ER NPs PLEASE HELP

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Hello Everyone,

I was recently offered and accepted a position working in the ER. I have 1 year of NP experience doing in-home assessments. I have 8 years of ER nursing experience. I am very excited and nervous about the new position, I will be working at a large teaching facility in LA county. I would like some suggestions from other ER NPs here on resources to use for references as well as any advice or suggestions so that I am a safe and competent provide.

Although I will have 3 months of training I am extremely nervous now that I will be the provider rather than the RN, Please help.

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Specializes in ER.

My only experience is from doing 300 clinical hours for my FNP program in the ER of a Level II trauma center, but I noticed all the NPs relied heavily on UpToDate which was available on the facility network. I had the UpToDate app on my phone which I (and my preceptors) used constantly, but the non-student price is pretty hefty. They also all used other phone apps like Epocrates and GoodRx - GoodRx was used a lot by the "kinder" providers who wanted to be sure the patients could afford the meds they were being prescribed. But I think with your 8 years of ER background you will find yourself doing great way before your orientation is up! I'm interested to see what working ER NPs suggest :D

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Specializes in Surgery.

Not an ER NP but I do consult on these patients occasionally and I'd say AgileMD is a great free app. Juan suggested it actually and there's a ton of info on there including snipets like this:

Acute Appendicitis

Hx:1 d hx generalized/epigastric or periumbilical pain localizing to RLQ, + anorexia, ± F/C/N/V

PE: + RLQ tenderness @ McBurney's pt (2/3 from umbilicus to iliac crest), ± rebound/guarding, ± Rovsing (pain in RLQ when palpating LLQ), obturator (pain when hip is flexed and knee medially rotated), and psoas (pain on extension of R leg at the hip) signs

Labs: ↑ WBC

Imaging

US: thickened, non-compressible appendix, ± luminal stones

CT: dilated appendix ± fecalith, periappendiceal stranding

Ddx

GI

Terminal ileitis / new onset Crohn's: no surgery, cool down with abx, c-scope as outpatient, refer to GI for medical management

Mesenteric lymphadenitis: no surgery, ± broad spectrum abx

Other:

Children: meckel's diverticulitis, intussusception

Older adults: right-sided diverticulitis, colon CA

GYN (Mittleschmerz, ruptured ovarian cyst, PID, ectopic pregnancy)

A/P

Admit, NPO/IVF, abx, preop for OR

If ruptured with abscess, admit for IR drainage of abscess, IV abx, and plan for interval appy in 4-6 weeks

I find Uptodate too wordy for any quick info I may need but good to review after the fact.

Anyways congrats and good luck!!

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I have the Epocrates app but not Up-to-Date it is very expensive. Never heard of GoodRX but will look into it. Keep the suggestions coming all are welcomed. Please if you are an ER NPs reading this message feel free to offer me words of wisdom or share your experience as a newbie ER NP and some of the pitfalls you experienced working in emergency services.

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Specializes in Surgery.

Your workplace will most likely have an Uptodate subscription and then you can just remotely sign in on your smart phone app..

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If your new in the er as long as you have a helpful ER doctor you shouldn't have much to worry about.

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I like using my 5 minute Consult book. I do not work in ER.

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