New to ED - What things should I do to become a better ED nurse?

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    Hello Nurse Beth! It is assuring to read your advice and it makes me feel that I am not alone as I am hoping for insights not only from you but also from other members as I try to become a better ER nurse.

    New to ED - What things should I do to become a better ED nurse?

    I have been a nurse for 8 years now and had worked in a nursing home. I recently decided to transition to a hospital as everything in my life is undergoing change.

    I do believe in God and with every decision that i make, I always ask his guidance. Thus, when i uploaded my resume, this hospital called me with a job interview for Med-Surg. During the interview, the hospital recruiter asks me if I would be open to be interviewed for telemetry, rehab and ER. I said yes and fortunately, 2 offers came my way. Tele and ER. Of course, I chose ER just because I can see myself working in that kind of setting.

    I am currently 3 months in the ER and I can say that I am learning a lot. For a long time nurse like me who is new to the ER setting, I am obviously struggling. A colleague of mine told me that it would take me a year to get at least a bit comfortable with the transition. It is a fact that nursing home nurses are being looked down upon by hospital ones. But i don't let that get to me. I am lucky to have a "good bedside skills" preceptor but she has a tendency to become a sucker for her colleagues. Sucker in a sense when her colleagues has 4 patients, she has 8. The charge knows she will not complain to him/her. Nonetheless, I am not expecting anybody to hold my hand. I am currently reading/reinforcing further on things that I've learned for the day.

    Now my question is, how do I become a better ER Nurse? What are the things I should read/take/undergo? Certifications?
    (I did not acquire my BSN Degree nor my schooling in this country and I am originally not from here)
    I am also looking to get a masters degree.. What career path do you think I should take? is it better to get it online or in a classroom? How does one get a higher pay grade?

    Also, have you ever experienced workplace politics? The reason why I asked is because i realized, the hospital is no different. I hate racism and although I shrug it off, i can't help but feel it. The hospital is trying to promote cultural diversity but apparently majority of the nurses there are not open to this idea. They can be very ****** and gang up on you as what happened to the other orientee in our batch.

    As a nurse, do I have to be a member of certain organizations? If yes, which one? ANA? What else?

    Anyways, thank you Nurse Beth. I'm Looking forward to reading your advice for me.

    Dear New to the ED,

    Good for you for in having the courage to make such a huge change! Time and experience will make you a better ED nurse, like your colleague said. Give yourself time.

    Emergency (ED) nurses typically are required to have Pediatric Advanced Life Support (PALS) and Advanced Cardiac Life Support (ACLS). I would start with those and then later ask your manager or colleagues if they recommend Trauma Nurse Core Course (TNCC) for your particular ED. Becoming board certified (CEN) requires two years of ED experience.

    Put off your MSN decision until you are more comfortable in your new job. Before embarking on your MSN, spend time considering what role you ultimately want in what setting. MSN programs offer educational tracks, administrative tracks and more. You may even decide that you want your FNP.

    Check with your manager and/or HR for information on pay grades, as they vary from facility to facility. Some hospitals reward advanced degrees, some do not. Start working on your Clinical Ladder advancement if your facility offers one.

    Workplace politics exist everywhere, and ED settings are no exception by any means. In some specialized ED circles, you have to "earn your stripes", which is often a function of time and learning how to fit in.

    Racism in the workplace should never be tolerated but unfortunately, stereotyping and hostility do exist. Blatant discrimination may not be apparent, but subtle social messaging is. The challenge is knowing when behaviors cross the line and become reportable - which isn't really what you asked, but bears mentioning whenever this topic is brought up.
    We still have a long way to go, and nurses all need to be part of the solution, not the problem.

    Consider joining the Emergency Nurses Association (ENA) and getting involved in your local chapter as well as joining the American Nurses Association (ANA). Nurses can only bring about change when we work together and the benefits of professional membership are enormous.

    Best wishes,
    Nurse Beth

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  3. by   cjcsoon2bnp
    Nurse Beth, as always your advice is spot on! I've worked in ED settings for about 2.5 years and one thing that I noticed when nurses first transition to this setting is that the best nurses are the ones who remain humble and are always open to learning. Whether you are a new grad. or nurses transitioning from a med/surg unit, you need to realize that this is a new specialty for you and every opportunity is a learning experience.

    I have oriented new nurses to the ED and it is extremely offputting to hear them brag on about how much experience they have (either from their nursing student clinicals or from the floor that they worked on). If you are being asked about your comfort or experience with a particular procedure or diagnosis then it's fine to discuss it but otherwise it's best to keep discussion of your prior experience to a minimum because it could be perceived as bragging. I also suggest that when a nurse comes to the ED they should be open to practicing any skill, even if it is one they have done a lot before. I witnessed a new nurse who came to the ED after only 8 months of med/surg experience and about 2 weeks into orientation her preceptor asked her if she wanted to go start an IV, the nurse responded "I'm pretty good with IVs so I think I'm all set" and the went back to talking with another nurse. I was immediately put off by her response and so were many of my co-workers. I still work with this individual and while I think she is a good person I think that she overestimates her skill level and doesn't take initiative unless she views something as a truly unique learning experience. The point of sharing this story is that when you first start in an ED, nurses should remain humble, ask good questions, and be seen as a team player. Being new to a department can be rough at first but things should all fall into place after a bit. Best of luck to the OP!

    Last edit by cjcsoon2bnp on Nov 18, '16
  4. by   B52Bomber

    Just thought I would add my 2 cents on this great question of yours! I worked in the emergency psychiatry dept (crisis center) in a level 1 trauma center in Detroit. Although I may be biased to the mental health/behavioral world (my practice area) I would highly suggest sharpening your skills on the neurological and psychological/behavioral aspects of the patient! Many times I've experienced a wide range of psych symptoms that are actually secondary to an exacerbation of a medical condition or medical symptoms associated with acute withdrawal or detox from various drugs. It may seem obvious - but understand the mental status exam and changes! Also assess for any recent alcohol/substance use or recent quitting because many a times I've experienced the patient withdrawing from benzos and sure enough after careful monitoring of BP and HR they were sent to ICU! Also I've experienced few patients suffering from stroke which was assessed by changes in pupils and neuromuscular functioning (thanks to working in neuro ICU!) which was difficult due to their recent drug use and history of psych issues! I've even had the manic/psychotic patient with no psych history returning to the ED because of recent steroid induced psychosis just to treat his pneumonia. After working ICU and floating between the regular ED and the "dark side" I definitely picked up on signs and symptoms that others may not have realized could be psych related! Always keep your eyes observing, your ears listening and your mind open to the many possibilities! Good luck to you!
  5. by   BlackbirdRN
    I worked in the ER for 9 years, about 30 years ago. I came from a busy Med Surg floor and I found the transition to ER to be challenging. Not just because of the increased knowledge needed but because the attitudes of ER nurses were less welcoming than the floor nurses. It took me about 4 months to start really liking it. Before that the ER nurse used to say some really not helpful things to me about how I wasn't experienced enough to come from the floor to the ER. That only ICU nurses should make that transition.

    The fact is, every nursing speciality brings unique knowledge and experience to the ER. While those ER nurses were more experienced at taking care of the sicker patients, I was much more experienced at taking care of large numbers of patients that are in separate rooms that I cannot readily see by glancing over on a gurney like in the critical care room. Those night shifts where I had 16 patients with just an N.A. helps makes one really good at time management and making sure a patient is safe before you leave a room.

    The only way to become better at being an ER nurse is to get a lot of experience being able to assess and anticipate the unknown. Unlike the floor or nursing home where you automatically know what the patient's diagnosis is and their meds, in the ER patients come to you like blank slates sharing only what they are not afraid to share. You must sleuth out their story and rely on those nursing skills of touch and smell much more.

    I suggest on a day you are off, asking if you can buddy with the Triage nurse for a couple of hours and learn how she/he triages. Then do the same for the Critical care nurses. Ask a lot of questions. Read about the conditions you see on your own, look up things again like a nursing student. Ask the doctors questions directly. Learn from their experience as well. Good luck to you. ER is an amazing experience that is unlike other areas of healthcare.