New Grad Starts in ED !!!!!! HELP !!!

roser13, ASN, RN · Oct 3, 2016

Do not chart "!!!!!!!!!!!"

LouDogg, BSN, RN · Oct 3, 2016

LOL !!!!

Duly noted... thank you....

TheCommuter, BSN, RN · Oct 4, 2016

Moved to the Emergency Nursing forum for more responses.

CX_EDRN · Oct 6, 2016

Ask questions, a lot of them. Get in on critical situations, don't hang back when stuff that you know how to do needs to get done. Volunteer to run the I-Stat, hook the patient up to the monitor, get a second line, etc during the pre-brief. Know that you won't be comfortable for at least a year, know that you can still be confident on your first day. Be respectful of your pre-hospital providers, say thank you to EVERYone, ie EVS to security to transporters. Study on your own time; look up patho/associated labs/imaging on each of your patients when you get home. There is something to learn from every single person- from a new grad like yourself to the seasoned and weathered RNs in the ED. But most of all- take care of yourself. Take a deep breath when **** goes down, leave it at work and live your life when you walk out the ED doors. Good luck!

LouDogg, BSN, RN · Oct 7, 2016

Excellent advice, CXâ€¦. thank youâ€¦

DayDreamin ER CRNP · Oct 8, 2016

Do a search on this board. This question is asked about every other week.

Congrats on the job!

my advice: buy GOOD shoes and great socks. Don't buy cheap crap. I wear Balega or Swiftwick socks. Drink lots of water on and off shift to stay hydrated.

ED_Murse · Oct 14, 2016

Congratulations! ED is a fantastic area to work in. It's tough coming in as a new grad - be prepared to feel out of your depth for at least 6 months, more like a year. That will pass though!

Be safe in your practice, ask lots of questions, especially the ones you think are dumb. Any department worth working in has senior staff more than willing to help out the new guys.

Make sure your documentation is up to scratch. Working in such a fast paced environment it's easy to miss something and if it ain't documented you don't have a leg to stand on.

Above all enjoy it - you worked hard to get here

cjcsoon2bnp, MSN, RN, NP · Oct 17, 2016

I think that the other users have all posted some really great tips and at the risk of being repetitive, I will post the basics that I tell all new grads. and new nurses coming into the ED.

1.

Always keep your eyes and ears open, but think before you speak.

- You're going to see and hear things you can't imagine but consider it all a learning experience (some are good and some are not). But a general rule of thumb is that you should be doing a lot more listening than you do talking.

Just to be clear, I don't mean that you shouldn't ask questions or be sociable with your peers but new grads. and new nurses transferring in the ED sometimes fall into the trap of having to show off how much they know, and it is both off-putting and not conducive to their learning.

2.

Don't turn down any opportunities to practice a skill.

- Whether you're a new grad or a new transfer into the ED from the inpatient units, do yourself a favor and take any opportunity that you can to practice certain skills or observe certain experiences. When you are first starting out you should be willing to jump in and help your peers with getting EKGs, putting patients onto the cardiac monitor, starting IVs, placing NG/OGs, etc.

I'm not new to the ED but when our computer system recently changed over I have volunteered to help my peers with the initial triage and assessment documentation (when I have a free moment) so that I can get practice and become more efficient at that part of the job.

Another example, a few months ago we had a nurse who transferred to the ED from the inpatient med/surg. units (let's call her Kelsey) and she had approximately 1 year of nursing experience. A few months into her orientation one of my peers asked Kelsey if she wanted some more practice starting IVs and she said "Oh no thanks, I'm good now" and went back to using her cell phone. Having worked with Kelsey on more than one occasion, I disagreed with her assessment; she needed more practice with many of the skills we do in the ED and had a skewed sense of teamwork. I know that when she declined to help that day it raised more than a few eyebrows and has impacted the opinion that her in the department.

3.

Be willing to help.

- This goes along with the last tip. Always be willing to help your peers. You need to manage your time efficiently so that you don't get behind on your assignment by trying to always help others, but if you have the time, then you should offer to help your peers. Keep in mind that not everyone will ask for help, but if you offer it they are more likely to take it. I try to have the rule of thumb be "If we all can't sit [at the nurse's station] then no one sits."

4.

Learning doesn't stop when your shift ends.

- I've been a nurse for about five years now, and I view each and every shift as a new learning experience. I try to take a few quick notes of things that I encounter which I might not be familiar with or that I might have a question about. If it's about a specific order from a provider (MD/DO/PA/NP) then I will try to ask the provider the detailed rationale for why they ordered what they did (if time permits) and then look it up to gather more information. If it is a general question related to a disease process, drug mechanism, or pathophysiology, then I will look it up using a reliable source on my own time.

If you go into this job thinking that your learning only occurs during the hours that you are "on the clock" then you're not showing a commitment to the field and are limiting your potential as an ED nurse.

5.

Take care of yourself.

- Lastly, you're starting a new job in a great specialty, and this is supposed to be an exciting time in your career. The ED can be a high-stress setting and can take a lot out of you emotionally, physically, and mentally. Make sure that you (a) do something that you enjoy, (b) eat well, © exercise. (d) get plenty of rest/sleep, (e) spend time with family/friends, and (f) stay hydrated.

!Chris :specs:

Dragonnurse1, ASN, RN · Oct 18, 2016

Congrats on the ED job. I graduated on a Friday and started the ED on the following Monday. You have been given some really good advice. I have one more piece - pace yourself. If possible make a list of the skills that you want to either learn or bone up on then volunteer to do them for about a week. Then move on to another skill and repeat. I started with NG tubes as we did not do them much in school.

Cheat sheets for drug infusions. My hospital had them printed and I could grab one do my calculations faster than the guys using calculators. Some people bought small notebooks and wrote them down. If you run into a drug that is not normally listed write your notes about the infusion in your book. And if you ever get a pyridium overdose the anti-dote is methylene blue iv push, of course your patient will seize for a minute or two but that will pass.

Wear shoes not clogs - saw many nurses injured by their clogs during trauma care. Running with stretcher in clogs usually ended not well.

Ask questions when there is down time and jot down the answer. Get the doc to explain what happened in the last trauma and why he did some of the things he did. If the Doc writes discharge instructions that say "No salad sex" for heavens sakes keep a straight face while discharging the patient. Remind the Doc that he cannot write dead in the block that says patient condition on discharge. Management frowns on that one.

Study the ECG strips. If you are lucky you might get a Torsades de Point and give Levophed on the same shift. Old fashioned saying about levophed - Leave them dead with Levophed.

Never let someone else draw up your meds. If you are pushing you draw them, mistakes are made that way and it is your signature on that push. Protect your license. I repeat NEVER push a med you did not draw.

Your good and I am sure you will do well. The ED was the best job I had, never left until I was forced by a latex allergy, it is fast, everything changes constantly but it is the front line. You need to make sure you have a way to destress when off. A good friend that will let you vent (but no names), a hobby, anything to take your mind of the patient you just lost, or the child injured in a stupid accident, the SIDS baby that was mottled on arrival but you spent 45 minutes trying to revive or the 12 yr old, released from another hospital that same day after a blaylock shunt was placed, brought in because the shunt disconnected from the heart. You get my drift, a form of decompression is vital to your survival in the Ed and a way to avoid burn out.

Good luck and carry on.

ERnursebyday · Oct 31, 2016

Huh do not chart???? Did I miss something?

WKShadowNP, DNP, APRN · Nov 1, 2016

Huh do not chart???? Did I miss something?

I think roser was saying don't over punctuate.