I'm about to be fired :(

[Lemon Bars]

I'm in my last few weeks of prerequisites for PA school and I've maintained a 3.8 GPA for the last two years. I was so excited when I was recently hired as an ER scribe, because now I'm working with the doctors and learning things instead of mostly wiping butts as a nurse aide. No offense intended if you are a nurse aide, but that'a about all they would let me do.

 

On Wednesday I go in for my fifth and final day of bedside training, and I just got a call from my supervisor that I haven't been cutting it. I'm failing to capture all the information from the patient interview and the doctor's physical exam, and I'm too slow at charting into the electronic records system.

 

Some of the docs I can keep up with, and some I can't. Sometimes the doctor will ask the patient a series of questions such as, "Any nausea, vomiting, blood in your urine? Have you had an appendectomy, hysterectomy, gallbladder out? Do you have diabetes, high blood pressure, had a stroke, so you smoke, drink, do drugs?" That was said in less than six seconds with the patient nodding or shaking their head instead of verbalizing. Some of the docs will repeat pertinent information by saying, "Oh so you have diabetes, and you smoke." That helps me. But other docs will go right into the physical exam without pause, verbalize nothing during the physical exam, then while walking back to the doctor's area they describe multiple findings on the physical exam in less than five seconds. EKG readings: two seconds. Xray readings: 2.5 seconds.

 

 

I try to write everything down and put it in the chart as fast as I can but I fall further and further behind as I switch between patient charts. My trainers seem to be able to capture and process all the information, but I can't keep up despite focusing all my effort on it. If anyone has similar experiences and suggestions, I'd appreciate it.

 

But more than that, I want to know what I should do next (if fired). I need more HCE. Would a medical assistant position in a clinic be more my speed? I've been to many clinics (as a patient) and they don't seem as rushed the emergency department. Thanks for any help!

[Timon]

So sorry to hear that Lemon Bars!

 

 

Have you made any other connections at the hospital? Any patient care tech, EKG tech, or any other positions that you can try to be moved over to?

 

 

Ya the ER is fast paced. I'm sure it was a huge challenge especially going from CNA to having to document everything and anticipate answers / fill the blanks / and interpret what's going on when its not verbalized.

 

Dont you have your EMT-B cert? Have you though of prehospital work or working for event staffing companies that require EMTs?

[EMEDPA]

medical asst would be much better. many places don't even consider scribe to be hce but more of a mobile transcriptionist(as you have discovered).

[Blessings!!]

Medical Assistant is not a bad idea. Do you hold MA diploma?

[PM2016]

Start wiping butts. No offense.

By the way, that's not all cna's do. Google it.

[Lemon Bars]

I do have an EMT-B cert but I can't drive an ambulance here in CA because my vision is poor in my right eye. I do not have an MA cert. I wish I'd done that instead of EMT. I think a clinic is where I need to be, not rushing around trying to extricate people from cars and get them to the ER before they die. I'm not an adrenaline junkie I just want to help people. I guess I'd better do another semester of school. Thanks for the advice folks!

[Lemon Bars]

Start wiping butts. No offense.

By the way, that's not all cna's do. Google it.

 

I already did it for three months. It was almost exclusively taking vital signs, toileting patients, fetching water, and telling nurses that their patient is asking for pain meds. If you're a nurse aide and you got to do EKGs and stuff I'm jealous.

[PM2016]

Every job is what you make of it. Ask questions, ask why they are getting certain meds, if they could show you how to do certain things like dressings or drawing blood from a picc line..most nurses are willing to teach! I work night shifts so it's slower and I have more time to actually learn

[lang]

I really enjoyed working as a back office medical assistant. (BTW, look for a back office position, not front office). I worked in a derm office where the Dr. wanted an assistant in every room during every visit (unless the patient asked for privacy) Because he ran his practice this way, I was in the room for all the great learning moments. For example, while he's looking at the issue and asking the right questions, I'm just observing his thinking, soaking up all the info, but I also get to assist in any procedures. Also we had surgery days where we would assist him all day long. Watching him come up with difficult closures of large defects in the face etc, I learned so much!! Derm is kinda a fantasy world where ppl really aren't that sick (usually) but you can still see how you do with smells (like ruptured cysts and the cautery) and blood (melanoma excision usually gets messy). I really recommend it. I had a blast for the 4 years I was there.

[cloak25]

I've been an ER scribe for a year now and it is tough at the beginning especially when you're not used to all the medical terminology/EMR system, etc (not to mention the fast paced nature of the ED). It's easy to get lost during the pt interview and start typing every single word down. The hard part is filtering out what's pertinent and what's not. But with experience/practice it will become much easier as you will know what to expect/document for a certain CC, so your HPIs should slowly improve. Ideally, you wana complete a chart from the time of the pt interview to discharge/admit in no more than 10 minutes. The hospital I work at uses EPIC which is pretty easy to use. You can always ask your doctor to repeat something you didn't catch or wasn't sure of. I'm sure they don't mind. After all, it's their chart. Always ask your doc if you're unsure of something or if you misheard something (due to the pt being a poor historian or if they're in distress, etc). I work at a hospital where the residents would present the pt to the attending and I would get the story from the residents. When it's too busy, I go with the attending to the pt's bedside and get the story from there. Scribing has really enhanced my critical listening skills as well as developed my short-term memory for things. Hang in there and show that you're trying. Like you said, it's a great learning opportunity!

 

Some tips:

Assuming you're using a laptop/tablet, use notepad to write type down all the notes (HPI, ROS, PE, orders, MDM) for each pt. Then transfer those notes into the chart. It's a good way to keep track of the pt's you saw and good way to stay organized.

[hiiamalysha]

If you already have your CNA, I would suggest looking into working as a Unit Secretary II (which is a unit secretary and CNA for the floor). That is the position I work at the hospital and not only do I do direct patient care, which is what most schools are looking for, but I also put in and verify doctors orders (which includes talking with a lot of doctors and nurses about the patient's care plan). So I learn A LOT about the patients conditions. I have learned SO MUCH from doing this and it has been some great experience because I am getting the best of both worlds. It requires a lot of balancing of your time throughout your shift because in between taking care of patients I have to run up to the nurse's station and put in orders, but it's totally worth it. I don't know how other hospitals do it, so it may be more laid back other places. Just a suggestion :)

[Lemon Bars]

Thanks a lot for the responses and advice folks!

[Just Steve]

Is it too late to approach your boss and say "thank you for the critique yesterday. What, if anything, can I work on to get up speed so that I am an asset to the group? Specifically, is there any additional training I can take part in?"

[Double Helix-7]

If you already have your CNA, I would suggest looking into working as a Unit Secretary II (which is a unit secretary and CNA for the floor). That is the position I work at the hospital and not only do I do direct patient care, which is what most schools are looking for, but I also put in and verify doctors orders (which includes talking with a lot of doctors and nurses about the patient's care plan). So I learn A LOT about the patients conditions. I have learned SO MUCH from doing this and it has been some great experience because I am getting the best of both worlds. It requires a lot of balancing of your time throughout your shift because in between taking care of patients I have to run up to the nurse's station and put in orders, but it's totally worth it. I don't know how other hospitals do it, so it may be more laid back other places. Just a suggestion :)

 

I work on the women's floor over here and every tech on the floor is also a unit secretary. They pretty much cross train you from the start. I would totally love to do that but since I work night shift I mainly just work the floor and do some of the orders. I think if I ever go back to days, I would love to be completely cross trained as a unit secretary because like you said I think you get to learn ALOT about how everything works in the hospital. (:

[Fordbiggs]

I work on the women's floor over here and every tech on the floor is also a unit secretary.

When you say "Tech", what does this mean? Lab tech? Is there a nursing technician?

 

I'm new to the hospital/clinic environment as I work in a private laboratory with lab technicians and technologists.

[GaeaAM]

I'm sorry to about your situation. I totally agree with the people who said go back to pursuing CNA. Most programs that I applied to and have friends attending have majority of their students with HCE as a CNA.

Also it is definitely what you make of it. I work at a hospital on a critical care unit as a CNA. It has been the greatest HCE I could have had. They are super willing to teach, demonstrate procedures, allow me to observe medical procedures. Also duties can include, but are not limited to, BUTT WIPING, vitals, baths, EKGs, monitoring telemetry (knowing heart rhythms and sitting all day to monitor the cardiac telemetry for all patients), unit clerk duties (chart maintenance, transferring/discharging pts). We see lots of diversely sick pts from which I've been able to learn about so many things!! The nurses, most doctors, PAs, NPs who round don't mind stopping for a minute to answer a curious pre-PA's questions (if the timing is appropriate). :smile:

Most importantly it is a good way to pay your dues and learn to respect all the levels of the health care team!

[whoRyou]

“The best thing that you can do in life is follow your heart. Take risks. Don't just take the safe and easy choices because your afraid of what might happen. Don't have any regrets and know that everything happens for a reason.” Unknown

 

“Follow your heart, but be quiet for a while first. Ask questions, then feel the answer. Learn to trust your heart.” Carl W Buechner

 

“I think it's imperative to follow your heart and choose a profession you're passionate about, and if you haven't found that spark yet, if you're not sure what you want to do with your lives - be persistent until you do.” Steve Kerr

 

LemonBars: You are half way there according to Kerr YOU KNOW your profession

[Lemon Bars]

Thanks so much for the encouragement you guys! I will push forward despite this potential setback.

[Double Helix-7]

When you say "Tech", what does this mean? Lab tech? Is there a nursing technician?

 

I'm new to the hospital/clinic environment as I work in a private laboratory with lab technicians and technologists.

 

Oh I'm sorry I meant to say the aides. They just recently changed our job title to patient care tech so people start writing tech on the boards to simplify it and calling us the tech. But basically the day PCTs are both CNA and unit sec.

[Friction]

On the one hand, I wouldn't give up so easy. Show that you're willing and able to adapt/change in the face of adversity. As others have said, the ER can be overwhelming at first. It takes a little bit of time to get acclimated to the pace and expectations. I volunteered in the ER for 9 months before being hired on and it still took me a good bit to get use to the speed and expectations of the staff around me.

 

On the other, as EMEDPA said, you might want to look into other HCE options. As he stated, many schools don't really consider scribe work as direct patient care experience. I'm not sure where you are geographically in CA, but I would look into ER Tech positions if at all possible. I don't think EMS EMT work is bad, it will get you into and around hospital staff, but ER Tech work will expose you to sooo much. I highly recommend it. It might even mean taking something less desirable until something better opens up.

 

Best of luck.

[Swarley]

I will join in for the team suggesting reverting back to CNA work.

 

1. Scribe work does not count as HCE for a number of schools

2. You can learn. I try to ask the nurses questions, even the PAs sometimes.

3. Work for a hospital and choose a specific unit. Do NOT join the float pool. I work on an organ transplant unit. I learned some good stuff specific to kidneys, livers, pancs, and transplants specifically.

4. Network. Get on the nurses good side. Do the extra stuff the other aides don't do like emptying the JPs etc. Talk to the nurses, every nurse should know you want to be a PA. A nurse grabbed one of my unit's PAs and introduced us. I shadowed that PA, she wrote my LOR, and she connected me with a fellow so that I could observe a transplant surgery.

5. Develop patient relation skills. There is a reason schools require HCE not health FIELD experience. They want you to experience working with a patient, understanding their issues, developing ways to relate to them. I think bedside manner will be my weakness. I have been working to develop rapport and humor with my patients now, and I feel better about my future encounters with patients as a PA.

 

MA sounds nice too, but its what 1 year of school? Why pay more money you have the skills for something that can work for you now.

[Swarley]

I will join in for the team suggesting reverting back to CNA work.

 

1. Scribe work does not count as HCE for a number of schools

2. You can learn. I try to ask the nurses questions, even the PAs sometimes.

3. Work for a hospital and choose a specific unit. Do NOT join the float pool. I work on an organ transplant unit. I learned some good stuff specific to kidneys, livers, pancs, and transplants specifically.

4. Network. Get on the nurses good side. Do the extra stuff the other aides don't do like emptying the JPs etc. Talk to the nurses, every nurse should know you want to be a PA. A nurse grabbed one of my unit's PAs and introduced us. I shadowed that PA, she wrote my LOR, and she connected me with a fellow so that I could observe a transplant surgery.

5. Develop patient relation skills. There is a reason schools require HCE not health FIELD experience. They want you to experience working with a patient, understanding their issues, developing ways to relate to them. I think bedside manner will be my weakness. I have been working to develop rapport and humor with my patients now, and I feel better about my future encounters with patients as a PA.

 

MA sounds nice too, but its what 1 year of school? Why pay more money you have the skills for something that can work for you now.

[jgaboria]

Hi Lemon Bar, I work as a tech in the ED. We don't have scribes but is it possible for you to maybe watch the doctor/patient interaction when they do their assessment and medical history with the patient and write notes on a piece of paper before charting into the computer? It might help you to see if the patient nods yes or no to certain questions and just quickly make a note for yourself before typing it in? Just a thought. Then throw the paper into an iron mountain bin for safe keeping/HIPPA laws :)

 

I also volunteer at a local hospice house and we do direct patient care here. I am able to give them their medication and help them with eating, washing, anything they need while they are here. Maybe something like that could be useful for you since it is direct patient care but at a very slow pace since hospice patients don't require as much medical interventions as ED patients.

 

Hope you find something, keep your energy positive!! :)

[jgaboria]

Hi Lemon Bar, I work as a tech in the ED. We don't have scribes but is it possible for you to maybe watch the doctor/patient interaction when they do their assessment and medical history with the patient and write notes on a piece of paper before charting into the computer? It might help you to see if the patient nods yes or no to certain questions and just quickly make a note for yourself before typing it in? Just a thought. Then throw the paper into an iron mountain bin for safe keeping/HIPPA laws :)

 

I also volunteer at a local hospice house and we do direct patient care here. I am able to give them their medication and help them with eating, washing, anything they need while they are here. Maybe something like that could be useful for you since it is direct patient care but at a very slow pace since hospice patients don't require as much medical interventions as ED patients.

 

Hope you find something, keep your energy positive!! :)

[dumbledore]

Hi Lemon Bars,

 

I can emphasize with you. I was a scribe once too and it was so tough at the beginning; but the nice thing was that they knew we would be super slow in the beginning, so they would see how we'd do after 3 months (not after 5x! that is unfortunate). i don't think any of the new scribes were able to write down EVERYTHING accurately after until 3-6 months into it. My suggestion is to learn how to use the computer system. I used EPIC which allowed me to use a lot of smart phrases (saves SO MUCH time). Also learn and make up as many abbreviations as you can. i find that it saves a lot of time!

 

For example:

+= positive

- = negative

v=vomit

c=cough

n=nausea

ed=edema

DM=diabetes

sm- smoke

bb=blood

htn= high bb pressure

10= tenderness

LBM= last bowel movement

px= pain

nvi= neurovascular intact

 

So for example in my notes I'd write (we didn't have tablets/laptops): something like +n, -v, +bb in u = patient has nausea, but no vomiting. has hematuria...

 

i suggest practicing at home; ask your trainer to help you out with practicing how to write the pt hx. for example, mine would give me hw assignments and she would critique what i write. i would also go into the ER early to practice with their computer system. being a scribe is very stressful...even our best scribe always seemed to be hyper and paranoid if the doc leaves her sight, but i think that alert attitude helped her catch every little detail.

 

if it doesn't go well, maybe you can try CNA since it's a fast route in getting HCE.