I start in the ER next week!

gospa · Mar 9, 2016

I was an ER tech then did medsurg RN then returned HOME to the ED. You'll do fine. Read books, take notes, ask questions of both Drs and RNs. Also I find it pretty important to be a great teammate. I help my team nurses to the max. When you can, make yourself available. Another RN starting an IV for you while you interview and assess the pt can really save time. Then I help that RN do the same for their next pt whenever I'm not swamped. Your teammates will notice and in my experience they oftentimes become more than willing to help you.

Best of luck.

Ryan RN · Mar 9, 2016

so heres my input on your situation

youre a medic, your colleagues will know youre not an idiot and familiar with the emergency setting.

here are the differences between being a medic and being a er rn

1- you will now have x patients at the same time instead of your usual 1 at a time

2- you will now be with the patient for hours instead of your usual 15 minutes

3- you will now get dumped on instead of being the dumper (haha)

4- you will now be serving turkey sandwiches to your patients and figuring out how they will be going home

hopefully, you get a good preceptor. somebody who most importantly can train you in a fun way. I would rather have an ok but fun preceptor than a very smart/educated but strict one. you can practice safely and still have fun doing it

good luck!

akulahawkRN, ADN, RN, EMT-P · Mar 9, 2016

I am both a paramedic and an ER nurse. I have been working in the ER for about a year now and I have about 7 years experience as a paramedic. I would have to say that probably the hardest thing about making the transition from paramedic to ED RN is learning to prioritize tasks between your patients. And you will always be reprioritizing what you do and when you do it. Another thing that you will have to get used to as an ED RN is that you will probably not have quite the extensive protocols that you are used to having as a paramedic, at least as far as patient care is concerned. There are lots of policies that you will have to get used to and there will be some protocols that you will be allowed to follow but the majority of what you do will depend upon the medical practitioner that you work with.

As it pertains to patient care, in my ER we have a grid of things that we can do without consulting ER physician. This grid basically follows 12 conditions that may present to the ED and what they want us to do during the triage process, including ordering x-rays, lab work, medications, fluids, etc. On top of that, some physicians are just different, mostly in that they would rather you do the basic triage stuff and then they'll come in and assess the patient and determine what labs and studies need to be done.

One good thing about the ED is that all of your orders and the like are typically "stat" and must be done basically right then or very nearly so. In a typical MedSurg environment a lot of your medications and tasks are set to be done at certain times of the day and I really load you up with stuff to do. In a typical day I will usually see somewhere between 13 and 22 patients, depending upon the shift that I work. Generally speaking, that means that I do all the work of assessing, charting, passing medications, doing various tasks, communicating with multiple people and getting my patient to the floor, transport, or discharge home that many times a day. It also means that I am typically seeing 3 to 4 patients at a time all day long. I then get to turn my rooms over and make them ready for new patients between 4 and 6 times per room, on average. I will have some patience under my care for hours and some I will have under my care for maybe an hour. This past week I had several patients that were under my care for less than half an hour. I have also had patients that were under my care for the better part of 8 hours and were turned over to the next shift.

There are also times that we have had absolutely no patients in the waiting room or in the ER so we had absolutely nothing to do for quite a while. When that happens, typically I start looking to do things like restocking the rooms and making sure things are clean and checking inventories and only if there's nothing else that I need to do, I might then sit down at the computer and surf the Internet for a little while.

I have been at this for a little over a year now. I'm certainly getting more competent in what I do but I still have a ways to go before I consider myself very capable of handling anything that comes through the doors. Do understand that I am not in a nurse that is incapable of handling stuff, rather I'm still somewhat new and I'm still learning things. One of my biggest tasks over the next year is for me to become even faster at things that I do. One of the things that I do not do "fast" is deal with medications. That is the only area that I will not be fast simply because if I make a mistake with the medications, that can have profound implications for the patient if something is not correct. And I have caught problems with medications simply because I have taken the time to check. Everything else that I do is typically done very quickly.

The biggest thing you will probably spend more time doing is learning to manage your time effectively. You will also probably have less autonomy than you are used to but your scope of practice will be much wider than it was in some ways.

You have indicated that your orientation period will be 12 weeks. I highly suggest that you really take to heart the "lessons" in the book "Fast Facts for the ER Nurse" as you are currently reading it, continue studying it. Probably your first day or two actually in the ER as a nurse will be spent shadowing. I would then expect that you will get one patient at a time for about a week, maybe 2, and then you will probably add another patient to your load every week or 2 until you are at a full load. After that you will probably spend a lot of time working on time management and prioritization. With any luck, you will not get a nurse that does not like new grads in the ER, especially those that were paramedics before. I had one of those. Fortunately for me, she at least did her job and once I switched over to a different preceptor, I was able to do very well.

I wish you the best of luck! The ER is a wonderfully crazy weird place to work and I would not want to work anywhere else.

Editorial Team / Moderator · Mar 9, 2016

Girl, you already know what I think. You'll be great! It's going to be uncomfortable for a bit and you will feel slow and overwhelmed, but that will fade. I am so excited for you!

MedicFireRN · Mar 9, 2016

so heres my input on your situation
youre a medic, your colleagues will know youre not an idiot and familiar with the emergency setting.
here are the differences between being a medic and being a er rn
1- you will now have x patients at the same time instead of your usual 1 at a time
2- you will now be with the patient for hours instead of your usual 15 minutes
3- you will now get dumped on instead of being the dumper (haha)
4- you will now be serving turkey sandwiches to your patients and figuring out how they will be going home
hopefully, you get a good preceptor. somebody who most importantly can train you in a fun way. I would rather have an ok but fun preceptor than a very smart/educated but strict one. you can practice safely and still have fun doing it
good luck!

Thanks Ryan! I am already pretty familiar with the "turkey or ham?" sandwiches delivery LOL.

It's very strange around here, it's the only place where I have worked that since the ALS Transport company I work for is owned by the hospital, they de-prioritize us in terms of beds. Even for transfers, they will make us wait. It's not uncommon for me to sit in the ER with a patient on my stretcher for 35 minutes to an hour before they take report. Crazy! I think the meds from the pyxis and scanning a wristband is going to be quite an adjustment for me.

MedicFireRN · Mar 9, 2016

I am both a paramedic and an ER nurse. I have been working in the ER for about a year now and I have about 7 years experience as a paramedic. I would have to say that probably the hardest thing about making the transition from paramedic to ED RN is learning to prioritize tasks between your patients. And you will always be reprioritizing what you do and when you do it. Another thing that you will have to get used to as an ED RN is that you will probably not have quite the extensive protocols that you are used to having as a paramedic, at least as far as patient care is concerned. There are lots of policies that you will have to get used to and there will be some protocols that you will be allowed to follow but the majority of what you do will depend upon the medical practitioner that you work with.
As it pertains to patient care, in my ER we have a grid of things that we can do without consulting ER physician. This grid basically follows 12 conditions that may present to the ED and what they want us to do during the triage process, including ordering x-rays, lab work, medications, fluids, etc. On top of that, some physicians are just different, mostly in that they would rather you do the basic triage stuff and then they'll come in and assess the patient and determine what labs and studies need to be done.
One good thing about the ED is that all of your orders and the like are typically "stat" and must be done basically right then or very nearly so. In a typical MedSurg environment a lot of your medications and tasks are set to be done at certain times of the day and I really load you up with stuff to do. In a typical day I will usually see somewhere between 13 and 22 patients, depending upon the shift that I work. Generally speaking, that means that I do all the work of assessing, charting, passing medications, doing various tasks, communicating with multiple people and getting my patient to the floor, transport, or discharge home that many times a day. It also means that I am typically seeing 3 to 4 patients at a time all day long. I then get to turn my rooms over and make them ready for new patients between 4 and 6 times per room, on average. I will have some patience under my care for hours and some I will have under my care for maybe an hour. This past week I had several patients that were under my care for less than half an hour. I have also had patients that were under my care for the better part of 8 hours and were turned over to the next shift.
There are also times that we have had absolutely no patients in the waiting room or in the ER so we had absolutely nothing to do for quite a while. When that happens, typically I start looking to do things like restocking the rooms and making sure things are clean and checking inventories and only if there's nothing else that I need to do, I might then sit down at the computer and surf the Internet for a little while.
I have been at this for a little over a year now. I'm certainly getting more competent in what I do but I still have a ways to go before I consider myself very capable of handling anything that comes through the doors. Do understand that I am not in a nurse that is incapable of handling stuff, rather I'm still somewhat new and I'm still learning things. One of my biggest tasks over the next year is for me to become even faster at things that I do. One of the things that I do not do "fast" is deal with medications. That is the only area that I will not be fast simply because if I make a mistake with the medications, that can have profound implications for the patient if something is not correct. And I have caught problems with medications simply because I have taken the time to check. Everything else that I do is typically done very quickly.
The biggest thing you will probably spend more time doing is learning to manage your time effectively. You will also probably have less autonomy than you are used to but your scope of practice will be much wider than it was in some ways.
You have indicated that your orientation period will be 12 weeks. I highly suggest that you really take to heart the "lessons" in the book "Fast Facts for the ER Nurse" as you are currently reading it, continue studying it. Probably your first day or two actually in the ER as a nurse will be spent shadowing. I would then expect that you will get one patient at a time for about a week, maybe 2, and then you will probably add another patient to your load every week or 2 until you are at a full load. After that you will probably spend a lot of time working on time management and prioritization. With any luck, you will not get a nurse that does not like new grads in the ER, especially those that were paramedics before. I had one of those. Fortunately for me, she at least did her job and once I switched over to a different preceptor, I was able to do very well.
I wish you the best of luck! The ER is a wonderfully crazy weird place to work and I would not want to work anywhere else.

Thanks, Akulahawk, that was super helpful :yes:

I definitely do think that the balance of having so many patients at once will be the biggest adjustment. Also, I am sure that like you I will be slow with the meds. Not trying to sound conceited but I am told I am a very good medic, and even so I am very deliberate about treatments, especially meds. Even on the truck where there is only one patient and almost all the meds are only carried in one concentration, I am anal about my checks and the med math. I can imagine that's going to be one of the biggest (if not the biggest) things that slows me down. I have tarascon's pocket pharm for nurses and I think that will help me to not have to dig out a big med book, but it's still going to be a great source of apprehension for me until I become familiar with the meds that the providers in the department like to use a lot.

MedicFireRN · Mar 9, 2016

Girl, you already know what I think. You'll be great! It's going to be uncomfortable for a bit and you will feel slow and overwhelmed, but that will fade. I am so excited for you!

Aw, shucks. Thanks :) You know I will be PMing you if I have any questions. I'm kind of like that stray cat that shows up and never leaves

emtb2rn, BSN, RN, EMT-B · Mar 9, 2016

And check this out, when you go to see your patient you won't have to ask them to first secure the dog. And there'll be adequate lighting in the room. And no stairs. Enjoy.

MedicFireRN · Mar 10, 2016

And check this out, when you go to see your patient you won't have to ask them to first secure the dog. And there'll be adequate lighting in the room. And no stairs. Enjoy.

I can't like this post enough. So true!!!! Wading through a hoarder's house that reeks of cat urine will no longer be a typical occurrence!

jeniffied · Mar 10, 2016

Good luck! Just graduated from nursing school and now looking for ED too!

blockmomRN · Mar 11, 2016

We all had to start somewhere, at the bottom, as the outsider ...you will do fine. As a fellow night nurse, night shift brings a certain level of comradary(sp) that other shifts just don't get. Stay busy, always ask your teammates if they need help (even if you know they don't) shows you are a team player. Admit that you don't know everything, even after years of experience, I will be the first one to admit that I am still learning daily. Don't be afraid to ask questions, we want you to ask before you do something that might jeopardize at patient's life.

Know that you are not alone, all nurses have these same feelings at first....they just don't admit to it.

Good Luck!

:up: Leslie