Registered Nurse - ER
Posted on May 18, 2019 by Mount Auburn Hospital
1. The emergency nurse initiates accurate and ongoing assessment of physical, psychological and social problems of patients within the emergency care system.
a. Obtains initial focused subjective and objective data through history taking, physical examination, review of records and communication with health care providers, significant others and caretakers, as appropriate.
b. Uses assessment techniques and criteria that are pertinent to the patient's age-specific physical, psychological, and social needs.
c. Documents relevant data for every patient as appropriate to the nature and severity of illness or injury.
d. Communicates significant data to appropriate personnel throughout the patient's emergency department experience.
2. The emergency nurse analyzes assessment data to formulate nursing diagnoses and identify collaborative problems for each patient.
a. Identifies nursing diagnoses/potential complications based on signs and symptoms recognized during a focused, systematic assessment.
b. Documents nursing diagnoses/potential complications on each patient.
3. The emergency nurse formulates a plan of care for the emergency patient based on assessment data and nursing diagnoses/potential complications.
a. Develops a plan of care for each patient, in collaboration with the patient, significant others and other health care providers, based on current scientific knowledge and in accordance with the established standards of emergency nursing care.
b. Identifies priorities for nursing interventions.
c. Communicates plan of care to other health care providers to ensure continuity of care.
4. The emergency nurse implements a plan of care for the emergency patient based on assessment data and nursing diagnoses/potential complications.
a. Implements plan of care for each patient
b. Provides necessary education regarding procedures, treatment regimens, and identified outcomes to each patient and significant others.
c. Accurately implements physician orders in accordance with each patient's priority of care.
d. Performs appropriate patient monitoring and documents patient's response to intervention.
e. Demonstrates prioritization and organizational skills in caring for multiple complex patients simultaneously.
f. Seeks assistance/guidance when confronted with nursing procedures not yet mastered.
5. The emergency nurse evaluates and modifies the plan of care based on observable patient responses and attainment of expected outcomes.
a. Evaluates and documents patient's response to interventions and changes in patient's condition and revises plan of care as appropriate in collaboration with the physicians and other health care providers.
6. The emergency nurse assists the patient and significant others to obtain knowledge about illness and injury prevention and treatment.
a. Explains written instructions regarding aftercare, follow-up and referrals to patients and their significant others.
b. Documents patient's understanding of discharge plan of care.
c. Notifies physician and/or appropriate resource personnel of any barriers to patient compliance with discharge plan of care.
d. Assists patients and significant others in the identification of factors that place them "at risk" for illness and injury.
7. The emergency nurse collaborates with other health care providers to deliver patient-centered care in a manner consistent with safe, efficient and cost-effective resource utilization.
a. Assigns tasks or delegates care based on the needs of the client and the knowledge and skill of the provider selected; appropriate delegation to less experienced RNs and CA's
b. Assists the patients and significant others in identifying and securing appropriate services available to address health-related needs; social service consultation, home care services, case management consultation, mandatory reporting.
c. Ensures that supplies and equipment are readily available and in working order: completion of equipment checklists as assigned.
d. Ensures that patient charges are accurate and reflect the care that the patient received: pharmacy, level of care charges.
e. Implements safety procedures for each patient in accordance with that patient's specific needs: namebands, siderails, and appropriate level of observation provided.
f. Demonstrates knowledge and compliance with practices that protect the health care provider and reduce the spread of infection in the emergency care setting: use of standard precautions, isolation procedures.
g. Recognizes the potential for violence in the emergency setting and institutes appropriate action: use of Protection Services, CPI techniques.
8. The emergency nurse triages each patient and determines priority of care based on physical, psychological and social needs as well as factors influencing patient flow through the emergency care system.
a. Performs focused assessment of chief complaint on each patient in a timely manner according to established triage guidelines.
b. Documents triage assessment, including appropriate subjective and objective data.
c. Differentiates severity of patient complaints and assigns appropriate triage acuity levels.
d. Identifies and initiates nursing interventions per established protocol.
e. Reassures the patient according to acuity and established procedures and revises the acuity level based on new information or changes in assessment data.
f. Maintains open communication with Charge Nurse and Attending Physician regarding patient acuity, flow, and bed availability. Institutes "modified triage" when appropriate.
g. Provides information about the patient's condition to the patient and significant others as appropriate. Maintains crowd control.
9. The emergency nurse engages in activities and behaviors that characterize a professional leader.
a. Accepts accountability and responsibility for maximizing department operations and patient outcomes using sound judgement.
b. Adjusts staff assignments according to assessed nursing capabilities and responsibilities, patient acuity/level of need, volume and flow within the department.
c. Identifies self as a resource person who willingly shares knowledge and skills with colleagues and others.
d. Provides peers with constructive feedback regarding their practice.
e. Demonstrates and provides unified leadership in the department by encouraging staff to discuss issues with appropriate management personnel who can assist with problem solving.
f. Demonstrates knowledge of department operational policies including, but not limited to: informed consent for treatment, patient transfer, COBRA legislation, patient confidentiality, patient restraint and the department's scope of practice.
10. The emergency nurse recognizes self-learning needs and is accountable for maximizing professional development and optimal emergency nursing practice.
a. Attends 50% RN/department staff meetings annually.
b. Attends 50% inservices offered in the department annually.
c. Maintains BLS, ACLS certification
d. Attends Emergency Department RN Competency Review Course annually.
e. Attends hospital-based Education Fair annually.
f. Pursues continuing education/certifications in the specialty of emergency nursing to enhance nursing practice.
g. Participates on at least one department based committee and/or assists in facilitating formal or informal learning experiences for professional peers and students in a courteous, supportive manner.
h. Participates in Quality Improvement initiatives to measure and improve quality of care.