Any advice for this new ER nurse?

DavidDudley · Dec 27, 2013

My advice is to always ask questions when you don't know something but always show confidence to the patients, even if your really clueless. Fake it till you make it.

Never underestimate a patient's condition. I've had STEMI's and strokes come in undetected because people (usually paramedics) underestimated their condition and downplayed it.

While we primarily focus on chief complaint's in the ER, keep in mind that a patient may complain about one thing, but have a huge issue completely different from their chief complaint. I've had a patient come in which the ONLY complaint was blood in the urine, but ended up having a heart attack. No chest pain, no SOB, no nothing. In my ER, most doc's will order an EKG if your over 50 years old, regardless of their chief complaint.

It's also good to go to work with the right mindset. Understand that everytime you walk out to the floor your entering into an uncontrolled environment. Anybody, anything, can come in through that door at any time. Expect the unexpected. People like me thrive in such environments, some do not.

Guests · Dec 27, 2013

Congratulations... ER is where it's at!!

I began my ER career with little experience and little orientation... it was a tiny hospital so I had some time to learn on the fly but there were times I was overwhelmed. I went out of my way to ask questions and actively solicit criticism... and I still do. The easiest way to flame out in the ED is to be too prickly to accept advice from other nurses and docs.

Be a hard worker... check on ALL alarms... whether they're yours or not... and then update the nurse as you what you found/did.

Never ever stand around... there's always (almost... 12/24 and 12/25 were slow for us) something that needs to be done for someone's patient... if yours are all dialed in, check in with the other nurses to see if theirs are.

As you form relationships, spend time in rooms with other nurses as they're tending to their patients... you'll learn a lot.

If possible, be in the room when the MD assesses the patient... you'll learn a lot and you'll start to form your relationship with the MDs.

Learn, learn, learn... from the MDs, the RNs, the RTs, and... even some of the patients... a lot of whom know way more about their condition than do even the docs.

If something seems just not right... tell the doc.

In my first job... remember, inexperienced me in a 1-doc, 1-nurse ER... doc decides to place a subclavian central line... all goes fine... over time, pt begins a slight cough... otherwise doing fine, VS WNL, AOx4, no distress... just this intermittent little cough... which was remarkable only because he'd not been coughing at all before (hyperglycemia patient). The little cough kept up... I kept waiting for the doc to notice (we sat right next to each other) but he didn't. Finally, I go in and listen to his breath sounds... a little diminished on the left, I thought... not too sure, though.

Finally, I tell the doc (a pretty unapproachable guy), "You know this guy's got a new cough... I listened to his lungs and they might be a little diminished... I'm just not sure... would you please go take a look?" I got a look from the doc who then went back to his computer. I just sat there. Finally, a few minutes later, the doc went and checked on the patient. He came back and said, "Good catch... he's got a pneumo... call x-ray for a STAT PCXR and get set up for a chest tube."

Also, never ever forget that all patients and families have the potential for violence... keep your safety always in mind and as your top priority. I've seen more than one patient play possum and then take a swing at the nurse... and don't forget that they can headbutt, too... and bite... and scratch... Never be reluctant to ask someone to come into a room with you, especially when starting a line or drawing blood on an altered patient or psych eval... the most vulnerable that you'll ever be is starting a line because you're head is down and you're so focused.

HikingEDRN, BSN, RN · Dec 30, 2013

Great comments. I wanted to add a word of encouragement. The last few nurses who have come to us with 1-3 years of fast-paced med/surg/tele have done quite well :). Good luck!

NurseOnAMotorcycle, ASN, RN · Dec 30, 2013

I saw that you've already got some fantastic experience. You're already aware of most of this, but here it is anyway for anyone else who has the same questions.

When the stress is high and the coworkers are cranky, snappy, etc, just let it roll off. I can guarantee that in another two days you'll both have forgotten it. If you're either thin-skinned or hold grudges, you won't be very happy in the E.R. (I suppose that statement stands for almost any specialty...)

Find the people you work well with and try to team up with them as much as possible. Find the people who you don't and just steer clear as much as possible (without taking offense). When it hits the fan, E.R. staff work together like you wouldn't believe even if they don't normally do well together.

You're never alone so don't be afraid if something happens. Just hit the code button or yell for help. If you're not sure if you should be freaking out for a pt, ask someone to "just look at this guy" and get a second opinion.

If they invite you to hang out outside of work, go and enjoy yourself!

Be quick to offer help if someone is starting to look overloaded or if there is a code. The biggest help would be comforting the (terrified!!) family or watching the other patients if there is already enough help in the room.

Don't dismiss other specialties, be quick to help them out if they need it. They have buttloads of information that you will absolutely need some day. If I come across something I don't know, I sometimes call other specialty floors for info/help with skills or paperwork that we don't use very often in the E.R. (Most recently, a NICU nurse helped us get bloodwork and the tiniest IV I've seen in a sick 6 week old baby... and made it look easy!)

Ok that's about it for me. I have to work tonight and haven't slept much.

GOOD LUCK!! I hope you love it as much as I do!