First shift in ER!

[Mebzone05, BSN]

Hello

I am an RN with 2.5 years experience. My first year was in a med surg unit and my second year was in an observation unit. My dream has always been to work in the ED. I was recently hired into a level 3 truama center. I hope to one day become and ENP.

I just wanted to give some feedback on my first shift as an ER nurse for new grads or nurses interested in the specialty.

The first difference that I noticed between the floor and the ED was the pace. The pace in the ED is insane. You will run for 12 hours straight. I did almost as many IV's and Foleys in one day as I have done in my entire career thus far. Charting is far less of a priority than on the floors. Having a doc present makes things move so much faster. I used to hate having to wait 30 minutes for a call back simply to get a patient some acetaminophen for a headache. I love not having to worry about silly things like a K of 3.5 or a bp of 160/80 in an asymptomatic patient. I love not knowing the diagnosis when the pt arrives. My assessment actually makes a difference in the ED. On the floor I always felt like I was assessing the patient for legal reasons instead of it being of actual benefit to the patient. I put 2 units of blood in a patient in ten minutes instead of it taking like 7 hours. The techs are actually helpful, no offense to non ED techs. I've also never worked in an ICU, which I'd assume that techs there would also be pretty good. The techs are proficient at IV's, lab draws, EKG's, Foley's and straight caths. I didn't have to delegate anything all day. I actually had to tell the tech to let me start some IV's and draw labs because it was usually done before I even saw the patient. Call lights are used far less often and almost everyone is npo so I never had to search the entire hospital for a ginger ale. I dont have to chart a full neuro assessment on a 20 year old with kidney stones lol.

It's only been one day but I think I made a great decision. I am nervous though, I feel like I have a ton to learn in a short amount of time. The charting system is completely different and just learning that will take weeks.

I was always the person to tell new grads to go straight into whatever specialty they wanted to go into, but my first ED shift has changed my opinion. There is no way, without a ridiculously long orientation, that a new grad with no prior ems experience could succeed in this ED. As a new grad, I was pretty terrible at nursing skills. I had no clue how to read an EKG, nor did I know the treatments for each rhythm. My time management was awful, my assessment skills were mediocre. In my ED, I can pull any med I want to out of the pyxis regardless of a physician's order. As a new grad, not being knowledgeable of many medications and their typical dosages, I'd likely commit several med errors considering the fact that we don't scan medication like we do on the floors. We also don't have to wait for pharmacies approval so you better pay close attention to the patients allergies, electrolytes, and med rec. Knowing what meds not to give depending on things such as liver on or kidney fuction is also something I think that 99% of new grads would struggle with. Can most new grads determine whether or not a pt with kidney failure is ok to send for a CT with contrast? This is something that I actually had to bring up to a physician multiple times during my shift. I doubt I could have properly prioritized my patients as a new grad as well. Idk, maybe I was just a bad bew grad.

Either way, I loved my first shift. The ED is awsome. All of you ED nurses out there are heroes. I've never been around so many great nurses at once. I am looking forward to a long career in the ED.

I will post an update on day 2. I didn't want to go into any pt details because of hippa and I have other posts on here that could lead to someone to being able to guess what hospital I work at.

[IrinK]

Wow! Thank you so much for this post. Starting my very first shift at ER tomorrow and feeling so anxious and scared. Coming from tele floor. 1 year and 3 months experience. I hope to survive lol

[CKPM2RN, ASN, EMT-P]

On 11/9/2019 at 6:01 PM, IrinK said:

Starting my very first shift at ER tomorrow and feeling so anxious and scared. Coming from tele floor. 1 year and 3 months experience. I hope to survive lol

You can survive and thrive! The flow is what you will need to learn first.

[shakabrah]

Thank you for this! I just landed an ED position, coming from 1.5yrs tele; I start January 2020 ? . I'm so stoked but nervous at the same time?. Please post updates! and any tips you have/pick up?! How long will you be with a preceptor? @Mebzone05, @IrinK.. I'm just wondering what's considered suitable for somebody with no ED background.