I've been in the ER going on 7 years. I started in a new grad program, it was awesome, and very challenging, to go from student to ER nurse!
One thing I had to realize quickly was that I was no longer a student! Even though we spent a great deal of time in classroom settings and trainings that first 6 months, even though I was rotating around through EMS and all the ICUs and Psych, I had the full responsibility of my license to carry. Like it wasn't OK if I didn't know the answer to something anymore, it couldn't wait till I got home and could look it up! It's always OK to not have every answer at the tip of your tongue (you can never know everything), but I had to know HOW to get the exact right answer and how to get it FAST! I had to develop a plan and get to understand all available resources.
Giving report was much more weighted with responsibility suddenly - I wasn't reporting off to my Professor who could chide me or ask me questions and nudge me to notice any omissions or mistakes. Suddenly I'm a new grad RN and I'm on the phone wth a kick-ass CTICU or MICU nurse giving report and wow did I get schooled a few times!
So develop a system for how you find answers quickly when action is required. You get a patient with hypertensive crisis and a head injury needs a Cardene drip titrated or some other critical drug (and dangerous drug) what methods are available to you to check the appropriateness of the order, the dose, etc? What's the policy for how that patient is monitored? You have to move fast in the ER but you also cannot take any shortcuts with safety....so it's very stressful the first year when EVERY situation is new and many drugs are unfamiliar.
Drug orders are verified by Pharmacy in our ER but not critical stat orders, and in a code or other sh*t show crash verbal orders will fly at you in the Trauma Room. Sometimes we had a Pharmacist in the ER and I could grab her and ask a quick question, sometimes, especially on nights, I called the Pharmacy to ask questions. You have to be thick skinned and curious and not proud! Sometimes you have NO extra 30 seconds to call Pharmacy, you can't leave the bedside, patient is dying - so what's your plan?
I'm just using drug orders as an example - drugs are just one of many interventions that you are expected to deliver expertly and quickly. I realized I needed a laminated cheat sheet of critical (deadly) drugs that fit in my pocket. I needed a laminated little list of all the inter-department extensions (Blood Bank, the Lab, Micro, Pharmacy, Anaesthesia, the OR, Respiratory, MICU Resident spectralink, ER RIC (resident in charge) spectralink; ER charge nurse spectralink, ER Manager spectralink, Educator spectralink, Social Work, Psych, ADN, etc.) And let me tell you I carry those laminated babies with me to this day!!
I learned I can never be afraid or too proud to just speak up and say "I need help here, now!" or "That dose doesn't sound right to me can you re-check?" Some Docs or Residents will get irritated with your question, so you have to be thick skinned - so what if they have to dbl check a wt based calculation, I don't mind being wrong, I just don't want to kill anyone. That same Doc will come and hug you when you save their a** from a med error!
In fact, it is the Team spirit that I love about the ER, and now that I know my stuff I love to help out anyone who needs a hand or a 2nd pair of eyes on a drug order or dose, or a 2nd set of hands to clean up a disaster of body fluids! We get through it all together.
In that first year (and of course even today) when I'd get home or had a day off I had stuff I needed to review and learn more about. But in the moment, on the job, I had to develop my own style and method for getting accurate answers quickly, right then when they are needed. You learn which nurses are your allies and who you can trust. You learn quickly that some of the Residents are actually not very good, and that you have to double check all their orders!! And you're never alone, your preceptor will have some methods that work for you, and some you will develop your ow style.
Oh man, it is a wild ride that first year in the ER - but hang tough, develop your own methods for swift safe practice, and just keep learning. It's a great place to work! Good Luck!