Advice for First Night on the Floor?

[EDis4me]

Hi Everyone,

I am a new grad going to the ED. The other new grads and I have been in class for about 2 weeks now per our hospital's orientation program, and this week I will finally have my first night on the floor. (I am 7p-7a). We are to start out running one room and work our way up to four. Any advice for the first shift? Anything appreciated! Thanks!

[catlover13]

I know that the rooms are supposed to be stocked, but...

I always try to check at the beginning of the shift...

IV tray full? asst sizes of cannulas? an open ns, and a full ns. Tape, alcohol pads, etc.

And do I have all sizes of bp cuffs on the dinamap? And is there a cuff, in case the dinamap is misbehaving?

Pedi supplies.

O2 cannulas, masks, etc.

Hope that helps give you a direction to go...

[Roy Fokker, BSN, RN]

Here's my ritual at the start of each shift:

* Check crash carts in your assigned pod (especially if working the acute side). At this time, also check airway kits. Make sure the blade/scope lights are in working order. Check to make sure your RSI/tPA/tnkASE kits are locked and good to go.

* Make sure the O2 tanks are full (check under the stretchers too!)

* Make sure all wall mounted and portable suction equipment are working.

* Check all defibrillators/pacers.

* Make sure bedside monitors are in working order. Check to see if each room has a working "manual BP" cuff.

* Finally check for adequate linen/bedpans/urinals/puke buckets. Do a spot clean up of the general area. Stow away equipment to where they belong.

* Last but not least. Give yourself a minute. Compose yourself. Grab a cup of coffee and go take report :)

Tips for ED nursing:

* Assess, process, think THEN and ONLY THEN ACT! Acting without thinking will cause you more trouble than is worth!

* I'm reemphasizing this because it needs to be reemphasized --- always give yourself a moment to think. If you feel the need to, carry around a notepad and jot down relavent bits of pt. assessment. It might help you focus.

* Try to avoid "tunnel vision". Don't get so focused on one particular problem that you forget the rest. This will be difficult at first but with practice it'll get better.

* When it doubt, run it by someone else. If it's a particularly strange set of complaints and symptoms, I'll usually flag down an ED attending (even if no one has signed up for the patient) and run it by them. I do this especially if the ED is really busy to save time.

* Pt. assessment is as much an art as it is a science. Since in the ED, the focus is on speed and rapid intervention, so too should be your assessment. However, rapid assessment doesn't mean shoddy assessment. The trick is learning to ask the right questions. Again, as you gain more experience you'll get better as you go along.

* Prioritize. Prioritize. Prioritize. You'll find that your priorities keep changing, sometimes as often as every 5 minutes for just one single patient.

* Learn to multi task. Example: listen to lung sounds while patient is undressing. Put on monitor leads when pt. is changing into hospital gown. Get the rest of assessment while you're hooking up the BP cuff/monitor etc.

* Learn to delegate.

* If you think you're drowning, ask for help! Don't try to be "macho" and tough it out...

* Chart as soon as you finish doing something. Don't wait "until later" (unless you're dealing with a critical/crashing patient).

* Listen to the voice of experience. Find good mentors and leech from them (be they techs/MSTs or other nurses or ED docs).

* Have fun while you're at it. Welcome to the ED - you'll never be the same again! :)

cheers,

[NursewithHeart]

First...STAY CALM. When I was a new grad in the ED, I was a basket case. The nurses used to call me "Starbucks" because I was at top speed to the point of almost shaking all night long like I had 10 too many lattes before work. Haha.

Second...LISTEN to your patients. Many times they are on point. Do you remember learning about feelings of impending doom? If a patient tells you they are going to die, they are probably right. Stay on top of them. I have seen this many times and it's so creepy.

Third..like others have said, find a mentor. Ask questions when you are unsure.

Most of all...have fun and keep learning. I learn something new everyday. Learn from your patients, the ED techs, other nurses, doctors, everyone around you.

ER nursing is fast paced, dramatic, fun, funny, sad, joyous, scary...ever changing. BE FLEXIBLE, BE READY FOR ANYTHING and EVERYTHING.

[Displaced]

Do ask questions! Frequently!

[tempest]

don't kill anyone! :lol_hitti