New to ED question

  1. Hey y'all,

    apologies if if this has been posted, I looked and nothing popped right up. So I have 2 yr OR exp ambulatory surgery, and 1.5 yr telemetry/intermediate. I just got hired on in the adult ED in my hospital system, level 1 trauma center. I have many reasons for wanting to make the change. I don't expect to be good at it right away, but I want to have as much knowledge going in as I can. I saw in another thread some folks recommended Sheehy's Emergency Nursing Manual and the Emergency Nursing Bible. I know that I won't be able to control the adrenaline and unfamiliarity at first, but I can control how prepared I am mentally to some degree. I bought the ENB, but have to wait til til next paycheck for Sheehy . Are there other books, materials, websites, shows, etc that yall feel like give an accurate portrayal of ED life or pertinent information? Any tips to prepare myself emotionally? I'm not the toughest bird out there but I'm no wuss, either. I still have 3 weeks before the transfer happens, so I want to read up as much as I can. Also, I streamlined the heck out of my brain sheet for floor nursing, but it occurs to me that I won't be needing it anymore in the new position... do y'all carry an ED equivalent of a brain sheet? If so, would you mind sharing it with me? I'm so thankful for any insight you can share. Oh, I read on a thread here the importance of real time charting in ED... any tips you have on time management are welcome, too? I left a message with my new sup asking her these same things, but I figured nobody ever died from having too many perspectives on a topic, right? Thanks y'all!
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    About RN in training

    Joined: Feb '11; Posts: 387; Likes: 509


  3. by   Cominginhot
    Hey! Congrats on making a change! There are a lot of different ways to skin a cat, as they say. I work with several nurses who use and love their, "brain," but, personally, I've never used one. The ones I've seen others use are typically handwritten and just consist of the pt's name, chief complaint, and hx. It's a little different in the ER as you'll typically be gathering all the information on your pt's in real time. When meds get ordered, you'll be the one hanging them, you'll place their IV's and be monitoring their vitals all in real time, so theres not much reason to have all of that written down for your pts, IMHO.

    As for time management, prioritization is key. When you have 4 or more pt's, you just need to think, "what NEEDS to be done first?" The rest can wait. It sucks to have people waiting, and often times tempers are relatively high in the ER, but you can't do it all, especially not at once. So, do what you can, when you can.

    As far as the research goes, IMO you won't really know what to expect until you've done it. I don't really feel there is a whole lot you can do to prepare until you get down there and figure out what your weaknesses are. There are some handy commonly used drug dosages that I have taped to my badge but other than that, you won't really know until you know. I know that must be kind of silly-sounding, but i really feel that you just need to jump in with both feet and figure out what you're a little deficient in once you're there.

    Lastly, please ask ALL of the questions. Your co-workers, more than likely, are GLAD you're there and they want you to do well. Most ER's are relatively short staffed with fairly high-ish turnovers so we are almost always glad to see new help. Ask questions and don't "fake it until you make it," down there. We can usually tell when a newbie doesn't know something and when they just bluster behind bravado it can be annoying and potentially dangerous. We want to help. Let us.

    Good luck with everything! Try not to stress too much and just know that we're happy to help you if/when you need it!
  4. by   RN in training
    Thank you so much for your thoughtful reply! I have another question I just thought of- how do you do shift change report? Is it expected that you try to DC/admit to inpatient all the pts you can before leaving? Or just report off and hit the road when it's time? Also, I feel so silly saying this having been a nurse for 4.5 yrs now but I've only ever called a few rapid responses and a couple code strokes... never had to call a code. So anxious about that, even thought I *know* what to do and how everything should work, I'm anxious I'll go blank in the moment! God I feel like a new grad again...
  5. by   ICUman
    Quote from Cominginhot
    Most ER's are relatively short staffed with fairly high-ish turnovers so we are almost always glad to see new help.
    I agree with you. I wonder why that is,though. It's a desirable specialty and so many competencies are achieved.
  6. by   RN in training
    Quote from ICUman
    I agree with you. I wonder why that is,though. It's a desirable specialty and so many competencies are achieved.

    I've been told by a few it's because of burnout? As of right now, I can see myself making a career in the ED... fingers crossed.
  7. by   nightbrightener
    Burnout is an issue, but in my experience it breaks down to 3 categories generally for why people leave or stay. 1- LEAVE A springboard to other, NP, TNU or ICU, flight RN, management, other hospitals, etc. 2- LEAVE burnout, emotional exhaustion, also feeling like overall clinical skills are eroding in terms of disease progression and disease course, sick of verbal or physical abuse, hours or other. 3- STAY love autonomy, challenge, environment and novelty, couldn't imagine floor nursing or sitting in an office. These people tend to transition only with age or disability, 10 years in think it's safe to say i am one of them lol.

    As far as the fear of having to run a code yourself, it really depends on hospital, shift and the day. Generally though, in my hospital you almost have to fight to be the "one in charge" in a code situation since we all work together and if you are documenting as primary other will do your lines, meds, interventions and not expect you to actively participate at the bedside. Also honestly, we know new nurses are not clinical rockstars and want to ensure a good outcome for the patient so we will direct as needed. Short staff night, multiple traumas... different situation but still, ABC's and a scratch pad will get you through, and I have never known a nurse to be by themselves in a code situation, every. If anything it is after the patient is tubed, resuscitated, and the drips are running that you will be left alone.

    Personal thoughts on ways to get a good rep... respect the PTCA's, aids, unit clerks and do the dirty jobs with them. Don't leave a mess at shift change, even if it means you stay 20 late to give PO meds or start a line, ask for intellectual/clinical help but do the job yourself, don't lose it if someone is short with you. They should be nice but the mantra never take anything yelled in a trauma bay seriously is worth remembering. Sometimes people are **sholes under stress. Biggest thing honestly- be willing- no passive aggression, no heavy sighs when you get the ambulance, no eye rolling etc. it sounds simple but over and over have seen people shoot themselves in the foot on this one. Have a "can do" attitude, it will be appreciated and respected.