What's the inside scoop?

  1. 1
    Hello to all my ER nurses! I've been working as a med-surg float nurse for over three years now, with a speciality in neurology. Ever since college I've felt like I belong in the emergency department, I did my preceptorship there but couldn't find a facility that would hire a new grad. The one year of med-surg experience I needed to transfer has turned into three. I am ready, and have interviewed and now have a job shadowing assignment this week. I am excited, but also nervous because I've oriented and know that skeptical feeling that a nurse has when told that someone unknown must follow them around all day. I hate to sound conceited but I'm smart, and I'm organized and ready for the challenge of working in the department. But I have the impression that they do "staff interviews" and the nurse I shadow will have a say in whether I land my position. So I ask you, if you were to have a nurse shadow you, that may potentially become a coworker, what would you want to see? What would drive you crazy? Thanks in advance for the help, my fingers and toes are all crossed that this works out!
    jrsRN07 likes this.

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  2. 7
    Where I work (32 beds):

    -Just be willing to help and learn.
    -Do not afraid to say "I didn't know that."
    -Stand back if there's a lot going on, and say "what can I help with?" It'll prob be VS and undressing a pt into a gown. If you aren't really paired with someone in particular, follow the new pt coming on an ambulance and help in that room.
    -Treat everyone you meet with respect because an E.D. is incredibly team oriented. NPs, transporters, CNAs, MDs, LPNs, Techs, RNs, PAs, and volunteers are like a family living together. Treat one of them badly and we will defend them.

    Good luck!
    jrsRN07, Aliakey, weemsp, and 4 others like this.
  3. 1
    We do one-on-one peer interviews in my ED. I have done three myself. If you are following a nurse, ask plenty of questions. If a trauma, code, stroke, or STEMI rolls in, you go. Stand back and observe how the team works those situations. When it is done, ask questions.

    Ask for help. Don't look down on anybody in the ER, from the housekeepers to the doctors. If you have a superior attitude, you will be knocked off your horse. And the housekeepers are part of the ER family and we will go to bat for them.

    Offer help. Although you may be following someone, ask what you can do. If a chest pain comes in, offer to get the patient undressed and hooked up to the monitor. Ask the tech if it's ok if you do the EKG. Trust me, people will notice and take note of it.

    One thing I think alot of floor nurses struggle with when transferring from the floor to the ED is the concept of "my patient". No, it's the ED patient, which means it's "everyone" patient. You will need to know what is going on with every patient in your pod because if your pod mate goes to a trauma, that leaves you alone with them.

    Team work can't be stressed enough in the ED. Just my opinion.
    jrsRN07 likes this.
  4. 2
    Like the above said, we're team oriented down in the ED

    I recently finished orienting and when I started 2 other people were orienting with me. When I finished, I was the only one left . What I noticed that got the others booted out of the ER quickly, 1) they acted like know-it-alls, when a nurse would explain why they did something they would try to finish what they were saying before them (and normally they were incorrect), 2) NEVER asked for help and made SEVERAL mistakes (some really REALLY dangerous ones), 3) didn't ask questions and seemed unwilling to learn or help out their teammates!

    Just ask a lot of questions, help when you can, be willing to learn, expect to feel overwhelmed and like a new grad again, bc you will. Good luck!
    NO50FRANNY and jrsRN07 like this.
  5. 2
    In the ED, we do a lot of anticipation with the care we provide. For example: in my ED, abdominal pain is always going to need UA dipstick and micro, saline lock, CBC, CMP, amylase/lipase profile, and NPO status. So I ask for a urine sample from my pt. and drop the IV and draw the blood while I'm at it. I try to stay ahead of the game so that by the time the doc sees the pt, and the orders have been put in, everything has been done Same thing for chest pain, EKG needs to be done STAT, I drop the line and run a istat troponin on the pt. I don't wait for the orders to come in, I just do it per protocol. Speed is VERY important in the ED.
    jrsRN07 and mcknis like this.
  6. 1
    Like hella mentioned above, speed is very important. If you do anything, make sure to stay caught up. That is probably the best information I could provide. I can attest that if a tech, nurse, medic, provider (doc, NP, PA) is behind, everyone feels it. But, yes anticipation of orders is important. We do the same as far as obtaining urine, labs, EKG, etc., and it can really get you behind if you do not fulfill this. Believe me, triage nurses expect the nurses in the "back" to be anticipating orders and completing them before the provider gets to them. If you don't act on these "pre-filled" orders, you will have more and more patients sent to you while you attempt to get caught back up. Also, once you start in the ED, try to do most of the work yourself and only delegate what you don't have time for. Everyone will love you for it, including your other nursing staff who are trying to pick up slack left from your care. Sorry for this being a little rant in itself, but have had some challenges lately with my department staff. Each department/facility is different, however.
    jrsRN07 likes this.
  7. 2
    Agree with all stayed above. I'll add in:
    - know & use standing orders if your er has them. Can shave a lot of time off the visit, get those labs spinning.
    - get that urine sample when they arrive (walkie/talkies especially). If septic, it'll be a straight cath so no worries.
    - if you know the scripts from the princess bride, blazing saddles, young frankenstein, pulp fiction and the holy grail, it will pay off. Edit for cussin' as appropriate. "i need housekeeping in 45 with pliers and a blowtorch" "could be worse, could be raining"
    - last but not least, have fun.
    jrsRN07 and puppyrunner like this.
  8. 1
    Know your strengths. As a floor RN, there will be stuff you are more comfortable and efficient with than most ER RN's. As ER nurses, we are generalists, good at some stuff, with just a passing knowledge of other stuff. I love haveing nurses from other units around.
    jrsRN07 likes this.
  9. 0
    Quote from NurseOnAMotorcycle
    Where I work (32 beds):

    -Just be willing to help and learn.
    -Do not afraid to say "I didn't know that."
    -Stand back if there's a lot going on, and say "what can I help with?" It'll prob be VS and undressing a pt into a gown. If you aren't really paired with someone in particular, follow the new pt coming on an ambulance and help in that room.
    -Treat everyone you meet with respect because an E.D. is incredibly team oriented. NPs, transporters, CNAs, MDs, LPNs, Techs, RNs, PAs, and volunteers are like a family living together. Treat one of them badly and we will defend them.

    Good luck!

    The part where you said the ER crew is like a family living together is possibly the BEST description I have read for the dynamics / culture / teamwork in an emergency department. So, so important to remember, and one of the best aspects of the job for me. Very sage advice.


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