ER ADVICE

[meech2015]

I have two questions for those who have been working in the ER.

What resources did you use to better prepare yourself for the ER?

What is the most beneficial piece of advice you would tell a new grad entering the ER or ICU straight out of school?

[ParalyticAgent]

I kept a notebook with me at all times to write down meds, conditions, treatments I was unfamiliar with. When I got home, I was able to study them more in depth.

That's the advice I give to all of my new hires! :)

[Lev, MSN, RN, NP]

ACLS, practice with rhythm strips, critical care course, and self study of meds/conditions from my nursing school text books.

Learn, Ask, and Listen!

[WannaBNursey, ADN, ASN, RN]

1. I bought a couple of books to study up on the ER, but really the only thing that helped was having the experience I had from Med-surg, knowing common meds and having a kick-butt preceptor. She was wonderful! I will say that I still have problems with some rhythms, but all I need for the job is knowing the lethal stuff and what to do with somebody in A. fib RVR or SVT. These things I learned in med-surg in 6 months.

2. The few new grads that go right into the ER have a hard time doing things that would be simple for somebody with even a little med-surg experience. I only had 6 months, but at least those six months taught me something. Another nurse and I were discussing this when a nurse off of orientation ran blood at 50 ml/hour for an hour. Thankfully the other nurse saw it and increased the rate so the blood would run in, in time. Because the newer nurse doesn't have floor experience she doesn't run blood often. Basic skills like running blood are best learned on the floor. I highly recommend even 5 months Med-surg before the ER.

[applesxoranges, BSN, RN]

I was a volunteer EMT and then worked as a paramedic in the ER.

[Chinpop]

I started as a new grad RN in the ER and had never seen an emergency room besides one day doing a rotation during clinicals.

I didn't have any problem adjusting to the high flow population, and I am in a trauma ED next to a major airport; although it could be personality based and the huge chip on my shoulder to prove everyone wrong and be a kick-butt nurse.

That being said,

I would NEVER EVER recommend med surg first. The previous poster talks about learning stuff like drugs for Afib RHR and SVT in 6 months....uh, you learn that in two days in your ACLS certification class. I know it's not true for everyone, but I firmly believe that if you start on the floor it will slow you down and you will end up putting things like blood on a pump (REGARDLESS OF FLOW RATE) when you should just open it up and get it in (most of the time, there are exceptions). Shoot, sometimes you will be pressure bagging blood and fluids into a dude who has a ruptured spleen but was brought in BLS because the first responders thought it was a "minor" car accident.

I got my CEN when I was 18 months into nursing, that's less than the recommended two years being an emergency RN and heck I hadn't done anything else and I attribute it to starting off right away in the ED. I now work at three hospitals, including a trauma I, trauma IV cardiac and stroke center, and a pediatric hospital.

The trick is to be proactive and do your ACLS, PALS, and TNCC. Don't just get the questions right, know why you are getting the questions right. Apply the algorithms to real life. Observe how the good nurses do it in the ER. I say good because there are just as many complacent nurses and you don't want to end up like them.

Although I would recommend getting your first job where there is an ED residency, those are very helpful.

[NurseIndependa]

I would NEVER EVER recommend med surg first. The previous poster talks about learning stuff like drugs for Afib RHR and SVT in 6 months....uh, you learn that in two days in your ACLS certification class. I know it's not true for everyone, but I firmly believe that if you start on the floor it will slow you down and you will end up putting things like blood on a pump (REGARDLESS OF FLOW RATE) when you should just open it up and get it in (most of the time, there are exceptions)

Although I would recommend getting your first job where there is an ED residency, those are very helpful.

I've got to add on to this. If you take part in an excellent residency program, that will truly prepare you. My unit has a 5 month residency and uses the ENA modules as well as their other recommended curriculum.

This year is the first time they only hired new grads and completely stopped offering spots to floor nurses or nurses with previous experiences. I am not sure why, but obviously they know new grads can be successful in the ER

[JVoEDrn]

I've been doing this, running over the information constantly and discussing life saving meds and measures with my paramedic husband all with studying on my own as well! I have found it to be very beneficial!

[WannaBNursey, ADN, ASN, RN]

I would NEVER EVER recommend med surg first. The previous poster talks about learning stuff like drugs for Afib RHR and SVT in 6 months....uh, you learn that in two days in your ACLS certification class. I know it's not true for everyone, but I firmly believe that if you start on the floor it will slow you down and you will end up putting things like blood on a pump (REGARDLESS OF FLOW RATE) when you should just open it up and get it in (most of the time, there are exceptions). Shoot, sometimes you will be pressure bagging blood and fluids into a dude who has a ruptured spleen but was brought in BLS because the first responders thought it was a "minor" car accident.

That's great that you were able to just jump right into the ER with such a supportive new-grad program, however, not all ER's are like this. My ER only gives 4-6 weeks orientation for new grads to the ER. One of the nurses I graduated got a job in the ER right out of school and it was obvious she was not properly trained. Nobody wanted to work with her, and she constantly made stupid mistakes (like running blood in over 4 freaking hours). 2 newer graduates have made this mistake. Med-surg experience is invaluable, especially if you work in a facility that has holds in the ER...if you don't work in a facility that holds in the ER, count yourself fortunate, you don't have to double as a floor nurse and an emergency nurse. Med-surg teaches basic nursing skills that somebody might not have time to learn while also learning the ER, not to mention it teaches good time management. I'll never tell anybody to NOT do Med-surg first, it's an amazing experience, especially if you're used to taking 8 patients and being chronically understaffed. Those stresses in Med-surg teach you how to deal with stresses in the ER, though it's a different kind of stress.

[NickiLaughs, ADN, BSN, RN]

That's great that you were able to just jump right into the ER with such a supportive new-grad program, however, not all ER's are like this. My ER only gives 4-6 weeks orientation for new grads to the ER. One of the nurses I graduated got a job in the ER right out of school and it was obvious she was not properly trained. Nobody wanted to work with her, and she constantly made stupid mistakes (like running blood in over 4 freaking hours). 2 newer graduates have made this mistake. Med-surg experience is invaluable, especially if you work in a facility that has holds in the ER...if you don't work in a facility that holds in the ER, count yourself fortunate, you don't have to double as a floor nurse and an emergency nurse. Med-surg teaches basic nursing skills that somebody might not have time to learn while also learning the ER, not to mention it teaches good time management. I'll never tell anybody to NOT do Med-surg first, it's an amazing experience, especially if you're used to taking 8 patients and being chronically understaffed. Those stresses in Med-surg teach you how to deal with stresses in the ER, though it's a different kind of stress.

Or you burn out because you're taking 8 patients in med surg and it's not for you. Med surg is hard if you don't love it. Every time I floated there I wanted to quit nursing, my hat is off tho those who can do it. Everyone's different, I know plenty of nurses who went straight for their specialty and did fine, and I know nurses who def should have had basic skills down first and I know nurses who should have never been nurses. It's better to get into the job that is the right fit for you from the beginning. I have a ER coworker who wanted to do L &D, no one wants to train her in a whole new specialty. It's hard to break from what you know.