10 Tips from Nurses to Rock Your EM Clerkship

10 Tips from Nurses to Rock Your EM Clerkship

There are lots of ways to prepare for clerkship, like finding mentors, reading up, and making learning goals, as outlined in this past post. While those tips will help you maximize your skills building and demonstrate your professional competencies, it’s also important to use clerkship as an opportunity to learn how to work as part of an interdisciplinary team within a complex health care system. There is growing recognition that quality care and patient safety depend on teamwork, and evidence demonstrates that increased collaboration between physicians, nurses, and allied health professionals helps improve client outcomes [1]. With that in mind, here are tips from nurses to help you work with respect and synergy as part of the team.

10 Tips from Nurses to Rock Your EM Clerkship

Tip 1 – Be courteous

Often health care providers can be so focused on their patients and the endless tasks at hand that we can forget what it means to be courteous. Emergency departments can be hectic places full of people in crisis, but we can still take a few moments to exercise common courtesy with our colleagues. Start conversations with “hello” or “how are you?” and introduce yourself (#hellomynameis isn’t just for patient interactions). This allows us to build professional relationships from a place of trust and respect.

Other daily courtesies apply to workplace settings, too. Respectful and polite language, like saying “please” and “thank you”, sharing workspaces, returning supplies and charts when you’re finished with them, remembering to log off computers – all of these things help improve workflow and can make a sometimes chaotic environment just a little more pleasant. Other tips for being courteous in the workplace are available from the business sector here.

Tip 2 – Capitalize on other people’s expertise

There’s a reason that health care has interdisciplinary teams with specialties and sub-specialties – we can’t all know everything. Make the most of the variety and depth of knowledge that surrounds you. Nurses, especially, know the patients, staff, policies, and hospital well, and appreciate being recognized as a resource. We are (typically) with our patients for 8-12 hours at a time and are very familiar with their baseline status, so please trust us when we are worried, and listen to our concerns. This interesting paper takes a “pragmatic view of intuitive knowledge in nursing practice” and highlights the importance of a nurses’ intuition [2]. We’re also happy to show you what we know, especially if you’ll teach us something, too.

Tip 3 – Strategically pick your timing

Research shows that, like physicians, nurses also face many interruptions. One study showed that nurses are interrupted once every 6 minutes [3]. While it’s great to ask questions, solicit and give feedback, and have an open dialogue with colleagues, there are better and worse times for these discussions. Refrain from interrupting procedures, and wait until we have completed our assessment to start yours. Know that all health care providers are juggling a lot of competing priorities, and although we want to support your learning and attend to your patients, we may need to prioritize something else, so please be patient. Having said that, if you have immediate concerns about patient safety, speak up.

Tip 4 – Strategically pick your location

Pick your location wisely when questioning someone’s practice or debating a plan of care. Don’t do so in front of a patient, unless there is an immediate safety concern or bedside rounds are standard at your institution. Those conversations are probably best saved for the charting station, not the hallway, where patient confidentiality is easily compromised. When picking a location to do extra reading or learning, choose somewhere where you won’t be interrupted by people maneuvering around you for supplies or charts. When picking a location to watch a procedure, be mindful of sterile fields and introduce yourself to the patient and provider(s) rather than silently hovering.

Tip 5 – Practice Stewardship: Leave your patients, colleagues and the department how you found them or better

Nothing feels more disrespectful than someone leaving their mess for me to clean up. It’s definitely best practice to remove bedding, clothing, dressings and diapers to examine your patients, but please put them all back when you’re done. If there’s a complex wound, feel free to ask when the next dressing change is so that you can assess it then, or at least let the nurse know that you’ll have to remove a dressing so we can plan our care accordingly. Return or throw-out supplies when you’re finished a procedure, and dispose of all your sharps properly. If you don’t know where something goes, ask instead of putting it away in the wrong place. Ask your colleagues how you can help and what you can do to help make their job easier. Ask patients if there is anything they need before you leave the room.

Tip 6 – Take responsibility for patient safety

Little things make all the difference, even when you are a medical student. Leaving patients in better shape than you found them is also about patient safety. This means assuring that bed-rails are put back up and the call-bell is within reach. A significant number of patients experience adverse events in the hospital, especially falls [4]. Keep this in mind when mobilizing patients, and communicate fall risk with the rest of the healthcare team.

Tip 7 – WASH. YOUR. HANDS.

Hand hygiene is an important part of patient safety – so important that it warranted its own section. We all know that practicing hand hygiene is the number one way to reduce the spread of infection. But it’s incredible how few healthcare providers do it properly or as often as they should. Brush up on best practices and follow them.

Tip 8 – Do not touch things if you don’t know what they are

If you’re going to change or remove any tubes, pumps, IVs, or ventilator settings, please let us know. Unless you are totally familiar with how to use them, please do not touch them without asking first, as the nurse probably spent a significant amount of time setting them up, untangling them, and completing safety checks. If you’re curious about what a patient is hooked up to, just ask! Also, it’s best to keep your hands to yourself when observing a sterile procedure.

Tip 9 – Take care of yourself

Adjusting to long shifts can be physically and mentally exhausting. It’s harder to care for others if we’re not caring for ourselves. It’s your own responsibility to assure that you’re fed and watered and ready to learn. We are all doing what we can to take care of ourselves and our patients, so please don’t rely on others to take care of you, too. Remember, many of your nursing colleagues have had years of experience with working shifts. If you’re having trouble, reach out to them, as they will likely have some tried and true tips to share.

stolen foodTip 10 – Do not steal anyone’s snacks

Just trust me.

Acknowledgements: Thanks to my colleagues for their input on this post, including the nurses at BC Children’s Hospital and those who contribute to the online forums at reddit/r/nursing. Check out the great Reddit feed started by Claire for even more advice. 

This post was edited by Teresa Chan and Eve Purdy.

References

  1. Martin, J. S., Ummenhofer, W., Manser, T., & Spirig, R. (2010). Interprofessional collaboration among nurses and physicians: making a difference in patient outcome. Swiss Med Wkly, 140, w13062.
  2. Billay, D., Myrick, F., Luhanga, F., & Yonge, O. (2007) A pragmatic view of intuitive knowledge in nursing practice. Nurs Forum ; 42(3): 147-55. (http://www.ncbi.nlm.nih.gov/pubmed/17661807)
  3. Kalisch, B. J., & Aebersold, M. (2010). Interruptions and multitasking in nursing care. Joint Commission Journal on Quality and Patient Safety36(3), 126-132. (https://www.researchgate.net/publication/42253476_Interruptions_and_multitasking_in_nursing_care)
  4. Hitcho, E. et al. (2004). Characterstics and circumstances of falls in a hospital setting. J Gen Int Med; 19(7): 732.789. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1492485/)
Claire O'Gorman
Claire is a registered nurse and program director @YouthCO. She is interested in public health, nursing, social determinants of health, and infectious ideas.
Claire O'Gorman

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  • Nadim Lalani

    When I worked at Earl’s (restaurant) … we used to precede any interruptions with with the phrase “May I (interrupt)?”. I suggest using this phrase when interrupting any colleague. It allows them to dictate whether they can handle your request or not.

  • Brent Thoma

    My Facebook wall has had some great more tips posted as a result of this article that I’d like to share.

    From Carol (EM Nurse)

    In all my infinite wisdom (lol 3 years of nursing)… here are my tips:

    1) My #1 tip = COMMUNICATION!!! Firstly, communicate with patients! Explain the tests and treatments you’ve ordered, and later explain the results. Make sure they understand their discharge. Let them know about consults. You have no idea how many questions nurses field about these things and how many frustrations get taken out on us when patients don’t feel informed. And on that note, communicate with the nurses! We need to be informed to be on the same page as you and to respond to all those questions and frustrations.

    2) I know it’s hard for some, but try to write legibly. Less chance of errors and less chance of us bothering you later. Also, if possible, taking an extra few seconds to verbally go over the orders you’ve written with the nurse before walking away is also appreciated. Then we know what you wrote, and it also gives us an opportunity for questions or clarification. Like I said before, communication!

    3) Teach us! Most ED nurses love learning!! Just make sure to keep your tone warm and friendly, not condescending, otherwise this will backfire. Rule of thumb: teach how you’d like to be taught.

    4) Emergency Medicine is a team sport. We are one team with the same goals, and we can only reach those goals if we support each other and work together. You may be the world’s best quarterback, but you won’t win a game without your O-line. We win together, we lose together, we laugh together, we cry together, we have each other’s backs. Cherish and nurture this relationship, because the patient experience will only be better for it.

    5) To go along with the author’s tip 10 – bring snacks to share! Nurses are always hungry (haha, we really are like an O-line!)

    From Mackenzie (Former EM Nurse)

    While I’m saddened that I no longer count in your ER reference list, I’ll add my own anyways.
    1) Be humble. I once had a resident walk in, say, “hey, I’m _____. It’s my first day, I don’t really know what I’m doing, so sorry if I’m slow and ask a lot of questions”. I went to the ends of the earth to help him. But if you walk in with this “I’m the doctor (even though I’ve never actually touched a patient or seen anything except textbook pictures) and you’re the nurse” attitude, no nurse is going to go out of their way to help you learn from their experiences.
    2) If you need to ask a question, try and figure it out on your own first. Then come say, hey, I don’t know (how to do/where to find) this, I’ve already (tried/looked) (this/here)…… I hate being asked to help people find something that is right in front of them
    3) Remember people’s names. I remember walking by Jeffrey Anchan, and him saying “hi Mackenzie” and me thinking who the heck is that guy? Didn’t take me long to find out, and remember him, and how friendly he was, and want to help him as much as I could in future!

    From Tyler (EM Nurse)

    Great article! Carol and Mackenzie’s suggestion’s are awesome additions to the list too. My only thing to add is to remember breathe. It’s cheesy and sounds like an inspirational poster, I know, but it is easy for new nurses, residents, anyone really to get overwhelmed by the chaos. I have seen many people hit the wall and get that deer in the headlight look, and it doesn’t just happen to people who are new. We have so little control over what comes in to the deptartment and I find that taking a few seconds or minutes to just stop, take a few deep breaths, maybe pound a juice or take a big swig of your now ice cold coffee can be a great way to gain that little bit of sanity back. Also I really want to reinforce something Carol said, there are no ends to my desire to snack when working, so bringing those snacks for others will definitely earn you brownie points. Oh and coffee! The people who bring a box of fresh coffee when they come on shift, and I’m half way through mine, those people are saints well before they save a life!

    From Jeff (Fellow)

    From day 1, I’ve considered all parts of the health care team as important and valued in their own roles. I don’t consider myself better than anyone else – we all have different areas of expertise, different skills and duties, and being respectful and treating someone like a person and not just as a tool makes for a team that works well together and truly enhances patient care.

    I can be somewhat absent-minded with some things, but I am good at remembering things I consider important- and that includes names. Such a small thing, but it makes a huge difference! Take time to learn something about the people you work with- at the end of the day we all are living breathing people and not machines. I’ve grown to care for and cherish lots of the team in emergency and on the wards, and have made lifelong friends. I really do feel like we are one team, and when you have people you care about on the team, you will watch out for each other and keep each other going, despite what may walk (or roll) through that door!

    It goes a long way to communicate, and there are many nurses, as Carolmentioned, that love to learn- daily learning is one awesome aspect of our jobs! Be willing to teach, and also to learn from nurses, techs, clerks, and all parts of the team. The truly humbling thing about doing training for as long as we do is to realize how little we truly know. Don’t underestimate what other parts of the team have to offer!

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