Help, Pls! New to the ED

Congrats on the position!

I would recommend a medication quick reference book that you can keep in your pocket- with medications like pressors, ketamine, cardiac gtts, etc. I keep a penlight, trauma sheers, and hemostats in my pocket, so if you don't have those I would recommend them. Oh, and hang out with the pharmacists and pick their brains- they are amazing.

Get to know your techs/EMT's- they can teach you so much. Have them show you things that they know. For instance, in the level 1 that I work in, they mostly operate the Belmont (rapid infuser) but in case an EMT wasn't available, I want to know all the ins and outs of the Belmont so that I can operate it.

Other than that, when you have free time, help out your fellow coworkers, or ask them to show you things that are interesting. Murmurs, lung sounds, wounds, etc.

Freshen up on your assessments, like being be able to rip a good neuro exam.

Other than that, be able to take criticism/feedback well, and always ask what you can improve upon.

Good luck, and congrats again!

Just for the feel of the E.D. I'd go with Emergency 24/7 by Echo Heron.

For general knowledge I really liked Quick Reference to Critical Care by Nancy Diepenbrock.

Stay humble once you get your feet. I hate cocky people, and the ED breeds them. ED nursing is probably the worst for this, EMS contributes their part, and EM occasionally puts out some awfully arrogant physicians - although I find them to have some of the best personalities of all the specialties generally.

All you have to remember about EM is that no, you (we) haven't seen everything yet, and no, you are not the best and you don't need to let everyone know it. We all started new at some point so beating up on an intern for their clunky orders doesn't make you cool. Don't be "that person."

Other than that, its a great specialty. Its hard and fun, loses a lot of luster of time, but with that comes a very satisfying ability to calmly handle crises and unusual situations. Great teamwork, mostly down to earth normal people, patients generally suck but I deal with them more on my own terms than the floors, and I really look out for those that need it. Check it out, if you can work hard you will guarantee fit in - we'll make sure you don't sink.

Stay humble once you get your feet. I hate cocky people, and the ED breeds them. ED nursing is probably the worst for this, EMS contributes their part, and EM occasionally puts out some awfully arrogant physicians - although I find them to have some of the best personalities of all the specialties generally.

All you have to remember about EM is that no, you (we) haven't seen everything yet, and no, you are not the best and you don't need to let everyone know it. We all started new at some point so beating up on an intern for their clunky orders doesn't make you cool. Don't be "that person."

Other than that, its a great specialty. Its hard and fun, loses a lot of luster of time, but with that comes a very satisfying ability to calmly handle crises and unusual situations. Great teamwork, mostly down to earth normal people, patients generally suck but I deal with them more on my own terms than the floors, and I really look out for those that need it. Check it out, if you can work hard you will guarantee fit in - we'll make sure you don't sink.

Yes. That is all

I'm pretty new to the ED and everything people said above is true--team work, ask questions, check out "interesting" things that other RNs have, and teamwork!

What I'd add--

1) If you don't know something about a diagnosis--ask the ED doctors. I've found that most of the ED doctors are willing to explain something that doesn't make sense, especially their orders. Like, the other night I was asked to give Glucagon IM to a pt. who had swallowed something that he felt was stuck in his throat. I had no clue why, so I asked the doc and he explained about Glucagon also being a smooth muscle relaxer for the GI tract. I was able to explain to the pt. and I learned something! I've found that because I'm willing to ask questions, the ED doctors like working with me and we have a good relationship. It helps when I am questioning a decision of theirs (such as why they'd try to put a DKA pt. on med/surg and ignore the potassium level of 2.5, especially when they are prescribing IV insulin to be given every hour...)

2) Pitch in! If someone is busy, offer to start IVS or hang meds or do whatever it is you can do so they can get caught up!

3) Always keep an eye out, even if they aren't your patient. Esp. when there are pts in the hallways and on gurney's.

Keep your mind open.

I have been doing this 12 years, and most of my co-workers and supervisors would say I am pretty good at it.

Last week I was inches away from a med error that would have been bad. I nearly triple dosed a PT with long term insulin. This PT later became critical for reasons unrelated to sugar. Had I thrown persistent hypoglycemia into the mix, it would have hugely complicated things and probably been missed.

Despite having really good reasons to give the med, I did not. I am really glad I didn't. this was at east 50% luck, but partly my credit for being open minded and constantly re-examining things.