How to prepare for working in the ER

Welcome to the dark side ...

What will your orientation be like? If you have not yet had ACLS you will likely be scheduled for it as soon as possible -- that will be a starting point to answer your questions about codes. Make the most of your orientation -- be a sponge and soak up everything that you can. Keep a running list of meds/presenting symptoms/protocols/etc. to look up and/or ask your preceptor about.

Be prepared for a pretty major paradigm shift -- the ER priorities are very different than the floor.

Good luck to you!

Hi there! I started in the ER after 3 years of mixed nursing experience. I had no critical care background whatsoever. My work put me through an 8 week critical care course, had me ACLS certified, and gave me a 4 month orientation. For me, it was all about the hands on experience. I learned as each scenario came up, and at this point I feel fairly comfortable taking care of patients on multiple drips. You'll hopefully never come to a point where you're responsible for multiple patients on drips in the ER. It's usually one really sick patient and a couple of stable ones, at least it is where I work. Good luck!!

I am ACLS, PALS, ECG/Pharmacology certified already. I plan on getting TNCC and ENPC certified soon. Thanks for the posts keep em going!

The certifications are a great start. Every hospital has their own version of orientation, some better than others but....if you are talking a level 1 or 2 trauma facility with a decent number of beds there should be no way you will be the only one doing the code. As a general rule we usually have 3 or 4 nurses in the room. 1 writing (primary), 1 pulling meds from a crash cart, 1 hooking pt to defib/running for meds, 1 taking care of the rest of the primary's assignment and their own. The biggest thing that you may have to adjust to, and here's hoping i don't get flamed, moving quicker in different ways from the floor. You won't have to rush through 7 patients giving a.m. meds but you may have to write up 2 ambulances within 10/15 minutes. The trick is finding, very quickly, any abnormals and then anticipating/charting all of this. It's going to take some getting used to but you shouldn't be alone and it will get easier. A friend of mine who works ICU said something once that I laughed at... "You ER guys are the only ones I know who would send a vented patient, in jeans, to the floor." It's just a different style of nursing, few new meds, whole new attitude, and slightly more chance of getting punched. good luck

Jem, one suggestion. TNCC is not really going to make much sense to you until you have some time under your belt in the ER. I would wait until you have assessed and cared from some trauma cases to really get the basic understanding of what a primary vs. secondary survey is and what to look for.

Hello! I have been working on a med/surg unit for a year now and I am FINALLY able to transfer over to the ER:yeah:! I have a few questions to prepare myself for this new transition. I was a new graduate and med/surg was the first unit I worked in but I have not yet been a part of a Code Blue. My patients were all DNR's, I called a rapid response once (with a positive turn-out!) but its not the same. Can you guys give me some help on what to expect with a Code in the ER ? Also, I know there are a lot of drips used, how did you guys study for these drips? Or is it more of a learning while working type thing? I just don't want to be completely ignorant when my patients are place on the different drips. Thank you in advance for all your help!!!

I just watched my second "true" Code yesterday. This one I saw very up close, my other one was from the hall. I think for me and the type of learner I am is too watch. I have already talked to my preceptor and anytime there is a Code I can go in and watch and do compressions so I can get comfortable with it all. It will move very fast and their can often be communication issues and I am a hands on learner so for me this is the best method. Another good thing that I am going to do is my preceptor will be the recorder and I will take a copy to "record" as well, that way I can get the feel of all that as well. Congrats on the ED. Yesterday was my second shift on the floor and I absolutely love it!

"You ER guys are the only ones I know who would send a vented patient, in jeans, to the floor."

I love, love LOVE working in the ER. Transferred there in May after 2 years cardiac/tele and have never looked back. I think it took awhile to get used to the completely different prioritization that occurs in the ER. No AM meds, no checking off a bazillion orders, treatments upon treatments, dressing changes, etc. It's all about stabilizing the patients and moving on. Being able to think very quickly on your feet, absorbing everything around you, and always being prepared are essential. The squads don't care if you already have one vented pt and another on multiple drips--they keep bringing patients! Rascals, ha ha. I found Critical Care Nursing Made Incredibly Easy to be quite helpful in terms of mastering some of the more ICU-related issues that can occur. Brushing up on your arrhythmias and interventions for each one would be helpful. That will help you anticipate what drips you need to be thinking about. Also, each ER is different, so finding out the most common complaints you see on a daily basis and then getting a good feel for the typical protocols would be really helpful. Example--a patient comes in with abd. pain, I have a good idea of the workup the Doc/NP is going to order, what meds will be utilized, the consulting MDs, etc. etc. In orientation I kept a list of each of the major complaints--chest pain, abd pain, headache, stroke, gyn complaints, psych, and then kept notes on each topic--what tests were usually ordered, protocols, meds.

One thing about the ER...we do OB/Gyn/Peds/Neuro/Ortho/Psych/ICU/Tele/MedSurg/Onc...and that's the short list. You have to be a bit of a Jack (or Jill) of all trades to an extent. Good luck!

My preparation for my nightly shift consists of 3 shots of hard liquor with a PRN dose of patron! Lol!! Feel free to experiment! :) Have fun!

Thanks much for the advice! Very appreciated.