Listening for ER nurses 101
By: Austin Chapin III, RN
As an ER nurse part of your role is being a good listener. You engage in conversation with the patient for investigational reasons to complete the charting and the patient gives you a long story on why they are in the ER. I can’t tell you how many people in the public while standing in line somewhere are complaining about some nurse that wouldn’t listen to them. Honestly, I hear it all the time. Unknown if the lady’s claim was legit or not there seems to be a problem in the medical field with listening to the patient. Doctors and P.A’s the same goes for you.
I’m not referring to the sport of swinging the ass-end of a small import around a dirt track here in talking about standing at the computer while the patient is telling you the story and your mind is drifting to some tropical island somewhere in the south pacific. The patient is a blur while you are sunbathing and the sound of the waves crashing has drowned out every important detail that you were just given. This can be very frustrating to an individual that has already explained everything once to the Triage nurse. We have all been there but it is important that we really listen during the story. There are many reasons for this and I will explain.
- First, we are the medical person that is going to spend the most time with this individual for their stay at the hospital.
- We can sort things out for the docs that literally spend five minutes in the room.
- We can determine how many resources we will need and also insure that they are in the correct part of the ER. Triage has very little time to assess the patient and sometimes people get miss-triaged. I don’t know how many times I got a patient back in my room and they had quickly degraded to the point that a quick transport to the shock room was in order.
- We can establish trust and a general feel for what is really wrong with the patient.
A good example of a possible dangerous situation would be something like this:
Case #1 Respiratory
38 yo female to the ER for cc of SOB and L flank pain.
She is triaged into an observation room and vitals are HR 138 BP 134/96 RR 32 and diaphoretic with a normal temp. The nurse is taking down the story but not really listening to the whole story. While the nurse is jamming to Bob Marley in her mind the patient is really complaining about the pain and is now breathing heavier. Instead of doing a full assessment of the patient she thinks the docs got this and walks out of the room.
10 minutes later the Doc enters the room and calls out for a code blue for the patient because she had stopped breathing d/t respiratory distress. What was missed? Maybe the fact that a 38 yo had a sudden case of SOB…after!!! the fire POPPED. The CXR reviled pulmonary pneumothorax due to a .22 round bullet that had entered her L side and collapsed her lung. The small round made a very tiny hole in her side that had very little blood. Small round ammunitions can find their way into a fire in some rural spots around the country. Country folk, you know who you are. Anyway this is a made up case based on a true story. The round in that case grazed the ear of a family member that was near a fire.
I digress, the point here is that we all get busy and sometimes we need to take a little brain break. It is not the time for a mental hiatus when a patient is telling you the reason for their visit.
Learn how to effectively listen!
As nurses we need to really listen to the person telling a story. The best way to start a plan of care for this patient is to assess
- The tone of their voice (is it with an emergent tone?)
- The quality of speech(able to complete a sentence without being out of breath)
- Fluency (is there an underlining problem with being able to speak? Stroke etc..)
- Appropriateness (are the things being said appropriate to situation?)
- Rate( do they seem in a hurry or restless? indication of respiratory difficulty)
If the nurse was paying attention and really listening to the patient she would have noticed that the patient was having difficult time breathing. Assuming anything is a quick road to disaster in Nursing. The name of the game is stay alert, pay attention, and for god sakes keep the ammunition away from the fire……