New to ER - tips, tricks, recommendations & prioritization? - page 2

by acuariaRN

7,892 Views | 21 Comments

So, after 6.5 yrs as RN/shift charge on a step down unit, I moved to the ED! Very excited to work with the excellent team! Though I know how to be a nurse, being an ER nurse is a whole new world to me... different processes,... Read More


  1. 6
    Ok I had someone tell me this tip that was So Simple and SO BRILLIANT that I felt dumber just hearing it....

    MD orders 1000ml NS bolus stat then 200/hour continuous when that finishes...

    A 27 year veteran of emerg nursing told me: "Run the bolus as a secondary IV then the primary 200/hour will take over automatically when it's done."
  2. 2
    Thanks to "Nurseonamotorcycle" for the info on running the bolus as a secondary line. That's so cool. I plan on doing that from now on.
    jrsRN07 and Esme12 like this.
  3. 0
    I'm assuming you have computer charting, OP? Whenever I get an ambulance and have to triage, I always bring the computer with me so I can type the triage note as the EMS personnel give it to me, then as I get the initial set of vital signs I can just plug away at the computer, ask my other questions, assign the ESI level and bam! I'm done. I think a lot of times the triage note dictates who will be seen first by the providers and not necessarily the ESI level. ESI levels can change, however.

    As for the rest of the charting, it all can wait, in my opinion. I write all sorts of little notes on pieces of paper and then chart when I can, which isn't always right away.

    Where I work, we are very teamwork-oriented. A person would never get back-to-back ambulances unless of course you were assigned to the cardiac/trauma rooms and those patients coming in needed those rooms. Even so, we always help each other out and do team nursing. One nurse will do the triage, another nurse (or tech) will do the EKG, line/labs, assessment, etc.

    A lot of good advice in this thread. I was floated a lot to the ER since January but officially made the switch in April, and I couldn't be happier. I was shift charge and came from a step down unit just like you. I think that previous experience is invaluable to working in the ER!
  4. 0
    Quote from NurseOnAMotorcycle
    Ok I had someone tell me this tip that was So Simple and SO BRILLIANT that I felt dumber just hearing it....

    MD orders 1000ml NS bolus stat then 200/hour continuous when that finishes...

    A 27 year veteran of emerg nursing told me: "Run the bolus as a secondary IV then the primary 200/hour will take over automatically when it's done."
    What an awesome tip!! Thanks!
  5. 0
    Quote from IrishErin

    What an awesome tip!! Thanks!
    What pumps do you guys use? Seriously, I want them if they run fast enough on the secondary line to give a healthy adult a bolus (
    ours max at 999 ml/h). I do use this trick for bolusing CHF pts and Peds though
  6. 0
    Quote from CodeteamB

    What pumps do you guys use? Seriously, I want them if they run fast enough on the secondary line to give a healthy adult a bolus (
    ours max at 999 ml/h). I do use this trick for bolusing CHF pts and Peds though
    Ours max at 999 as well, so I usually end up hanging by gravity if a bolus is required, then attaching them to the pump afterwards
  7. 0
    I run it at 999.
  8. 0
    Quote from NurseOnAMotorcycle
    I run it at 999.
    Oh, ok, I was all excited!

    I'm a pressure bag kinda gal, to be honest. I rarely use a pump for saline.
  9. 0
    We're required to run everything on a pump, so a simple L bolus takes an hour :-/
  10. 0
    I only use pressure bags if someone's coding badly. If I need a pressure bag, there won't be an order to follow it up with 200/hour. It'll be followed up with another pressure bolus order.


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