[LPNNAL]

I have been working as a LPN on a med/surg floor for 8 years and I recently became a RN this month and was asked to take a job in the ER, I want to learn the ER part of nursing and accepted this position. Can anyone tell me the do's and don'ts in the ER.....Especially the big No, No's here? I am nervous about the transition, but I have been in my "safe" place and with a new "title" I want a change. It is a very small hospital and I know all the staff and everything really bad gets transferred anyway, any advice?

Cindy

[RunnerRN]

Even though "everything really bad gets transferred" you'll still have to care for and stabilize those patients until the helicopter/ambulance gets there. The biggest no-no I can think of is making assumptions about patients. Just because someone is annoying doesn't mean they can't be sick. And just because someone has been in with the same c/o 10x in a month doesn't mean their chest pain isn't indicative of an MI today. Good luck in your new position!

[mianders]

Expect the unexpected. You never know what is going to walk through the door. Prioritizing is very important. I hope they are giving you an internship. Every ER I worked in gave new RN's at least a 3 month internship. If they have not brought it up then you need to discuss it with them. MS and ER are completely different. Protect you license.

[Larry77]

We have a new RN that was an LPN for years on med/surg and she had a hard time fitting in because every time one of us offered a procedure to her or to watch a procedure she would tell us "I'm not a new nurse", or "I don't need the practice".

Of course we did not like her right off the bat. Now, after being humbled a few times her attitude has changed a lot and she has become a descent ED nurse.

My suggestion is to have the attitude of a new nurse who wants all the exposure she can get and when someone offers you a chance to help or watch take it.

Good luck and welcome to the best specialty on the planet!!!

[LPNNAL]

I realize that I will have to stabilize and take care of my patients, I did not mean it they way it sounded, I was trying to paint the picture of a small hospital...And I am going to this new position in a starting over attitude, and I love to learn new things, and never have or will I say that phrase, "I am not a new nurse"! And yep they told me I can be on orientation as long as I needed, not forever of course, but until I felt comfortable!

Thanks Cindy

[Anagray]

Here is what I've learned as a med-surg RN going to ER

- My purpose is to assess, stabilize and ship pt out to appropriate unit as quickly as possible, because you just do not know when 10 ambulances are going to show up at the same time. The hardest part about it is doing this quickly and wihtout looking like I don't care to the patient. This all means that I can not give filthy patients sponge baths and change every single dressing on their coccyx or foot.

- I am not there to resolve social issues. Again, I need to make the right assessment and make appropriate referrals - whether it is to call CPS, police, set up an outpatient referral to the social work or to give report to RN upstairs to get discharge planning and social work involved.

- Interview patient carefully, but to the point. In 5 minutes MD will show up and ask the same exact questions you just drilled them with.

- If I don't know something I do not do it.

- KNOW appropriate drug administration. I have seen ER doctors give the most stupid and dangerous orders. Example: one ER doc ordered a propofol drip on a patient who just had a brainstem CVA, but was still oxygenationg and breathing OK. Or 2 mg of IV Dilaudid to an old lady. Or even Cardizem drip to a patient with a heart rate of 40. Toradol to a patient with severe NSAID allergy. On the other end of the spectrum - hesitating giving fluids to a dialysis pt in hypotensive shock.

- pediatrics are not at all like adults.

- detox patients have seizures and diseases too. Even though I have very strong personal feelings, I do not let them cloud my judgement and ethic.

- It is OK to be tough, but pollite with drug seekers. Don't be a cream puff like me !

- Many families can not be pleased, because they are too anxious to think about how hard you are working and they just do not understand why you do what you do. do not take their anger personally.

- You are going to LOVE ER!

Best wishes!

Nat

[JBudd]

Get ready to do your assessments much faster and more focused. Concentrate on the chief complaint; you'll find some want to describe every single cold, sniffle and sprain they've had in the last 20 years, but tonight's complaint is urinary. Ask "what brought in you tonight? and "is that bothering you tonight?" Try to keep things focused.

On a slow night (yeah, right ), don't start thinking "I'll have time to do that later", 'cause you won't.

Priorities are different in the ER than the floors were, ask your preceptor how she decides what to do first.

Good luck, and welcome to our world!