So I recently noticed a trend in myself and my experience in the ER. I am just about to complete my seventh week in orientation, and have about 5 more to go.

Yesterday I was thinking about my time in orientation, about my days and how they go, and I realized something really interesting. I seem to be focused on one and only one thing - tasks!! Once I get into the ER I seem to switch into "getting things done" mode. I want to clear off all the orders on every patient as fast as I can. All I'm thinking is "I need to get a line and labs in 2, then get the UA from 3, and damn I still have to get the triage info in on 4Hall and then call X-ray to do a portable on 4. Then I need to discharge 5 and then check if there are any new orders in the computer, and I have to remember to document, and..." It's all tasks. It's only when I get home that I start trying to piece it together in my head, the person, the presentation, the symptoms, the lab results, etc. I am so focused on getting the tasks done that I'm not looking at the big picture, at least most times I don't feel like I am.

This became very real for me today when were giving report to the next shift. I gave report on two patients, and then watched my preceptor give report, and the difference was amazing. While I rushed through the chief complaint, what I had done, and what still needed to be done, she mentioned those things but in addition pointed out pertinent things in the patient's history and lab results that were interesting, and that the nurse needed to be aware of in order to surveil for complications. She talked about how a patient's BUN was high and how dehydrated he looked, and yet his hemoglobin and RBC were on the low side, leading her to conclude that he was most likely very anemic, and therefore that he may need a transfusion. She went on to point out other interesting connections to his history. She went on to give report on our other patients and I stood there in awe, listening and wondering, how in heaven's name did I miss all this?

I learned some very valuable lessons today, and I know I still have a lot to learn. But one thing I learned is that I am way too obsessed with the tasks.

I suppose I will be focused on tasks for a while longer until I get more used to the job, but I hope that I never get stuck in the "need to do"'s, but will learn to spend time in the "need to know"'s, making the connections and seeing the bigger picture.