To all the newbie ER nurses out there...

Specialties Emergency

Published

I'd love to know what my fellow new grads have learned since becoming nurses. I'm a brand new RN and I've worked in a level 1 trauma center for 3 weeks now. Here are the most important things that I've learned so far: 1. Knowledge is your best weapon. 2. Manage your time carefully. 3. CYA. 4. Ask questions. Lots of questions. 5. Don't let yourself get pushed around. 6. Everything is different in the real world. What have you guys learned?

Specializes in Clinical Research, Outpt Women's Health.

"I guess if I really cared about people knowing I was male, I'd have named myself RNhasamember or ERmanlyb*lls"

:yeah::yeah::yeah::lol2::lol2::lol2::lol2::lol2:

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Specializes in med/surg, ER.

1. Trust your gut instinct. Even if it is wrong, you will learn something.

2. If you don't know, say so and get help. Trying to bluff your way through might kill your patient.

3. Don't take it personally.

4. Appreciate the techs and those who help you, and tell them you do.

5. Check meds the pharmacy sends you with the orders.

6. Ask questions and listen to the answers.

7. Working in the ED means you education is about to begin. Learn all you can from everyone you can.

8. The hoofbeats are usually horses, but the zebras in the herd will get you if you don't watch for and recognize them.

9. It's okay to cry with your patients and fellow nurses. We are caring human beings, no matter what the other floors think.

10. Don't bring home to work, or work to home.

11. Find someone safe to vent to.

12. Be kind to yourself.

Ann

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Specializes in CEN, SCRN.

Don't be rude to EMS. Your bad day taken out on the medic and EMT will come to bite you in the orifice later on when you get a code brown from the same crew and for some reason they were unable to get any info for you and the only thing you do get is a first name.

Don't take things personally from your fellow nurses or physicians (especially towards the end of the 3rd day).

Have a friend in the ER you can vent with.

Remember that you are no better than anyone else. You are nurse, not a miracle worker. Just because you have a bit more schooling than others doesn't make you a better person.

Never quit trying to learn more. When you think you've finally learned enough about your job, it is time for you to hang it up.

Remember that the nastiest patient will be the first to write a nasty gram about you for management as they are walking out of your ER with their script for 3 tabs of soma.

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Specializes in peds cardiac, peds ER.

Thanks for all the tips. I spent 5 years on tele and now I'm new to the ER. I've had 4 shifts off orientation and go back to work tomorrow.

Here's what I've learned: The paramedics and EDTs have a lot of knowledge and skill to share. It's rotten when they are out sick.

-It's amazing to me how many of the things I already know apply here in the ER, and are helpful to me. It's even more amazing how many things I don't know, and how much I have to learn.

-I work my 3 shifts in a row, and after I'm off sometime during my off days I spend 20 minutes looking up all the things I wish I had known during the week. It's helped me tremendously.

-It's going to take alot of time for me to develop the kind of friendships I had in my old area, but I'll get there.

Most of all, the ER is fun. I'm glad I made the change.

P.S.: We used the term "crumping" all the time on my step down floor. In the same hospital, no one in the ER had heard it. I was surprised to see it on here. I'm interested to know where it originated?

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Specializes in Clinical Research, Outpt Women's Health.

It is originally from an old movie. Shite! I am trying to remember the book/movie it was from. they also coined the term 'Gomer" -get out of my ER!

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Specializes in ER/Trauma.
Forgive me I am a newbie...but what does it mean when a patient goes "bad"?
It's related to the answer someone gave for "crump".

Let me set up a scenario for you:

Mr. Mark Smith is 30 years old, has no known allergies, no medical history, surgical history for tonsillectomy, No Psych history, is a 'pack a week' smoker and 'social' drinker. Mr. Smith is being admitted for sudden onset right lower quadrant abdominal pain (onset about 4 hours ago), with intermittent episodes of nausea with no vomiting. Pain increases with palpation at the right lower quadrant of the abdomen. Vital signs upon admission: Blood Pressure: 130/74, Heart Rate: 89, Respiration: 18, Temp: 99.0, Pulse Oximetry: 100/room air, Pain: 4/10.

Other data at admission: Pt. is alert and oriented to self, time and place. Respiration is even an unlaboured - the pt. does not appear to be in distress. Heart sounds are normal upon auscultation. Pulses are even and regular. Abdomen is soft on palpation but still tender to the right lower quadrant - pt. states pain is 4/10, despite getting pain medication in the ER. Nausea is relieved from medication received in the ER. Pt. has no loss of sensation or movement to extremeties. Skin is warm and dry.

2 hours pass. You step into Mr. Smith's room to check up. Here's what you see:

Mr. Smith is curled up on the bed. Knees pulled up. He looks uncomfortable. You call for an assistant to re-check his vital signs while you do an assessment. Mr. Smith seems delirious - he knows he's in a hospital but can't tell you what year it is. His skin is drenched with sweat, soaking the bedsheets. He won't co-operate with your abdominal exam, guarding his abdomen with his arms and legs. He moans through clenched teeth about severe pain in his abdomen. You manage to listen to his heart and lungs - lungs sound clear but the heart is pounding away. Just then, your assistant reports that Mr. Smith has: BP- 80/30, HR- 145, Respiration- 26, rectal temp- 102.0 F.

You place a call to the surgeon right away and...

-----------------

It's simplified... but the message is the same!

Patients can "go bad" in a multitude of ways - heart attack, stroke, pulmonary embolism etc. etc. etc. etc. etc.!!

If nothing else - a quick 'criterion' for a patient 'going bad' would mean: a drastic, symptomatic change of presentation that is unexpected or abnormal from baseline; co-related with vital signs/studies.

Hope I didn't muddle/confuse you too much!

cheers,

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Specializes in ER/Trauma.
It is originally from an old movie. Shite! I am trying to remember the book/movie it was from. they also coined the term 'Gomer" -get out of my ER!
Samuel Shem and "House of God"??

cheers,

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Specializes in peds cardiac, peds ER.

Ah, thanks Roy, I bet that's it! I keep meaning to read that. Must be time.

Excellent example of going bad. I have to add that for kids, I like the (admittedly, less professional) term "crapping out". It's such a good description of what kids do. They compensate, and compensate, and compensate...and look good, look good, look good...then they crap out. Fast and furious.

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Specializes in Clinical Research, Outpt Women's Health.

Yes Roy - good memory!

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

I read "House of God," did they actually make it a movie? I hope not! LOL

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Specializes in ER.

I have been working in the ER for 3 months so far. I have learned become nice with the paramedics, less likely to gladly bring you trolls and also to learn how to work with certain doctors. I got told off by a doctor because I asked if he was going to write the admit orders for a pt we were admitting. He had told me and the charge nurse he was admitting the pt 2 hours ago, waiting room was full and we actually had a bed upstairs, just needed orders to send him up. Have learned now to make my questions seem like I am dumb and that he is the smart one so things get done and that it makes him feel like its his idea.

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Specializes in ER/Trauma.
I read "House of God," did they actually make it a movie? I hope not! LOL
IIRC, the movie was made but not released.

cheers,

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