Help and advice for an ER RN newbie.

bill4745, RN · Aug 10, 2007

First, relax-you'll do great!

There are some things that most newbies find different about ER:

1. Autonomy-when a pt is placed in your room, you need to know what to do before the doc sees the pt. (And also when to call the doc stat). If chest pains sounds remotely cardiac, you would do an EKG, IV & draw labs ("line & lab"), place on monitor, give O2, and give EKG to the doc. For most abd pain, line & lab, hang saline, dip urine. You will learn these over time.

2. Chaos - your priorities can change in an instant, depending on what comes in the door. You will learn to "pick up" where you were with your other pts after you finish the code that the medics brought in without advanced notification.

To work in ER it helps if you have ADD and are a bit psychotic. Seriously,I have been there for three years (after ten in ICU) and love it 90% of the time. It is never dull, you always are thinking, & I have formed great relatioships with my co-workers. There is a definite feeling of pride with working in one of the more difficult parts of the hospital. I hope you grow to enjoy it as much as I do. It will take a long time before you feel confident, but you will get there.

MAISY, RN-ER, BSN, RN · Aug 10, 2007

Bill's advice was spot on. Any patient coming in for anything remotely emergent is going to go on monitor, oxygen, be lined and labbed, urine at bedside, foley(possibly), fluids ready to go, and ekg ordered-usually standing order, no doctor there yet. It's assumed you will go ahead and do, OH yeah, if elderly with fever, blood cultures at bedside too! You'll learn that even though meds are not generally administered without doc order first you must be prepared to give.

Additional advice, follow your preceptor's advice as they practice different things for different situations-it's even better if you have several preceptors to follow. ER is a different animal-although you should always try to do great assessments-that sacral wound a patient may have will never be as important as their chest pain and it's treatment. Again, do your job as a nurse, but floor nurses have different priorities. Yours is to keep patient alive, and provide the giftwrapped package to the floor!

Good luck in your new job,

Maisy;)

alkaleidi · Aug 10, 2007

To work in ER it helps if you have ADD and are a bit psychotic. ... I hope you grow to enjoy it as much as I do. It will take a long time before you feel confident, but you will get there.

Thanks for the words of encouragement! I do have a bit of ADD and am a tad neurotic/perfectionist (ok, more than a tad perfectionist)... and I multitask like it's 2nd nature, so I think the ER will be a positive, healthy, grounding experience for me. LOL. I look forward to the change... I need a kick in the butt, and I think the position will make me even more marketable when we do decide to relocate (in IL now, looking at anywhere it doesn't snow from November to March... LOL).

Thanks again. If anyone has any good reference type websites sort of specific to ER/trauma/etc I'd love to check them out!

-A

LPN2RNdude · Aug 10, 2007

yeah im an RN and start the ER this monday.... im nervous as well..... a lot of my friends work there so they are all up for helping me out... good luck!!!

TooterIA · Aug 13, 2007

My advice is less medical and more on the people side of it-I find my patients are defensive more often so my smile always has to be on. For example you have to find a way of asking "What makes the earache different now, at 3am than it was last evening?" in a non-snotty way.

Jessica

vampireslayer · Aug 15, 2007

I would guess (hope) your ED has a set of protocols for common complaints, get a hold of that. (Chest pain-CBC, CMP, troponin, chest xray, EKG, oxygen. Abdominal pain- CBC, CMP, amylase/lipase, UA and UA HCG if female of childbearing years with no hysterectomy). At the very least, try to gather everything necessary to get the patient monitored, locked & labbed. So as you enter the room, or walk your patient to the room, (however that's handled at your facility) make sure you already have your BP cuff, your cardiac leads, your pulse ox, IV start supplies, all the necessary blood tubes. If it's in any way abd pain/flank pain, get the urine sample right away before you start everything else. I'll intentionally walk them by the bathroom first, before even entering the patient's room.

Get your entire rainbow (all the blood tubes) regardless of whether or not you think the doc will order everything. Try to develop a standard set of assessment questions, you'll see common threads come up as you see specific types of patients...if they have chest pain, is it sharp or dull? More like pressure? If so, then off you go on the cardiac route, any pain in the left arm, shoulder, jaw? Diaphoretic? Nauseated? Short of breath? If it's sharp pain, worse when they take a deep breath? Coughing? Any woman of POSSIBLE child bearing age with a uterus should get a UA and a urine preg.

Try to get IV access as soon as possible and get them on that cardiac monitor (and admitted to the central bank of monitors) as quickly as possible...so if they do go south when you didn't expect it (duh, they didn't LOOK that sick), they can be cared for immediately when they call the code! There's nothing worse than getting a patient back from their xrays to find they're profoundly diaphoretic, decreasing LOC, BP in the 50's, and NO IV ACCESS (ask me how I know, no, it wasn't my patient)! Try not to let them go anywhere without IV access!

Go back to the charts of your patients that you've started, and see what other things the docs ordered on them that you hadn't thought of. It's a great learning experience. Ask the docs why they ordered what they did, if that's something you should consider initiating (labs/xrays/whatever) yourself.

Come up with a standard report to the doc that you can rattle off in 30 seconds: Age, history, complaint, and whatever vitals you find abnormal, and usually, once you get more experienced, you'll finish up with "do you want ____________" as far as labs, xrays, CTs, meds, and the doc will just agree with you! But until you're comfortable with that, just stop with the brief report and ask the doc what he wants done before he gets in the room.

I dont' know if that helps, or just makes you more stressed! My biggest and best advice is to watch what happens with all the patients you can, not just yours, any of them. See what their complaint was, what their final diagnosis was, how the doc determined that, what labs were ordered, what scans were ordered, and why.

Good luck!

VS