ED as first clinical RN position?

Double-Helix, BSN, RN · Aug 11, 2011

Start studying the skills that you think you will use the most. When you go to shadow, ask the ED nurse for the major skills/conditions that you will need to perform so you can brush up on them. Remember that you will have an orientation and not be expected to just jump right in. ED is not for everyone, and it's a tough specialty, but you can make it work if you are dedicated and willing to learn.

Editorial Team / Moderator · Aug 11, 2011

Just make sure they have a strong orientation program -- good preceptor(s), structure, feedback, and of sufficient length (which is kind of a subjective thing).

netglow, ASN, RN · Aug 11, 2011

Good luck Nire83!

Nire83 · Aug 11, 2011

Thanks guys! Keeping my fingers crossed and hoping for an amazing preceptor!

skylark, BSN, RN · Aug 11, 2011

Can I suggest having a look through the CEN syllabus, just to get an overview, and refresh your memory? It will give you clues as to where your gaps in knowledge are likely to be, and get you reading!

BackpackingRN · Aug 12, 2011

I am a new grad in the ED as my first position too! It is going well, I have 2 weeks left of a 3 month residency program with two phenomenal preceptors. In addition to the full time work in the ED with a preceptor who guides you then supervises your independent work when they feel you are ready, you also have class every week focused around an Emergency nursing textbook put out by the ENA that focuses on ED care.

I love the ED so far and am learning so much but I honestly go home every day scared and sometimes wake up in the middle of the night thinking that I forgot something... Apparently this goes on for a while; I have been told at least a year.

The most important thing I can tell you about starting out in an ED is that to them, you know nothing - which is pretty much true. They have been doing this a long time, and while we may have newer Evidence Based Practice and tons of new knowledge that we are bursting to share and we are dying to prove ourselves, we know nothing compared to what we need to know. I went in with a "please teach me" attitude, basically I shut up with what I knew, asked a ton of questions and everyone was bending over backwards to help me. If you stay humble, ask questions and practice safely you will do fine.

On the other hand there were 4 people total in my residency cohort, one other girl who took the same approach as me and then a male and a female who decided to go a different route. They basically told everyone right off that they had experience, answered with "Oh Ive already done that" or "We learned it this way, I don't think that's right".... talk about shooting your own horse. Well, needless to say the ED staff, nurses, techs and even doctors were not pleased. The nurses let them flounder and the techs ignored their requests. One lasted 3 weeks the other lasted 6.

Be nice to your techs

do as much of your own works as possible

remember it is a team and ask for help and help out if you can

ASK QUESTIONS, we have so much to learn and they WANT to teach

(as a caveat to that, don't be a pain in the ass and ask at appropriate times)

remember that this is their house, you are the new kid and while you have o prove yourself, don't ever say that you already know how to do something so you dont need to see it done or you don't need to do it.

This is how I have survived in the ED, I still go home and thank God I made it through the day. I talked to my preceptor and she said if I wasn't scared she would be worried.

You can do it.

Any other ED RNs have any advice? I am flying solo in 2 weeks and while they keep telling me I am more than ready, I am nervous!

Nire83 · Aug 13, 2011

Great advice backpacking! Thank you for the tips!

so......I GOT THE JOB!!!! I CANNOT believe it! I have been waiting 2 years for this; to feel like an actual nurse and to use clinical skills! I have a 12-20 week (depending on what i need) orientation with 2 preceptors and they said i wont have an acuity 1 patient for A YEAR! I am thrilled that not only is this an amazing experience, but that they actually arent throwing me in with no resources...and that i'll get the support and training that i need. PHEW! I think that was my biggest fear.

Good luck backpacking - you'll do great!

BackpackingRN · Aug 13, 2011

Congratulations! :)

EDNurse74 · Aug 15, 2011

I've been an RN for two years now and its all been in the ED, just by chance. I'm also the nurse that fell through any and all cracks available:

The Director that hired me quit before I started (and she had a plan for me to take classes and attend a few local conferences) so all I got was 16 week preceptor, then drop kicked on my own. I've learned to be loud and ask for questions/help/etc and who cares if everyone thinks I'm brain damaged.

After a year, got another job in an even bigger Trauma I ED. One again classes promised, blah, blah, blah. The ED internship program this place has is for RN's with at least 2 years exp that want to transfer into the ED. So they have a preceptor for 16 weeks as well as classes. So here I am with less exp than theses nurses and not taking the classes (officially) I just sit in them on my own time when I have the time. I figure screw it, its my job, I'm taking the bumpier road.

But when I meet up with my old nursing school buddies that are on the floor (and did have classes) I feel like I can run circles around most of them cause I still need to remember everything from nursing school AND I'm a whiz at starting IV's.

My advice: don't be afraid to ask questions. I just had an experienced nurse come up to me asking about how to set up syringes on the Alaris pumps, none of them could figure it out. I have been lucky enough to get lots of sick kids so I knew how to set it up and it's because the pharmacist on the floor took the time to show it to me once.....so also ask the ancillary staff questions too!