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

12/22/24 • 33 min

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

Support the show

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

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.

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

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

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

Support the show

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Previous Episode

80 | Lori Hodges Part 2 | Author | Paramedic | Emergency Manager

Lorihodges.com

(4) Lori Hodges, MA, CCP, PMP | LinkedIn

Shaking In The Forest: Finding Light in the Darkness: Hodges, Lori R.: 9798888244005: Amazon.com: Books

Debriefing helps to learn from a big crisis and then move on without continuing to judge yourself and your mistakes

We all make mistakes, getting stuck in the mindset of constantly reviewing what you could have done differently and dwelling on it is not helpful long term and can impact your next patient if you are distracted

It’s okay to not be okay and seek help for the things you are struggling with. We need to talk more about this in EMS

We see things that humans are not meant to see. We must be intentional about healing from the trauma

We all develop positive and negative coping mechanisms. We need to be aware of these

Dark humor is one of these strategies we commonly use

Lori talks about the hypervigilance she developed growing up with her father as an alcoholic. She picks up on subtle cues that others might miss as a result

It is important to take concerns from other emergency providers seriously, especially if they are spending more time with the patient. It’s important to build that trust with those around you

Finding the balance between compassion and carrying another’s burden is difficult

It’s also important to be able to teach others in emergencies by allowing them to make the decisions themselves but also being there to catch them

Lori talks about how she trains new emergency managers by allowing them to do hard things while being there to support them

Lori talks about how sometimes allowing people to learn from their mistakes instead of just firing them makes for better managers

Allowing people to admit their mistakes makes for a better environment where everyone is improving instead of being afraid to admit their errors

Collateral beauty is the light in the darkness, that must be

Support the show

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Next Episode

82 | Getting comfortable saying “I don’t know” | Advice for newbies | Learning from those lower than you on the perceived hierarchy

Batching work applies with nurses too. Do multiples things when you enter the room, so you don’t have to go in and out many times

Ben talks about efficiency in the field being important due to the limited time and resources

As providers we must get comfortable with saying “I don’t know”

In medicine in general we don’t know everything, nor can we diagnose everything. Especially true in emergency medicine

Chest pain is a great example. We don’t get a clear answer or diagnose most of the time

We must be careful what we tell patients is going on when there is not a clear answer. Specific diagnoses will follow patient for a long time

Ben talks about some struggles new EMT and paramedics have and how the scope of a paramedic is still poorly understood, they often hear “I didn’t know you could do that?”

Teaching the EMT and paramedic students the context of the “why” behind treatments and not just the skills themselves

The difference between magic and medicine is we can trouble shoot and analyze medicine, we know why it works and if it doesn’t there is usually an explanation

Keep your mind open and learn from others. You can usually find someone that has a similar style as you, but you can also learn a ton from those who practice different from you

Ask a lot of questions, grow your confidence gradually

You need to master the more mundane tasks before moving to the exciting in some circumstances

Charge nurses need to help develop their team and communicate well

Be a mentor and correct people in a non-public setting, grow people instead of getting rid of them if they are struggling

Find a mentor or multiple mentors when you are new and when you have some experience, mentor people

You must be constantly teaching newer people and learning from more experienced people in medicine

You can make or break someone’s medical experience when they are new to the field

Cultures can be developed by the poor attitudes of a few crews or staff

You have to guard against the bias that those that are burned out can bring

Constructive criticism can come from even those that are not nice or not tactful if you can be open enough to take the feedback

You can learn from anyone, even those lower on the perceived hierarchy

Support the show

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition