Brand new grad starting in ER next week- help!!

labdad1234RN · May 16, 2010

Congratulations nurse! :nurse: IT is completely natural to have the "butterflies in your stomach" prior to your very first shift. Like most freshly minted nurses, you will not be alone on your first day. You most probably have a more experienced nurse who will be your mentor. Lern from her/him. She has got the experience and knowledge that you will develop.

Remember when situations do arise such as Code, Trauma, etc... KEEP YOUR FOCUS. I find the best ER nurses I have worked with have that in common.

PostOpPrincess, BSN, RN · May 16, 2010

I really, really, really hope you get a good orientation.

For your patients and your license sake...otherwise, do your best and know your limits....if you can't continue in ER for the time being, consider going to a med-surg or less chaotic area first.

delilas · May 16, 2010

I don't have much to offer you in the way of advice, but CONGRATS! Keep your head down and absorb everything you see your first few months. I hope you love it.

t2krookie · May 16, 2010

Does your hospital not have an orrientation set up for you? At Presby Dallas, we had a 4 month (in class and in ED) orrientation for those of us new to ED, and we were experienced nurses. If this not possible, make sure you have a strong preceptor and ask every damn question that pops into your head or write them down (if the timing is not appropriate) and ask them later. This will aid your skills attainment. Also look into ED references as well. Above all, if you don't know "ask". If the faculty are not supportive in this, get the hell out of there asap.

murphyle, BSN, RN · May 16, 2010

From one "newbie on nights" to another, welcome to Emergency! :nurse:

Echoing what's already been said about preceptors: You'll be assigned to work with an experienced nurse for your first few weeks (6 or 12, depending on department policy; mine gives 12 to GN/new RN), who will be teaching you the ropes. He/she will probably also be checking your med passes and/or pulling meds for you until you sit for your NCLEX. (This too may vary by facility, but my hospital's policy is that you don't get Pyxis access until you're licensed.)

Your preceptor can make or break you - I can't stress this enough. Ideally this person should be clinically skilled, cool under fire and have excellent communication skills. (In the real world, though, you usually only get two out of three! ) You can usually figure out within a week or ten days if you and your preceptor are going to mesh. If not, you should consider asking your manager, department educator, or whoever runs your orientation program if you can switch. Talk to your preceptor on at least a daily basis; ask for running updates on where you're at in the orientation process, and advice on how to build your clinical skills. Also make sure that your preceptor knows where your strengths and weaknesses are, and don't ever be afraid to ask for help or for a quick pause to regroup and refocus. (If you have a particularly perceptive preceptor, he/she may be able to read your behavior and suggest a pause before you get too seriously over your head. My preceptor used to watch my facial expressions; if I wasn't smiling and cheerful, that was her hint that I needed to regroup.)

Also, now is the time to start introducing yourself and making friends. Ask around the department and find out who's well-regarded, who has leadership skills, who's a clinical resource, and make those people your patrons. Don't neglect to look up and down the clinical chain of command, either. Find out which techs are the IV wizards and which physicians you can go to when a patient doesn't look quite right.

On resuscitations and traumas: You won't be doing anything in a resus until you're licensed and ACLS-certified at a bare minimum, so that should be one worry off your plate. Just sit back and watch, ask questions if it isn't too terribly busy, get a feel for the flow of the operation. Try to observe what each member of the team is doing, and tie it back to your "alphabet" - it's ABCDE in resus, Airway, Breathing, Circulation, Disability/Deficits, Exposure/Examination.

Don't get too bent out of shape about how you might react in traumas and peds, either. Having been in both, including those that ended in an expiration, your primal brain tends to go "OMGWTH" for about two seconds (which will feel like an hour), and then training kicks in. Stay focused on the patient's overriding priorities and you'll be fine.

Best of luck to you, and let us know how it goes! :D

bluemartian, BSN · May 17, 2010

I did my clinical practicum in the ER and it was challenging, not in acuity levels of patients but the backstabbing by techs and nurses. Needless to say I did not accept a position in that ER, too bad...

mandababy0326 · May 17, 2010

Thank you so much everyone for the advice! We do get a 12 week orientation, 6 weeks on days/afternoons and 6 weeks on nights, which also includes various training classes. I definitely know what you all mean about connecting with my preceptor and asking questions- which I will be SURE to do! I feel slightly better about resus with you telling me that I won't have any major responsibilities until I'm more experienced and certified. I start Thursday, I will keep you updated!

t2krookie · May 18, 2010

Damn. Did we forget to mention cliquish stuff? Ohh well. High School should have prepared her for that :)

murphyle, BSN, RN · May 19, 2010

Funny, I've noticed a lot less isolationist behavior (clique-forming, gossiping, etc) on the night shift than I did in my first half of orientation, when I was on days. Then too, nights in my department tend to be a self-contained and self-limited cohort; people don't get rotated to and from night duty like they do in other units, and very few people sign up for nights, so while there are a ton of nurses on days and every shift has wildly differing rosters, on nights there are only about twenty or twenty-two in the whole RN pool. You can't afford to gossip in that small a group.

Food for thought, perhaps...

foreverLaur · May 19, 2010

I really, really, really hope you get a good orientation.
For your patients and your license sake...otherwise, do your best and know your limits....if you can't continue in ER for the time being, consider going to a med-surg or less chaotic area first.

Who says med/surg is less chaotic? The one I worked on as a PSA... the nurses all wanted to be floated so they could finally have a calm shift... they would rather go to the trauma floor or ED than work on the med/surg floor. The volume of patients and admissions on one shift and the work required for each one was awful. There is no sum of money you could ever pay me to work on a med/surg floor.

carmen1965 · Jun 10, 2010

Congratulations!!!!!!!!

I hope that your facility has provided you with a preceptor? If not or if one hasn't been "assigned" to you; I would take time to talk candidly with your manager and let him/her know your fears. Be honest about your level of expertise; don't either belittle yourself or give false assurances. Let the manager know exactly where you are. I would also let the other staff nurses working with you what your limitations are. Look for the nurse who is sure enough of herself and her skills that it is not necessary to belittle you; stay away from the emotional/psychological power zappers. Look for the nurses who can teach you/show you and who are willing to.

Ask!!!!!!! never feel like you have to know it all because noone does even if they act like they do. When faced with a new scenario or a weird situation; first take a deep breath (the brain needs oxygen for the nurse to function). Remember it is not all on you; look for and always use resources. Nooone should expect you to have everything memorized!!! look it up!!! Remember, if the patient is breathing and the heart is pumping those are the basics!! all else can wait a minute until you look it up or ask.

One last thing, once you find a nurse you really gel with who models effective, empathetic, non judgemental, and professional nursing; stick to him/her like glue. Chat about the shift/patient; ask for feedback; ask questions.

Above all, keep your head up - smile - and remember to put the patient and his/her safety first. You'll do great!!!!!!!!!

Take it from a newbie who knows how you feel