As an emergency room nurse, there are several times per day when I am presented with an opportunity to provide patient education. From dispelling common myths in triage to providing discharge instructions, it is one of our most important roles as nurses to provide solid education to the patients and families we meet every day.
Whether it’s the importance of hand hygiene, or how to properly take antibiotics, or the home management of diabetes, every piece of information we can impart to a patient can make a real difference in the wellness and health maintenance of our patient population and their families. Providing patient education is just as important as the other nursing care we deliver.
In a perfect world, nurses would have unlimited time to sit with patients and make sure they’re hearing what we are saying. We would have time to assess their preferred learning methods and to help them understand. We would have time to do a 15-minute crutches demonstration, for example, or to go over every possible side effect. And some days, we can! But how can you make sure you’re not skimping on patient education when staffing is tough, you’re stretched too thin, and when patient education might otherwise fall by the wayside?
Write it out. Sometimes I don’t have the time I would like to fully explain a patient’s home care instructions, but boy am I a fast typer (thanks, electronic medical records!). It takes me only a few moments to quickly type out home care instructions. Then, anything I want them to remember I know they are at least taking home with them. This is essential, since they won’t necessarily remember exactly what I said, but can refer back later to what I wrote.
Print! Find a patient education material app or website that you like or that your facility participates with. For me, it’s Mosby or Up-to-Date, which has pages and pages of patient information and handouts designed specifically for printing and passing over to the patient. Most are written at an easy reading level and include illustrations, and many are printable in other languages, as well.
Highlight! Stick a highlighter in one of your (overflowing) scrub pockets. If you’re pressed for time, highlight the most important pieces of the discharge paperwork for easy review. There is a lot of great information in a discharge packet, but there’s also a lot of extras. Make sure to give a brief guided tour of the paperwork and point out relevant lab results, follow up instructions, and home care.
Use teach back. One of the best ways to ensure patient learning is to ask them to teach it back to you, or at least repeat it back. You would be surprised how many times you have just gone over something only to have the patient forget what you just said or have missed your point entirely! It’s worth taking a moment to say, “Now tell me, what signs and symptoms would prompt you to seek help?”
Keep it brief. Remember, most people can only remember one or two learning points. Try to pick the most important ones to emphasize with the patient, and leave the rest for the (highlighted!) paperwork.
Include family members. If an elderly person seems particularly adverse to learning about fall prevention, enlist any family members to help. Especially in the case of family caregivers, who play a crucial role in patient’s well-being at home, it’s important to involve them in the learning process.
Don’t assume that your patients already know what you’re going to say. Don’t assume that the diabetic or hypertensive patient knows to take their medications even when they’re ill. Don’t assume that parents know to give their children the appropriate dosages of medications based on the child’s weight. Don’t assume that someone with a GI bug knows to eat a BRAT diet when resuming foods and fluid intake. Say it anyway!
Allow enough time for questions. Give the patient ample time to ask any questions about follow up care, medication side effects, or any disease process or health maintenance after discharge. Make sure he or she knows who to follow up with, too. I usually phrase this as “Ask me anything right now, and direct all questions after you leave to Dr. Smith or your primary care physician.”
Don’t leave it all for discharge! Remember to provide bits of information and patient education throughout your care for a patient and not just at the end of his or her visit. This prevents overwhelming the patient with details as they are about to leave, and helps make sure more of what you say can be retained.
It is our responsibility to ensure health literacy and competency in our patients, and that can start with little bits of information and education that we can pass along all throughout our care.
Below, I interview Erin Sullivan, BSN, RN, CEN, about her experiences in critical care. She recently switched her specialty from the emergency nursing to intensive care, and shares her reflections, challenges, and some advice.
What is your background in nursing?
I graduated as a second degree nursing student from George Washington University in 2014. I was a new graduate nurse in the emergency department (ED) for about two years before I switched to the MICU (medical intensive care unit) in March 2016.
When did you decide to change specialty, and why?
I decided to switch to the ICU about 18 months into working in the ED. At the time, I was considering applying to some graduate school programs that required ICU experience as a prerequisite, so I made the switch to broaden my experience and learn a new skill set.
What do you do now and what is your job/where?
I’m working in the MICU at Northwestern Memorial Hospital in Chicago. I also still work per diem in an ED.
What was challenging about the transition to the ICU?
The biggest challenge I had in transitioning from emergency nursing to the ICU was learning how to think like an ICU nurse. There are jokes in nursing that the two types of nurses are “wired differently.” In the ED, the goal is to quickly assess, diagnose, and stabilize patients, and then to move them out to an appropriate level of care as soon as possible. In the ICU, the goals for the patient are more long term, and you have to consider a bigger picture and a larger scope than I would in the ED. It’s a completely different way of thinking, organizing, and prioritizing patient care.
What do you miss most from ER nursing?
The thing I miss most about the ED is the teamwork. I don’t know that I can quite explain the team aspect of ER nursing to someone who’s never experienced it, but there is a special camaraderie that forms between all of your coworkers. Whether it’s one of the best shifts or the worst shift ever, your fellow coworkers join together to make sure we all come out on the other side. I also miss the organized chaos that is the ED, and the anticipation of never knowing what is coming through the door next.
What do you enjoy most about the ICU?
Being in the ICU, I really enjoy being able to watch a patient progress from being critically ill to becoming well enough to leave the unit. Unlike the ED, many times you have a patient three or four shifts in a row, so you can get to know the patients in a way I never got to in the ED.
What do you want to do with your nursing career moving forward?
I’m not sure what the next step is in my career. One of the reasons I chose nursing was because there are so many different options in what you can do. For now, I’m enjoying working in the MICU and picking up in the ED every now and again to get my adrenaline fix. I’m fairly certain though that I’ll find myself back in school pursuing a graduate degree in nursing at some point.
What tips or advice do you have for someone who wants to change their specialty?
My biggest advice for anyone considering switching their specialty is just to do it. As nurses we learn new things everyday, and we shouldn’t be intimidated or scared of the challenges that come with switching specialties!
That said, do your research. Can you handle the stress of a new job right now? Are you adaptable and a quick learner? Do you get along well with new people? These are all considerations before jumping into a new specialty. For me, I was still within the broader scope of critical care. If you’re completely changing specialties, from adults to pediatrics, or from med-surg to labor and delivery, make sure you talk to people who are in that field and that it seems like the right fit for you. But remember, you can always go back!
The holidays are coming! Chances are you need a gift idea for a colleague or work gift exchange, or there’s a special nurse in your life who needs a treat! Below are my holiday gift ideas for nurses. Whether it’s for a sister, friend, or colleague, the nurse in your life deserves something special! Here’s what may be on his or her wish list this year.
A new stethoscope, or a stethoscope charm.
Stethoscopes grow legs and walk away nearly every shift. Perhaps a doctor grabs it for an exam, or he leaves it in a patient’s room and it’s never seen again! If you want to splurge for a new one, the Littmann brand is generally renowned, but other ways to keep it from disappearing are with cute name charms or ID tags. The website Etsy has many retailers that feature such personalized tags.
Hand cream and a manicure.
Nurses winter hands can look like something from a horror film. Dry, cracked skin is mutilated by the hand-hygiene regimen, and the winter air makes everything worse. Treat her to some pampering with a manicure (most nurses can wear clear polish) or a really heavy duty hand cream.
A funny mug for her coffee, and a bag of nice coffee beans on the side.
We nurses love our coffee. A tough, spill-proof travel mug with insulation for hours, or a humorous nurse-themed coffee mug are both gifts that would probably get used often! Add some high-quality ground coffee or K-cups on the side and make it a complete set.
A day to relax.
I’m going to make a large generalization here and say that any nurse—any age, any gender—would love to get a gift certificate to a spa for a treatment or massage.
An etched wine glass and a bottle of wine.
Perhaps my favorite nurse gift I’ve ever gotten was this wine glass. Funny and useful!
Compression socks—with style!
There are several brands of compression socks and stockings that are in the market for making stylish, functional footwear. Check out Nabee or Vim & Vigr.
An “adult” coloring book and some colored pencils.
In whatever free time the nurse in your life has, he or she might enjoy coloring some funny pictures to unwind!
Below, I interview Rachel Barone, a registered nurse (RN) who works in an emergency department (ED) and also at an outpatient radiology center.
Tell me about your background in nursing. Was this your first or second career?
My background in nursing is in critical care. Nursing was my first career, I graduated from nursing school in 2012. I started as a new graduate RN in the ED and have been a nurse for almost five years.
Where do you currently work?
I have a full-time job in an ED, but I also work part-time as a nurse at an outpatient radiology center. I respond to any emergencies in the office in addition to providing direct patient care. The office is large, and spans three different floors, so I see a lot of patients on a daily basis. I work in the computed tomography (CT) department, but I respond to any of the radiology departments in an emergent situation. As a nurse, I start IV (intravenous) lines, obtain medical histories to present to physicians, and respond to any emergencies. For example, if a patient getting a CT scan with contrast dye were to have an allergic reaction to the dye, I would respond.
What is challenging about your role?
The only thing that’s challenging is that you have to prioritize emergencies by yourself. You make a lot of independent decisions alone, so you must have experience and be confident to make quick decisions. If someone jumps into a dangerous heart rhythm, for example, you’re by yourself and have to think very critically and immediately. Or, if someone were to have an allergic reaction to contrast, I would make the decision about how to treat the patient.
What is rewarding about your position?
A job like this is great because it’s generally flexible hours, with no holidays, nights, or weekends. There are also usually good benefits. You get a lot of time to talk to your patients, which can be very rewarding, and you don’t always have to jump on to the next thing or task. A lot of the patients are very nervous when they come in, so you have to be calming and reassuring. Many patients are cancer patients, and I enjoy working with that population.
What is a day in the life look like for you?
I go into work around 7:15 a.m. and start immediately with patient care. I call patients back from the waiting room, interview them, and take a full history. Then, I make the sure physician order and the history match, start the IV if necessary, and run the scan. Afterward, I monitor the patients for any adverse reactions. You also have to keep the flow moving!
Who would be successful in this position?
Any nurse who has critical care experience and who would be willing to work independently without a lot of guidance would enjoy this role. It’s also great for someone who needs flexible hours and who wants a less stressful work environment, but still enjoys critical care!
“What are you doing for Thanksgiving and Christmas this year?” Chances are, if you work in a hospital, the answer is, “Working.”
Working holidays is not ideal, but we all know it is part of the job. I remember when I found out I had to work my first Christmas shift, I got into my car, called my mom, and burst into tears. It’s harder for some of us to spend holidays at work than others, but it doesn’t have to be the end of the world.
What can you do to make the holiday at work bearable?
Plan ahead. Try to figure out as soon as you are able which holiday you will be working, and plan something with your friends or family on a different day. “Fakesmas” and “Fakesgiving” alternate every year in my family! Holidays aren’t restricted to celebration on a single calendar square. Encourage your family to be flexible and understanding so that you can still participate in festivities, even if you are also working. It is possible to do both.
Negotiate. In many departments, coworkers might be willing to trade if you only ask. Someone may not celebrate a particular holiday or may have travel plans that are more flexible than yours. A new mom may be grateful if you offer to trade your New Year’s for her Christmas morning. See if you can negotiate with someone—you never know!
Food is good. In my department, we’ve already got a sign-up sheet a mile long where staff can write down a contribution to our unit feast. This not only gives scheduled staff something to look forward to, but also makes the shift itself feel festive and fun. Chocolate helps!
Decorate. Even if you’re only allowed to decorate the break room, try to bring a little holiday cheer into the space. Have a snowflake-making contest!
Think about the green. Do you get paid double, or time-and-a-half to work the holiday? Try to use that as a little pick-me-up when you’re feeling down about working.
Embrace your work family. You’re all in it together. Can you play nursing bingo to pass the time, or all tell stories to keep each other entertained if it gets slow? Can you and a close coworker exchange small gifts?
Keep busy. Holidays in the ED can be boom or bust, so try to keep yourself busy if at all possible. The slower it is and the more downtime you have, the more likely you are to get sad.
Stay away from social media! If it is slow, do your best not to take a peek at the fun times your friends and family are having on Facebook or Instagram. Do yourself a favor and stay offline.
Attitude is everything. Try to be positive and happy while you’re working so that you don’t bring others down. No one wants to work with someone who is moping and complaining that they’re at work. Be the nurse you want to work with.
Remember: No matter how bad it gets, you still aren’t the patient in the bed. Take the time to really connect with your patients on the holiday, and remember that you have the potential to make a huge difference in their lives.