Advice for a new ER nurse

crashcartqueen, BSN, RN · Oct 25, 2015

I believe the most important part of ER orientation is having a great preceptor and learning everything you can from them. Ask tons of questions....some nurses think coming from the floor or another specialty gives them a heads up in general but really only with basic nursing skills (which still helps of course). The transition from another specialty to ER can be like starting over...and that is okay, because emergency nursing is like no other. We have ICU and floor nurses cross train with us often and sometimes new grads seem more comfortable because that is all they know and the floor nurses are adjusting what they know to a new environment. I learned so many important things during my orientation that I use daily as a nurse on my own. At first focus on skills/tasks - IV's, straight caths, drawing blood, hanging blood, meds, infusions, EKG interps, review BLS, PALS and ACLS concepts. Yes you do these skills on the floor but you may do a few IV's a week on the floor but you may put in 15+ in one shift in the ER. Learn charting methods as you go along, usually repetition of watching others chart, often you will need to ask for a charting only session with your preceptor as charting is done very very fast in the ER. As you start to learn your way around and are used to doing skills make sure you are asking WHY. Why is this patient getting these meds/needing these interventions/having these tests. Then think WHAT. What patient is most critical, what intervention is most important, what meds need to be given first, what do I need to do for my patients. From there you can learn to start anticipating things with your patients and that will save you time when you are by yourself. I could go on but the most important thing is to ask questions if you do not fully understand any patient's condition or treatment plan, be looking for new things to see and learn, and use your preceptor's knowledge to supplement yours. Good luck!

brek · Oct 28, 2015

I think think that the biggest challenge of going from the floor to the ED is the change of mindset and focus of care. Essentially you will have to unlearn what you knew about nursing on the floor and develop new habits which takes time.

First, Prioritize. When you take over a zone, who is your sickest patient? What needs to be done to get your patients home or to the floor? Our job is to rule out the worst case scenario based on the patients presenting and current symptoms. We don't care if your stomach hurt once two weeks ago. We care if it hurts now. Your challenge is to anticipate what they will need and to identify your most critical patients. Sometimes it's not always obvious. Know the plan of care or what you are trying to rule out for each patient.

Ask questions. It's always better to ask the question and feel stupid if you have any doubt then not ask the question. Show interest and get involved. If there's a code, get in there or atleast observe. Ask if there is anything you can help with. We notice that. Have a sense of urgency when appropriate.

There is so much more but you will learn. Good luck!

I believe the most important part of ER orientation is having a great preceptor and learning everything you can from them. Ask tons of questions....some nurses think coming from the floor or another specialty gives them a heads up in general but really only with basic nursing skills (which still helps of course). The transition from another specialty to ER can be like starting over...and that is okay, because emergency nursing is like no other. We have ICU and floor nurses cross train with us often and sometimes new grads seem more comfortable because that is all they know and the floor nurses are adjusting what they know to a new environment. I learned so many important things during my orientation that I use daily as a nurse on my own. At first focus on skills/tasks - IV's, straight caths, drawing blood, hanging blood, meds, infusions, EKG interps, review BLS, PALS and ACLS concepts. Yes you do these skills on the floor but you may do a few IV's a week on the floor but you may put in 15+ in one shift in the ER. Learn charting methods as you go along, usually repetition of watching others chart, often you will need to ask for a charting only session with your preceptor as charting is done very very fast in the ER. As you start to learn your way around and are used to doing skills make sure you are asking WHY. Why is this patient getting these meds/needing these interventions/having these tests. Then think WHAT. What patient is most critical, what intervention is most important, what meds need to be given first, what do I need to do for my patients. From there you can learn to start anticipating things with your patients and that will save you time when you are by yourself. I could go on but the most important thing is to ask questions if you do not fully understand any patient's condition or treatment plan, be looking for new things to see and learn, and use your preceptor's knowledge to supplement yours. Good luck!