Any advice for a new grad in the ER??

akulahawkRN, ADN, RN, EMT-P · Jun 2, 2018

For the first couple shifts, keep your ears open, your mouth shut, and be prepared to try nearly anything. The world of the ED is just very different from nearly everywhere else. Trust that you know more than you realize. Get to know your preceptor as they'll be the person that is going to try to get you acclimated to the ED and especially the pace of it. You will be constantly re-evaluating priorities, meds are almost always due "NOW" and keep up with when labs, xray, and other services will be doing things for your patients. You will be slow, the learning curve will be steep, and you'll likely feel like you're a hyperactive squirrel on meth that's just not getting things done or that you feel like you're not keeping track of everything all the time. You'll learn how.

Hopefully they'll give you an orientation that's at least 3-4 months. This isn't med/surg... you're going to have to learn a specialty on top of learning some real-world nursing and that takes time. Once you have passed orientation, give yourself at least a year before deciding to do anything else because it takes that long for someone to achieve some basic proficiency. It takes 2-4 years to develop into a solidly proficient nurse.

It's a tough but awesome road you're on... and I've been in your shoes not that long ago.

ThePrincessBride, MSN, RN, NP · Jun 3, 2018

Run!!

traumajunkie22 · Jun 3, 2018

I see you are a medic, I am as well. Did that help in the ED?

akulahawkRN, ADN, RN, EMT-P · Jun 4, 2018

Being a medic is both a help and a curse. Depending upon the ED where you'll end up working, you could end up getting a basic set of nursing protocols where you'll be officially allowed to do certain "medical" things on your own before a provider sees the patient, you could end up getting a very comprehensive set of nursing protocols that are basically expanded Paramedic protocols, with the addition of being able to order labs and certain imaging "by protocol", or you could end up (like me) where your ED has almost no nursing protocols but your providers see patients almost immediately and are able to put medical orders in, often before your patient even hits one of "your" beds.

Where the "Paramedic" brain kicks in is knowing how to function independently and within the rules. It's not often, but sometimes I'll do things a bit "aggressively" by initiating things before the order is officially written because I know that stuff will be written. Where it's a "curse" is that if you've become comfortable in your role as a Paramedic, you've become comfortable being the team lead. As the nurse, you'll be responsible for managing patient care. In effect, you become a coordinator of all the other services that come into contact with your patient. I have lost count how many times I have had various ancillary services folks ask me if it's OK to do something to/with my patient or to take the patient somewhere. There are times I have to ask them to come back later or in a different sequence because I need those things to happen in a certain sequence. There are times I have had to defer doing certain tasks because others were far more important, yet all will eventually need to be done.

The other "curse" with ED nursing vs Paramedic is that when you're a Paramedic, you're usually responsible for only one patient at a time. As an ED RN, you're going to be responsible for managing 4 (or more depending upon state/local/facility regs) and keeping everything pretty much running on time. Trust me, I fondly remember those days when I was 1:1 with a moderately sick patient that needed my attention and skill but not so sick that I needed to really work... These days I get lots of the latter and sometimes more patients that should be 1:1 or 1:2 than I'd like. I had one that basically went from 1:4 to 1:1 in the blink of an eye and I could see that change coming down the pike. The question was when and why, not "will it" happen.

If you've had some good solid patient care experience as a Paramedic dealing with sick patients, that'll be very good as you'll be able to assess them quickly for what they are or could be and you won't have to learn as much about managing them. My "sick" one definitely had some bad brewing and one of the differentials was certainly in the back of my mind and the "this one's bad" feeling was only intensified when I assessed the patient after I took over his care. So... when you really do know stuff, you really can use that knowledge and do some good patient care. It may even speed up some portions of your orientation without officially doing so because you'll demonstrate mastery of certain skills and abilities.

Best of luck to you!

traumajunkie22 · Jun 5, 2018

Thank you for your reply! I have spent 10 years as a medic in a rural area with almost no ALS FD, and then I was a firemedic for a rural area as well. I would have extremely long transport times with very sick patients (sometimes 2 if it was a bad scene), but I do understand that nursing world is so different. I will be in a trauma facility, large urban hospital. I am looking forward to it, but I am surely not naive in thinking it will not be a challenge to learning the "RN" way instead of medic way. Thanks for all the advice!