New ED nurse

nickster26 · Sep 5, 2016

Hey jv713,

I can totally empathize with how you're feeling right now. I recently graduated Nursing school (December 2015) and am currently in orientation at a Level II Trauma center in an urban area. I know what other people are going to say and I've heard it many times already but unlike most nursing students I have interned for 2 summers on a med-surg floor and externed at an ER as a graduate nurse. Back to your post though, I am in my 4th week of orientation and I love it but at the same time I am so nervous about being sent out on my own. In these 4 weeks of my also 12 week orientation I have already learned so much and am just starting to realize how steep the learning curve is. All this advice your getting is amazing and pertinent to me as well so thank you for posting. My nurse educator recommended getting the ENA published Emergency nursing textbook. I brought the textbooks and am currently reading them now. They are a great to the point refresher to common procedures and illnesses seen in the ER. The stress you're experiencing about organization is similar to mine. The ER is so fast paced and it seems like most nurses just remember everything regarding their patients. However, to me that seems dangerous and error prone. I've noticed several nurses take a blank sheet of paper, fold it in half, and put patient labels on it and write chief complaints, medications, and pertinent information under them. At the end of the day, they shred it to prevent any HIPPA violations.

Good Luck on orientation! :)

jv713 · Sep 5, 2016

hello thanks for posting! how is your orientation going so far? I'm on my 3rd week of orientation.i agree i am super nervous about alone once orientation is over but i hope and pray i feel atlas 50% more confident and comfortable (i don't know if that is the norm or expected). is it normal to feel totally stupid sometimes? there are times i feel like i just don't know a thing, i think partially because it is my nerves. and i agree about the nurses memorizing things i feel like it is dangerous as well plus i don't even have that well of memory to do so. i tried folding paper in half and putting patient stickers like you said... but i realized i didn't update my paper as often as i wish i was able too just because i would get so busy.. and then it would throw me up and confuse me. what i am going to try next is.. take the paper of the patient's stickers that are brought with the patient when they place them in the room.. turning it over and writing my cc, hx, sx, and small check list on that. and since those stickers are kept in a cubby at the nurses station, they will always be right there for me to refer too. what do you do to organize yourself? and that book definitely sounds like a good idea i will have to look into it!

pockunit, ADN, RN · Sep 7, 2016

I tend to do heart/lungs/belly on everyone just to CMA. Then I'll do a focused assessment based on their chief complaint. So chest pain clearly gets heart/lungs, but I'll also ask about musculoskeletal in case it's a strain. Rash? I think ticks along with diet/contact/meds/etc. It'll all fall into place. I like to hang around for the doc's assessment if I can, so I get to know what they ask with each kind of admission. Don't be afraid to ask them what they like to know, and then you can focus your questions.

Also, we use index cards in our ER, so I just put a pile in my pocket at the start of the shift, then put a pt sticker on each one. I can keep track of things that way. Mostly, though, I've moved away from a brain and use the computer since it's all there in our system.

pockunit, ADN, RN · Sep 7, 2016

wow thats great advice thanks so much. this actually eases my nerves because it assures me that i am actually picking up on some type of routine for example, all the questions you said about chest pain.. i find myself asking those exact questions without having to think too hard about what to ask. and that one post is very helpful. that is one complaint i actually said to my preceptor, that i feel super slow and when i try hard to speed up my tasks like getting meds, setting up meds or setting up things i find myself fumbling because i want to be as fast as the seasoned nurses. but i guess like you said... speed will come with time. i work tomorrow and i will have to go to work with a new mind set... that what i am feeling is completely normal and it is okay to be slow at first. thanks so so much :)

Yep. Do the things, and speed will come.

Just know that as soon as you feel like you have a handle on the things you see regularly, something that totally rocks your boat is going to come into one of your rooms.

bgxyrnf, MSN, RN · Sep 10, 2016

Learning to be an ED nurse is intimidating because sometimes seconds or minutes matter and you need to be able to multitask and continually reprioritize. It is not an easy thing to do, even for expert nurses from other areas. It takes time. Sure, taking classes and studying can accelerate it to a degree but ultimately, it takes experience with a variety of patients.

Don't feel badly about writing things down. I know a couple of experienced ED nurses who still do. I did for the first year or so but now I find that it takes too much time to write stuff down and I've learned to keep things in my head.

You'll be fine... and you'll probably shine on those rare occasions that you end up with a precipitous delivery (which, knock on wood, I've yet to participate in during 7 years of ED nursing. To date, I've seen only one kid birthed and that was my own... and I'd prefer to keep it that way.)

nickster26 · Sep 11, 2016

Hey I though I posted my response to you but I noticed that it never saved sorry. Orientations is going really well so far. The nurses are very supportive and open to showing me the ropes. I feel it is 100% normal to feel this way, as I definitely do at time. I honestly did not know how little I knew until I started clinical orientation. The learning curve is steep but like I mentioned in my last post I am currently reading the Emergency textbooks published by the ENA. To organize myself I use the method that I mentioned in my previous post and try to document as soon as possible, which 9/10 is never soon enough. But before I document, I always look back at the nursing triage note to refresh my memory... especially after seeing 3-4 patients back to back. But I think the best thing I have going for myself is that I am willing to try new methods until I find out what is best for me. One thing I learned from my preceptor is to not be scared and be sure of yourself when speaking to anyone from CNA's to PA's to MD's. Stay strong and survive orientation :)