Initial Patient Assessment

The initial patient assessment is a critical cornerstone of emergency nursing practice, and for new emergency nurses, mastering this skill is paramount to ensuring safe and effective patient care. As patients arrive in the emergency department with diverse and often unpredictable conditions, the ability to rapidly and accurately assess their needs is paramount. This assessment is the foundation for clinical decisions and guides the nurse's actions throughout the patient's ED journey.

NTS was founded by a group of preceptors who continue to lead an orientation program at a busy Level 1 Trauma Center in Central Illinois. We paired the teaching on the floor with didactic and simulation events to enhance the Learner's experience. The first simulation we ever wrote and still teach today aims to standardize the initial patient assessment. Most of our preceptors now have participated in this event during their orientation, and all understand the principles taught: 

• Primary Survey: Airway, Breathing, Circulation, Disability, Exposure
• Safety Net: Monitor, Pulse Oximetry, O2, IV, Glucose, 12-lead EKG, Physician

For new emergency nurses, honing their initial patient assessment skills begins with a solid understanding of anatomy, physiology, and various medical conditions. This knowledge empowers them to identify potentially life-threatening situations quickly, prioritize care, and intervene promptly. As the new nurse begins their practice, it is overwhelming to start matching up the extensive knowledge gained in nursing school with the appropriate skills. Consistently starting and following the same process for each patient will set them up for success. 

Incorporating strong communication skills is equally essential. As new emergency nurses interact with patients, their families, and the multidisciplinary team, effective communication helps gather crucial information, build rapport, and establish trust. A thorough patient history, including medical history, allergies, medications, and events leading to the current ED visit, enhances the nurse's ability to tailor care to the patient's unique circumstances.

Moreover, new emergency nurses must develop acute observational skills. The ability to detect subtle changes in a patient's condition, such as skin color, breathing patterns, or mental status, can signify deterioration and require immediate intervention. As they learn to synthesize information from various sources—physical assessment, vital signs, patient history, and diagnostic tests—new emergency nurses gradually build the capacity to formulate a comprehensive picture of the patient's status.

In the high-stress environment of the emergency department, new nurses learn the art of prioritization. The initial patient assessment guides them in determining whether the patient requires urgent intervention, can wait for further evaluation, or necessitates immediate escalation to a higher level of care. Making swift, informed decisions under pressure contributes to patient safety and the nurse's confidence and competence in handling emergencies.

An educator must demonstrate Return on Investment (ROI) to justify continuing education programs and assess if they meet their objectives. We measure ROI regarding tenure and preventing colleagues from departing their roles because they feel unprepared to practice independently. But, it can also be estimated by analyzing the volume and types of patients cared for by nurses who receive this training early in their tenure. At our site, new graduate RNs who receive our standard orientation, including this teaching on Initial Patient Assessment, care for more ESI 1 & 2 patients (40%) than their experienced counterparts (17%). However, they care for a similar number of patients overall. Many of those nurses also received the education later in their tenure.

In conclusion, the initial patient assessment is a skill set that new emergency nurses must master early in their careers. It requires clinical knowledge, communication proficiency, acute observation, and effective prioritization. As they refine these skills, new emergency nurses contribute significantly to delivering high-quality care in a dynamic and fast-paced environment.