First Job in ER, advice welcome

Y2K...........

I went into ER right out of school. I bought ACLA stuff, rhythm books, Trauma books, etc etc. The bottom line is experience. What the show you in books is the way it should look, not the way it can look. V-tach does not always look like what's in the book. Same as a-fib/a-flutter, etc etc. Take your time, don't be afraid to learn or ask questions. If you want to get ahead that's great. It is going to take some time though.........but you'll be fine. No matter what.........DO NOT get discouraged and leave prematurely. I have seen that happen to people that I thought were coming along just fine. Chin up!

Y2K
Welcome to the ER. Your gonna love it. But I agree with Rick, hang in there and don't get discouraged. It takes time and experience to feel comfortable in any new area, especially ER because things change and you have to know something about everything.
I do think though that a basic arrythmia course should be offered by your hospital as part of your Er orientation. If they don't look around and see if you can sign up for one. ACLS is great but it's more helpful if you already know the basics. As Rick said things are not always the same clinically as they are in a book so you will learn as you go along.
Pick a preceptor that enjoys teaching and never be afraid to ask questions.
Good luck and enjoy yourself, I'm glad your dream came true.

Yes, to the arrythmia class. When cardiacs do weird things, you've got to know your basics and the hallmarks of each arrythmia. Abberancy can change rules. Take a TNCC prep class after about 6 months to a year.

Look, listen, and ask questions. Don't be afraid to ask questions. Don't do things you aren't comfortable doing. Everyone is busy and they won't always greet your questions, but ask them anyhow. Listen to your gut. Remember, 70% of the dx is in the history, so listen to histories, that is listen to what your clients tell you. Desensitize yourself to asking sex questions, but don't get insensitive. That is, you do have to ask teen girls with belly pain if they are having sex, but don't do it in front of their mom or their friends. Listening to histories is important in trauma too since it often will tip you off to serious trauma when the patient might not look that bad.

There are many good books out there, but I thought _Sheehy's Emergency Nursing: Prin and Practice_ is a good overview. Nursing assessment is the ED is a different critter because you sometimes do it pretty focused and short and other times you have to know when to broaden it out. I think the favorite gem I remember from this book that I saw nurses fluff off repeatedly is, in eye injury, visual acuity is the vital sign of the eye.

I like Rick's advice too. ED is a long and steep learning curve. Expect to go home feeling stupid sometimes more than you want to. But be sure to give yourself credit for what you're learning and doing better.

Good luck.

Y2KRN:

Dito to what they others have said. I just finished my first year as an ER nurse. Book knowledge should be combined with experience. Often I come home and read up on things I run across that I was not all that comfortable with. Expereince is the best teacher but don't forget to supplement that with a little book review too.

The book that I found very helpful was "Emergency Nursing Core Curriculum" published by the Emergency Nurses Association (ENA). It is wrritten in outline format for the most part and is divided into sections such as cardiac, trauma, abdominal complaints, etc. Our ER uses this book as the main reference for new grads in the ER. Yep new grad in the ER. The ACLS ENPC and dsyrythmia books are all good references too.

Its not easy ER nursing requires kowledge in all areas of nursing from peds to geriatics and Trauma and cardiac to nausea vomiting and diarreha. Don't forget the GI bleeds and overdoses.

It takes time to learn and your coworkers should understand that, after all they all had to learn too.

If you have any questions or distress's Y2K email me or pm me...... I would be glad to help.

Y2KRN,
Good luck to you on your new adventure! I am an educator in an ER and currently execute a program to orient new grads. Hopefully with your experience you will bring organization & time management skills. Those take time to develop. The ER is organized in a very unique manner. You need to study EKG rhythms, ACLS protocols, PALS protocols, Sheehy's book is great [I developed 5 days of lecture from it alone]. The ENCC is also very good. Check out trauma websites to develop a thought process of trauma assessments. trauma.org is just great.

The "seasoned" staff will want you to ask questions, but on the flip side will want you to articulate clues and concepts about the patient care process. And the big push in the ER from the moment the patient hits the door is "where are they going?". So always look to differentiate the history, assessment, diagnostic testing, etc to discern a disposition plan and then be ready to execute it in a timely manner.

ERguru