First Day in ED in 3 days!!

Blee O'Myacin, BSN, RN · Apr 20, 2008

Hello,
I'm a new grad and I am finally starting my first job in the ED this week. I've read the stickies and searched this forum for information and suggestions for new grads in the ED. I was looking for some advice regarding clinical experiences. For example, on one thread someone suggested that I go through the most common ED complaints (i.e. ACS, MI etc) and go through what a nurse would/should do in each circumstance. Does anyone have any suggestions along those lines? Or are there any really useful cheat sheets I should take with me (or just the usual from my med/surg clinicals). I'm of course extremely nervous and I don't want to roll into my first day of work without reviewing something, especially since it has been so long since I graduated.
Some stats about my ER. It is a level II trauma center (soon to be level I). It is extremely busy with approx 300-400+ patients/day. It is also the county hospital if that makes any difference in the advice.
Thank you in advance!

Congrats on your new job. Take everything that you accumulated in nursing school and put it away in a nice, safe place where you are unlikely to trip over it. I carry a small canvas bag with me that can fit into my very small locker. My lunch goes in the fridge. If I can't carry something in my pocket, then I don't need it. I have a stethescope, a roll of tape, a pen and some alcohol wipes on me at all times. Before my bandage scissors met with an unfortunate end (fell out of my back pocket into the toilet), I had those too. That's all you need. Your first few weeks are going to be a blur. Just go with the flow, pay attention to what your preceptor is doing and when he or she does it, and things will start to fall into place.

Good luck!!

Blee

alkaleidi · Apr 20, 2008

A few things I find helpful...

-know your protocols for acute emergencies... we have 3 main ones: respiratory (previously called "pneumonia" but renamed because they wanting us using it with any major respiratory symptoms that come in), chest pain, and stroke. they are all very easy to complete, step by step, and outline the treatment on each.

-know your protocols for non-emergent conditions (fever, abdominal pain, etc)... may be called "standing orders" but either way, know what you can do without a specific MD order. know what orders you can put in (labs, xrays/ct, fluids, saline lock, etc) before the MD ever gets in to see the patient. this will decrease most patients' stay in the ED.

-develop a routine... if you use computerized charting (which many facilities do now), learn the "triage" screen... be able to ask all the triage questions without standing at the computer -- you can be asking all those questions while assessing, starting a lock and drawing blood... it hastens the process as well.

-I got a little pocket notebook and have notes in it on EVERYTHING... from protocols to lab values to drug doses, as well as dept extensions (handy for when you're in a room, pull up someone's labs and want to know why it's taken 1 hour for a UA to be done, or when you want to let CT know that a pt has finished their contrast, or tell xray that your patient is vomiting and isn't going to be able to go for their cxr right that second, or when you want to recheck compatibility of 2 drugs with pharmacy)... this has been one thing that I've used daily.

Good luck!!!

dragonflyaltoids · Apr 21, 2008

Never give nitro without an IV established (i learned that the hard way)

Know exactly what's in your code cart. So you aren't running out to grab dopamine when it's right next to you.

Always always always ask chest pains if the take viagra, etc.

And at least TRY to start your own IV's, you can't be good without practice.

Hope this helps. Welcome aboard!

edmia, BSN, RN · Apr 30, 2008

At Work: Pockets with black pen, red pen, pen light, trauma shears, and your palm device if you like to use one. Stethoscope, keep it around your neck or it will "disappear".

Stick with your preceptor but try to get your hands into the traumas and resuscitation cases as soon as possible. Even if you're just hanging the IV bag, you need to see the protocols in action in order to get them internalized.

At home: Sheehy's Manual of Emergency Nursing, Chart Smart, and Dale Dubin's Rapid Interpretation of EKG's are essential books to read.

Other less essential books are: Emergency Nursing Procedures, ENA's Emergency Nursing Core Curriculum, Emergency Nursing Made incredibly easy (not as good as Sheehy's but has nice charts, easier read).

And last but not least - be read to have fun, to feel like you know nothing, and to learn everything from scratch.

Nursing school did not prepare you for the ER, but if it's in your soul, you will love it, love it, love it.

Blee O'Myacin, BSN, RN · Apr 30, 2008

OP, how is it going? Are you taking the time during the shift to take care of your biological needs (ie - going to the bathroom and having a few snacks if not a real meal??)

Hope you are loving it as much as I do.

Blee

Trauma08 · May 1, 2008

Hello Everyone,

Thanks for all the replies I have definitely put some into action already. I've worked 6 shifts so far and things are going well. My preceptor is really nice and crazy energetic, but I'm learning tons. So far I'm taking 1-2 patients and doing all the charting etc and helping with other patients as well. I've been to a couple of codes and helped pass meds. I feel like I'm in a fog and I'm not sure what questions to ask but I like the idea of reading more on my own so thank you for those suggestions. There have even been a couple of times at work that I thought to myself that I was having fun. So, so far so good.

Thanks again and if you have more suggestions or ideas please let me know.

Roy Fokker, BSN, RN · May 2, 2008

Heh! I kinda know what OPs talking about.

I just got done with week 2 of my orientation in the ED. TOTALLY loving every minute of it - have such awesome, wonderful folks to work with!

We're a very busy ED (I laughed the other day when I saw the euphemism used to describe the places where we stash patients in the hall when we were overflowing. Rather than call it by what it was i.e. "a bed in the hall", we used a fancy sounding term for it :chuckle); and right from day one my preceptors and my boss were trying to tell me to "take it easy. Don't rush yourself".

But I feel comfortable jumping in. I made sure I told my preceptors to "ride my butt hard" because the more I sweat, the more I'll learn. And the more I learn, the easier it will be in the long run I have terrific preceptors - they let me do it all, while keeping a close eye to make sure I do it right.

It's been awesome so far! :w00t:

**canoehead, BSN, RN** · May 2, 2008

Get a few of those $5 calculators so you can keep one in your pocket, and some of the cheap kid's scissors too. You don't need heavy duty expensive stuff- you need stuff that can get lost or bled on without bankrupting you.

But get a decent stethoscope, and keep it on you.

Know how to calculate drips so that you can pull out a paper towel and calculator in the middle of a trauma- but always double check your numbers with at least one other person.

Go through the entire ER and find out what all the freaky stuff is used for, and how to set it up. You'll get some great stories out of your coworkers.

A clamp on your person is a wonderful thing, but expensive to replace, and will be borrowed frequently.