

Decisions in triage - nurses do everything in this domain.  Most ED's don't even have a provider up in triage. We seem to do okay in this area.  But then the patient comes in to get worked up and now ALL decisions to the providers.  Why??!  Why do you have to stop making decisions? You know what’s going on - You were trained for this! As nurses, we are the ones at the bedside - who better to answer these questions, than us?!

Nursing Autonomy

ED nursing is awesome because we have autonomy - why give it away? Aside from the ED, the only other unit that has these privileges are the ICUs. Remember, we deal with ICU/critical patients - why not have the same autonomy?

I encourage you to make clinical decisions in your practice. Yes, you may need orders for things but honestly, there shouldn't be an issue if the provider puts the order in 1-10 minutes later but gives a verbal order in the meantime. Don't let your patient suffer or crash over this. Especially not in your critically ill patient.

Examples

NPO status (needs procedure/waiting for labs/radiology)

Toileting  (Can this patient walk to the bathroom?)

Pain medication

Labs (remind the doctor to put in the order, or even better have a protocol where you can just order them yourself!)

i.e. Running gases for BIPAP patients

repeat troponin levels

BMP/ICU Venous panel levels for DKA

Drips  (titrate them!)

Respiratory interventions (bipap/intubation/vents) - learn how to adjust

Changes in Vital Signs (is this concerning or is this a watch and wait situation?)

Initiate an EKG

I’s & O’s

Multiple IV Lines

I believe that we have relinquished a lot of our decision-making capabilities as an emergency nurse - so I’m making a stance and let’s take it back. Let's own our ED practice - we see and do a lot. So stop deferring decisions you can make as a nurse. Communicate with your providers. And let’s work together to get these sick patients better.

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