If there was one piece of advice...

  1. I am a new grad. and will begin working in our level 2 Trauma center. I have worked in the hospital environment already, have good clinical skills and good grades but I know that the "real world" is so different - especially in the ED.

    Soooooooo...

    If you could give a new grad about to work in the ED one piece of advice what would it be???

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  2. 25 Comments

  3. by   CritterLover
    get the most out of your orientation.

    get in on all of the procedures that you can, especially if you hear that its not something that is done often. practice all of the ivs and catheters that come your way. volunteer to assist with whatever you can. watch, listen and learn. don't let them cut it short (happens sometimes when you already have clinical experience and the unit is short staffed). most importantly, try not to get too overwhelmed. getting organized in a busy er can seem daunting at first, but the organizational skills will come with time. many new nurses get caught in the "i'm never going to be able to do this," mindset. it will all fall in to place.
  4. by   nursefirefighter
    Quote from ImaERtraumaRN
    I am a new grad. and will begin working in our level 2 Trauma center. I have worked in the hospital environment already, have good clinical skills and good grades but I know that the "real world" is so different - especially in the ED.

    Soooooooo...

    If you could give a new grad about to work in the ED one piece of advice what would it be???

    I have been an ER nurse for 8 years..everyone will have "their" way of doing things. And "their" way is the "right" way, right??? WRONG!!! Take the advice from each staff member and make your own way of doing things.
    Always ask questions. "When it doubt, check it out"
    Smile.
    And most importantly....PRAY. Before your shift and after. GOD is the one who will put your hands to work and allow you to take care of these patients. Pray for confidence, patience, and knowledge to pick up on the symptoms your pt. is presenting with. Pray for a sense of comfort on your pt. Knowing that they are in good hands.
    Also, when you become "numb" to the death and the dying....get out of the field. Once you stop crying because u lost a pt. or things turn into "another one bites the dust" your duty to become a nurse has ended. You should never lose sympathy, or empathy to your pt. and family. GOOD LUCK!!!!!!!!!!!!!!
  5. by   2ndCareerRN
    Don't sweat the petty stuff, and don't pet the sweaty stuff.

    bob
  6. by   grammyr
    I have more than one. 1. Don't be afraid to say "I don't know but I want to learn." 2.Ask questions. There is no such thing as a dumb question. 3. When you lose a patient, whether young or old, don't be afraid to cry. 4. Welcome to the crazy, maddening, wonderful world of ER nursing. It is very DIFFERENT!!!
  7. by   ikimiwi
    There is always "a minute" to think. 60 sec a long time
  8. by   Dixielee
    Get yourself an ER related pocket resource book. The one I have was about $20, and is called Emergency Critical Care Pocket Guide, ACLS version. There are other more expensive ones, but this one is fine for me.

    You can take a drug book, but it will be easier if you have a PDA with some good drug programs. Epocrates is free to download and there are others you can buy. You have lots of quick drug info at a glance. You can also have drip calculations, etc instantly. In the ER you don't always have the luxury of flipping thru a resources book.

    You can get a good PDA with 32 mg RAM for under $200, very well worth the money!

    Don't be afraid to say, "I don't know but I can find out", and do it! Keep a small notebook with you, pocket sized, and when you get little pearls of wisdom, write them down. I also keep a pocket calculator with me, it is quicker than the calculator on the PDA. I also keep a little cheat sheet taped into the door of the calculator that has common names of intubation drugs, some docs may ask for Sux and some anectine....they are the same drug. Same with pavulon and pancuronium, vecuronium and norcuron. This will save confusion when you need things in an instant.

    When you are in your first code, pick one place to be an observe all you can. Or place yourself in a position to push drugs, or hand drugs from the cart, or record. Don't try to do everything. Stay in one place and learn that area well, but watch everything and learn. Stick around for the post mortum care. You will learn a lot by asking questions at that time.

    Realize that most emergency dept patients are NOT emergencies, and will not die if you do not jump immediately. In reality if you did not care at all to most of them in an entire shift, they would not die! They might be miserable, but they will not die. Do what you can when and where you can. You can not start 3 IV's at once, but you can prioritize who gets one first. Keep commonly used IV supplies in your pocket, i.e. alcohol swabs, tourniquets, extra catheters, Yes, your pockets get full! I like the cargo style scrub pants, because of the 2 large pockets on the sides and still use my scrub top pockets for other stuff. Once you decide what goes where, put everything in the same place every time, and you will not have to fumble for things.

    Also realize that even the most experienced nurse will have questions about certain things, so don't be afraid to ask questions. I worry about new grads who think they know enough rather than those who are a little insecure. If you are not insecure, you are probably dangerous.

    Most of all, try to enjoy the adventure. You will see things people in other walks of life can not even imagine. You will see the best and worst of humanity. You will see situations turn on a dime, so be ready. Never take anything for granted. The little old lady who looks sick but does not complain is usually in much worse shape than the ones who scream, yell and demand care. Watch out for the quiet ones, they will come back to bite you on the butt!

    Good luck, you will be terrified much of the time in your first year, don't worry, they can kill you, but they can't eat you!
  9. by   Spidey's mom
    Dixielee - great advice.

    I'd just like to add, to all nurses, do not sacrifice your family for your job. Remember, YOU are not the answer to your facility's staffing problem. Learn to say NO.

    steph
  10. by   2ndCareerRN
    Never, and I mean NEVER, stand in front of someone you have just given charcoal down a gavage tube to. Stand to the side, and a little behind if you can!

    Some day you will remember this advice, hopefully before and not after the charcoal comes back up.

    bob
  11. by   Dixielee
    2nd careerRN, you just brought back an acutely funny visual....well funny for some of us. We had an unusually mouthy clerk who decided she wanted to be a paramedic. I swear this was not planned, but she was standing AT THE END OF THE BED observing, when the charcoal went in, and she went running out the door as the charcoal came out! I thought someone had stepped on a cats tail when I heard the sound coming from her mouth!! She had charcoal from head to toe! She hit the shower cursing the patient, the nurses, the makers of the charcoal, and everyone ever involved in medicine.....sorry, just brought back fond memories....WHAAAAAAAAAAHAHAHAHA

    Sorry, I am composed now....great advice!
  12. by   rjflyn
    LOL- charcoal doesn't come out of scrubs. Dont wear while or any light color if you can help it.

    Rj
  13. by   shel_wny
    Quote from 2ndCareerRN
    Don't sweat the petty stuff, and don't pet the sweaty stuff.

    bob
    HAHA! LOVE this quote.
  14. by   calicamper
    For Dixielee especially, thanks for taking the time to write up this advice. I start working in an ED in October. Very much appreciated your suggestions, and everyone else's.


    Quote from Dixielee
    Get yourself an ER related pocket resource book. The one I have was about $20, and is called Emergency Critical Care Pocket Guide, ACLS version. There are other more expensive ones, but this one is fine for me.

    You can take a drug book, but it will be easier if you have a PDA with some good drug programs. Epocrates is free to download and there are others you can buy. You have lots of quick drug info at a glance. You can also have drip calculations, etc instantly. In the ER you don't always have the luxury of flipping thru a resources book.

    You can get a good PDA with 32 mg RAM for under $200, very well worth the money!

    Don't be afraid to say, "I don't know but I can find out", and do it! Keep a small notebook with you, pocket sized, and when you get little pearls of wisdom, write them down. I also keep a pocket calculator with me, it is quicker than the calculator on the PDA. I also keep a little cheat sheet taped into the door of the calculator that has common names of intubation drugs, some docs may ask for Sux and some anectine....they are the same drug. Same with pavulon and pancuronium, vecuronium and norcuron. This will save confusion when you need things in an instant.

    When you are in your first code, pick one place to be an observe all you can. Or place yourself in a position to push drugs, or hand drugs from the cart, or record. Don't try to do everything. Stay in one place and learn that area well, but watch everything and learn. Stick around for the post mortum care. You will learn a lot by asking questions at that time.

    Realize that most emergency dept patients are NOT emergencies, and will not die if you do not jump immediately. In reality if you did not care at all to most of them in an entire shift, they would not die! They might be miserable, but they will not die. Do what you can when and where you can. You can not start 3 IV's at once, but you can prioritize who gets one first. Keep commonly used IV supplies in your pocket, i.e. alcohol swabs, tourniquets, extra catheters, Yes, your pockets get full! I like the cargo style scrub pants, because of the 2 large pockets on the sides and still use my scrub top pockets for other stuff. Once you decide what goes where, put everything in the same place every time, and you will not have to fumble for things.

    Also realize that even the most experienced nurse will have questions about certain things, so don't be afraid to ask questions. I worry about new grads who think they know enough rather than those who are a little insecure. If you are not insecure, you are probably dangerous.

    Most of all, try to enjoy the adventure. You will see things people in other walks of life can not even imagine. You will see the best and worst of humanity. You will see situations turn on a dime, so be ready. Never take anything for granted. The little old lady who looks sick but does not complain is usually in much worse shape than the ones who scream, yell and demand care. Watch out for the quiet ones, they will come back to bite you on the butt!

    Good luck, you will be terrified much of the time in your first year, don't worry, they can kill you, but they can't eat you!

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