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

[mandababy0326]

I am a brand new graduate nurse (had my pinning yesterday! woo!) and I am both thrilled and blessed to be starting in a busy community hospital ER on FT midnights next week:yeah: THe only problem- I am becoming increasingly nervous as my first shift looms closer. I absolutely love nursing and love the fast-paced and diverse nature of emergency nursing, however I am extremely nervous, particularly for my role in code situations, considering I have only observed two codes previously. I am especially scared for my first trauma patient and my first peds resuscitation:uhoh3:. I would LOVE any advice that fellow emergency nurses- whether new or seasoned, could share with me! Thank you so much:D

[TNCC RN Guy]

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.

It's nice to see that experienced nurses have faith in new grads to be able to rise to the challenge , or not. M-S is less 'chaotic" than ED and critical care? One of my fellow grads had a preceptor with this belief when she was a new grad in the ICU. The "preceptor" would daily make references alluding to the belief that new grads shouldn't be in critical care while she was supposed to be "orientating" my friend . I wholeheartedly disagree with this line of thought. While I worked as a paramedic both in prehospital and Level II adult and peds trauma center ED environments, I started as a new grad in the ED. I've maintained my ACLS and PALS and completed TNCC in the first 6 months. CEN and an RN-MSN program is next on the horizon (I already hold a non-nursing bachelors). Don't let anyone tell you what you "can't" do (while in the same way taking sound feedback from reliable sources into account).

If you we're a little apprehensive, I'd be even more worried. Even with a strong background and months of experience as an ED RN, I still felt anxious in my first traumatic arrest, my first peds trauma code, the first time I had to console the surviving family of a patient who had passed away, the first few times I had "difficult" patients, both from a medical and personality perspective. Each time, though, I gained something form the experience and the next time a similar situation occurred, it felt almost natural to know what my role is and what to do.

Remember, when in doubt ask questions, and if you're not sure if you need to ask for help--you really do need to ask! No experienced RN who is worth taking help and advice from will shun you. If they do, then it's probably best to ask someone else anyway. Read, read and read some more. Take as many classes as you can whether the hospital pays for them or not. If you work with nurses that have prior experience in other specialties such as peds, psych, etc., ask them for advice when you have one of those patients and aren't sure about something (especially meds for peds or geriatrics!).

If you've got a big learning curve, obviously don't ask for the trauma rooms as an assignment right away ("right away"" being at least a year perhaps). Perhaps seek out express care, fast track, or whatever it's called in your ED if you want a solid start with lower acuity (in theory, at least) patients. As for codes, when in doubt, jump on the chest and start doing compressions or ventilate with the BVM until respiratory arrives and watch how the team works, who performs what roles, etc. The "team" concept of code management is strongly emphasized in ACLS as you'll learn in the future.

Above all, be wise and cognizant of when to ask for help. One of the biggest dangers for new ED nurses, be it new-to-ED nurses or new grads, is not realizing when they're in too deep and need help until they're so deep in the weeds they need search party to find them and many more resources than would have originally been necessary to help them correct the situation. Be aware and vigilant to protect both your patients and your license while not shying away from an appropriate opportunity to stretch yourself and learn something.

Some experienced nurses may give you a hard time as a new grad. If their concerns have merit, take what they say into account. If they're just complaining, and there are always at least a couple of complainers ho are never happy about anything in every unit, ED or otherwise, take what they say with a grain of salt. Remember, you are new, but not stupid. Just because you are new and need to refine your nursing practice and skills and expand your knowledge base does not automatically make you incompetent. I've been fortunate to work with fellow nurses and a manager that also believe this and provided me with outstanding support when I was a new grad (and continue to support me, as I support others who are now new grads).

Lastly,don't forget where you came from. Techs, housekeepers, etc are your friends and they remember who is nice to them and who isn't. When I have a messy patient that needs to be cleaned up or what not, I make a point of always helping with the job unless I'm absolutely tied up with another more critical situation. The techs know that I will help them and consequently are far more willing to help me as opposed to other nurses who the perceive as "abusing" them (their words, not mine).

Pardon the long-winded response and try to remember these tidbits as you start your new career. You can do it:yeah:!

[TNCC RN Guy]

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

+1. Sometimes, it may feel as though you're back in Jr High, depending on the culture of your ED.