New to ER

~Mi Vida Loca~RN, ASN, RN · Nov 9, 2012

I'm making the move from oncology/MS/tele to the ER. I start in a few weeks. Any advice for this ER newbie? I'll also be on nights if that might make a difference.

Learn and absorb all you can. The ER is a whole different world then any other kind of Nursing. I have been in the ER for almost a year (few weeks shy) and I absolutely love it. I can't imagine being anywhere else and I would probably get fired if I was because I am so used to all the autonomy that I have now.

Do not be afraid to ask questions, get to know your Docs good. Be nice to your techs and your anxilary staff. It's going to be important to have good relationships with them. Don't be afraid to seek others out and learn different ways to do things. It can be a hard adjustment when you go from having to have orders for every single thing to having to be able to have the knowledge to do it on your own. It can be overwhelming at first in the transition. Some of the things that were hardest for me. Running fluids wide open with no pump and no scanning of meds. (all the local hospitals I did clinicals at the meds were all scanned) so in the ER their is a huge oppertunity for Med Errors if you don't do your checks. But just running things without pumps was a hard adjustment for me.

The other thing that was hard for me that my preceptor simplized for me and made it all less overwhelming. I was always worried when I first started about what I might have, would I know what to do. I mean in the ER you never know what you're going to get.

But although you never know what's going to come through the doors, she told me "it's all the same, once you learn what you need to do for each situation, the same policies and protocols, then it doesn't matter and you aren't overwhelmed"

This was the best advice I got and took the "scariness" out of what I might get. For example;

If I have a patient coming in with any kind of heart issues, I know that no matter what, I am going to get them on the cardiac monitor, I'm going to get an EKG, I'm going to get a line started and draw labs, (if it's a legitimite chest painer I am going to start an iStat trop), if they have active pain I am going to get Nitro going and 4 baby aspirin. (if they haven't taken it already and aren't allergies and their blood pressure is within reason) I am going to do all this before the doc even makes it to the patient. It doesn't matter if the patient has Angina, is an active STEMI or having heart palpitations.

If I have a patient coming in for any kind of abdominal pain, I am going to get urine from them, get a line going, draw labs, get fluids hung (again, need to check for things like a hx of CHF) if their throwing up or really naseau's get some Zofran in them. All this before the doc might even see them.

Our hospital has protocols all in place for all these things giving us permission to do them. So it didn't matter if I have a patient in with cramping from N/V/D or an appendicits. I am going to do all the same things.

So once it all clicked that although every day in the ER is different, it's all the same (in it's own weird way) it all made sense and I was no longer intimidated by what might come in.

Emilynn09 · Nov 9, 2012

Good tips! Thank You. I am very excited and nervous all at the same time.

DC Collins, ASN · Nov 20, 2012

Our hospital has protocols all in place for all these things giving us permission to do them. So it didn't matter if I have a patient in with cramping from N/V/D or an appendicits. I am going to do all the same things.
So once it all clicked that although every day in the ER is different, it's all the same (in it's own weird way) it all made sense and I was no longer intimidated by what might come in.

That whole post was one of the best I have seen. It lays it out clearly. There are only a handful of types of true emergencies and you get to know those protocols FAST, automatically. The best part is that the doc is right there!

Having a coworker who has been a nurse for only a year longer than me (2 for me, 3 for him) but had his first year in Oncology, I got to watch his progress. His (and others I have seen transfer in from other departments) biggest issue was learning to 'treat'em and street'em).

You will have to learn, quickly if you don't want to drown, to go in and do a Quick, Focused assessment (if they are there for low acuity foot cellulitis, you don't always listen to the lungs if they appear to be breathing well). Then you go in and get whatever labs, give meds, get back out to the next pt.

You will then have to chart enough to CYA, but you won't do any of the, "pillow given, 50mL juice provided, 100mL output," etc. stuff. Then your discharge instruction time will be just a few minutes.

If you are mentally prepared for treat'em and street'em, then you should be able to make the transition fairly smoothly.

DC :-)

maverickemt · Dec 24, 2012

Hello everyone,

I have done a lot of medical/surgical nursing on the floors and PACU nursing for the 4 years I have been a nurse. I have my TNCC and I have also served my country in the air force. I have also been deployed. I want to know how hard is it to get into an ED without any previous ER experience? If there are any hospital nursing recruiters on this site, please feel free to chime in.

Thanks,

maverickemt

SionainnRN · Dec 24, 2012

Ask ask ask! I moved from ICU to surgical acute to ER and they are all so different. You need to ask questions about anything you're not sure of, and yes ER is completely different from the floor. It's all about "moving the meat" as my manager told me. Good luck and have fun!