hi everyone! thought i would make a blog and see if any fellow ER nurses could give me some advice. i have 1 year experience in a postpartum floor. decided to make the switch to ED because i realized i did not want to pursue a nursing career in OB. plus i have always wanted to some day try ED...i thought now would be a good time before i lost all of my basic nursing skills (but lets face it... i never used any in my old unit). i am a few weeks into my ER orientation in a SUPER BUSY hospital. i am feeling completely overwhelmed and feel like a brand new nurse all over again!! i know i technically am considered a new nurse still... but what i mean is, i am just NOW learning my basic nursing skills such as IVs. coming from a floor, i am used to writing down everything and organizing myself that way. my preceptor along with all the other ER nurses memorize every little thing and i am having such trouble remembering things. i am literally terrified to be on my own.. my training is 12 weeks clinical total. i am in week 3, and i know it is still early but maybe i am just too hard on myself. can anyone please give me words of wisdom? any tricks on how to organize yourself? transitioning from OB to ED is so hard
i wish i never went to OB first.. but i really want to succeed in the ER world and i am so determined i just hate feeling like a failure or a complete idiot at work
any advise? please and thank you
Sep 3, '16
Quote from jv713
thanks for replying! and thank you for such good advice. after my last shift i definitely came to the conclusion that i need to some how make a brain sheet. unlike the floor where i am used to the same team of patients all day (which makes it a lot easier to remember things without writing down)... the fact that its a constant turn over has me completely confused with things i have done, need to get done, or why the patient in room 1 is here in the first place without looking at my computer. i actually came up with something similar to what you have mentioned... i was thinking if i take a paper and fold it into 3-4 columns (our ratio is 1:3-4 depending on the pod we are in)... placing the patients sticker on top of each column. numbering each column per room number. then jotting down info such as cc, hx, sx, meds, allergies, things that i have already done (such as placed a line, drawn labs, ekg), and then write down things i still need to do and cross them out once i have done them. then for their dispo... just cross them out once i know they are discharged or admitted and placing the new patient's sticker on top of the old one. so organize it according to room basically. i hope it works. in my old unit.. all the nurses used the same "Brainsheet" since they were already printed out. but that paper was my life line and kept my day rolling smoothly lol.
but i am slowly starting to kindof see somethings that i can get done before the doc comes in for example like you said.. the pt with chest pain... will definitely need a line, need to be on heart monitor, need labs ect...
another question i have: what if you come into contact with a patient where you have no idea where to start? what questions to ask and correlate to their signs and symptoms... i guess that takes time? learning what questions to ask, and what to anticipate?
Once you've been in the ER for awhile you will realize that you are repeating many of the same questions over and over and you will get used to what questions to ask for for different complaints. You will sometimes have patients that you won't know if the doc is going to want to start a line and draw labs or not, so I just wait for orders when I get those so I don't do anything unnecessary. But you will always have to do your nursing assessment
and you will get a routine after awhile. Even for those questionable times when you aren't sure what the doc will order, you can still have your patient provide a urine sample just in case you need it and that alone will speed up the process and put you ahead of the game. All of this is assuming that you have the time to get things going that soon because there will certainly be times when you are so swamped the entire shift that you many never get to get things going before the doc sees the patient. When you have days like this, just occasionally take a slow deep breath, remind yourself to prioritize the most important things first, and do things one step at a time. Eventually it will all get done even if it's not as fast as you or your patients would like.
I should mention too, in case you haven't figured it out yet, that assessments in the ER are focused and not all patients are head to toe. This may annoy some of the nurses on the floor when you give report but that's the way it goes in the ER. Of course you will have your train wrecks that come in and you will end up doing more or less an HTT assessment out of necessity, but more often it is focused on the chief complaint primarily. I do make sure to document wounds that I happen to see or if the patient or family tells me that wounds are present, but I don't necessarily do a full body skin assessment in the ER.
Last edit by GM2RN on Sep 3, '16
Sep 4, '16
Quote from jv713
Yes!! I definitely see exactly what you are saying with the focused assessment. I've learned that with some patients I don't even place my stethoscope on their skin lol let alone MY actual hands. Sometimes the assessment is just a set of questions. My preceptor said it'll take time to know what kind of assessment to perform or what questions to ask but I'm scared I will miss something? Since it's also FOCUSED I wanna make sure I'm focusing on the right thing if that makes sense? For instance.. If a patient comes in with a set of symptoms.. How long will it take me to learn what condition/disease/illness that patient is experiencing in order to help guide my care/assessments/priorities if you know what I mean?
Don't worry about figuring out what their problem is, that's what they are there to find out. What you need to do is ask questions that will help determine what their problem is but it's not up to you to diagnose them. For instance, chest pain may be cardiac related but it could also be other things, like heartburn, muscle strain, stress or anxiety, etc. So you will ask everyone with chest pain pretty much the same questions: where is your pain; does it radiate; is it reproducible; when did it start; is it constant or intermittent; describe the pain; does it get worse with a deep breath; are you also short of breath; is there anything that you do that makes it better or worse; have you had any N/V. I will be asking these questions while getting the patient on the monitor and taking a set of vitals. If the answers to their questions lead me and the doc to suspect that it's not heart related, they will still be treated as a cardiac patient with a full workup to rule it out.
Many of the chest pain questions will be the same for any type of pain. For abdominal pain you won't necessarily ask if they are short of breath, but you will want to know about any abdominal surgeries, history of colon problems, last BM, nausea and vomiting, etc. This patient could be anything from appendicitis to bowel obstruction to a bad gallbladder, and you don't have to figure out which one with your assessment, but you will come to learn what your docs will tend to order with this type of patient. They may even do a cardiac workup on this patient depending on their symptoms and the patients age and gender. But generally speaking, for abdominal pain you can expect to start a line, draw blood, get a urine sample, hang fluids, and do a urine preg test on many of your females.
I also happened to come across a post from a newer nurse who has been in the ER now for 10 months and it explained very well what what I felt when I first started in my current position, and still do from time to time, so I'm including it below for you to get another perspective.
Quote from SweetCorn
I just hit 10 months in the ER as a new grad and had a 12 week preceptorship. I'm far from a seasoned nurse, but I'm not the same RN I was last November.
Those first few weeks/months should feel like a slow motion train wreck, at times. Don't jeopardize patient safety or your safety at any time.
When the taskws started piling up, sometimes I had to "slow down to speed up". Meaning that in order to tackle a mountain of tasks, I needed a quiet moment in the med room to develop a plan of attack. I found that if I slowed down a (tiny) bit, made sure to get the supplies I needed in one trip, was prepared for whatever I was doing, this makes things go so much easier and less stressful. You will be slow getting things together and setting them up but with repetition comes efficiency.
Lots of people on these threads have said that with exposure and experience comes confidence and comfort and at this point I agree. Something clicked around six or seven months for me and every month or so other things click, or at least I notice things fall into place with what feels like less effort or stress. Lots of things happen in what feels almost like automatic mode now.
Until then, you gotta stick out the tough shifts, the terrible patients, the (hopefully occasional) degrading comment and keep asking questions and taking notes and looking things up. Figure out who your pillars are on your shifts, lean on them (but not too much) and learn from them. You'll get it.
Last edit by GM2RN on Sep 4, '16
: Reason: Clarification, punctuation