I Got the ED job!!!

rnhope · Jan 12, 2011

Just wanted to say congrats on the new job!!! :yeah: I too am a new grad starting an ED job Feb. 14th!!! its all I have been obsessing over so excited yet so scared! Will I catch on quickly? I am hoping to love it as its been a dream of mine for years! Good luck and God Bless!

FrogKissingNurse · Jan 12, 2011

congrats to both of you! i was reading yesterday some blogs about emergency nursing. lots of great information on this site. i thought this one might be a good one for you to check out

https://allnurses.com/nursing-blogs/er-orientation-what-338723.html

tryharder · Jan 12, 2011

would it be fair to assume that the nursing jobs are beginning to open up a bit more. I see more posts everyday of someone that just got a new job as a new grad.

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Jan 12, 2011

Congrats to both of you for landing a job in the local "24 hour body repair shop." I'll only offer a few suggestions, but believe me for your own sake.

1. When you start, carry a small pocket sized notebook with you. You can keep track of frequently called phone numbers, specific uses or special equipment in specific rooms, names to remember, names to forget, whatever. After 6 months you may not need it, but have it with you on day one.

2. ER's all have some kind of rhythm to them. Certain times or days you can count on it being busy or not so much. If it's slow now, in a certain number of hours it will be busy. That said, NEVER, EVER, SAY THE WORD "QUIET" IN AN ER!. I'm telling you that for your own protection. Even if it is quiet, soon it wont be, and the docs, nurses, techs, aides, housekeepers will all blame it on you.

3. Spend $50 to 80 on a descent stethoscope. Try everybody Else's and choose. I like Littman for the sound quality, long tubing (I'm over 6 feet tall), and superb repair service.

4. Learn to know when you trust yourself or not. When in doubt, ask another nurse, doc, resident, guru, whatever. I once had a resident argue with me for ordering and upright chest xray on a patient who she swore had good breath sounds in all fields. I had it done anyway. The patient had a 100% pneumothorax on the side I said was silent.

5. You are the patient advocate, first and foremost. You are also one link in the ER team. If you think a patient should be treated/tested differently, speak up. Nobody knows everything. Make sure the patient gets the best available from the team. Make good patient care your most important goal and everything els will take care of itself.

5. Work in the ER as long as it excites you. If it becomes stressful instead of exciting, and you're losing sleep over it, save yourself and find another department to work in before you completely burn out. Good nurses are hard to come by, and ER nurses are the best IMHO, and the ER experience will serve you well anywhere you work.

May all your orders be legible and all your patients compliant. Paul

Gurmo · Jan 12, 2011

Congrats. I am a new grad (Aug) that got hired in the ER right away. It has been very exciting and honestly I am not sure I'd enjoy another department (but of course I have nothing to compare it to!).

As a new grad, I would recommend to never portray like you know it all. There is another nurse who was hired about 3 months prior to me who had about 6 months of ICU experience. I was told that she was already on some folks list because she comes off as someone who doesn't care what you want to teach them because she knows already. Does that make sense?

Even if someone is showing you something you've done already or are pretty confident in, sit back and let them show you. They may teach you something they don't; and even if that isn't the case, then they felt better for thinking they showed you something new. Does that make sense?

Good luck and have fun!

Nrsstudent09 · Jan 12, 2011

I start in the ED Feb 14 too!!

Traum-a-Rama · Jan 12, 2011

Thanks guys, please add more....I agree that there's nothing more dangerous than an overconfident, smart ass nurse. So, at the risk of annoying my colleagues, I will ask tons of questions when in doubt, which I guess will probably be all the time, at least this year.

Another question: I'm a little worried about my limited opportunities to start IV's...how long will it take before I feel comfortable?

And to the new grads on landing a dream job, CONGRATS!!! :yeah:

I know that this is going to be stressful, but exciting! I :redbeathe allnurses!

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Jan 13, 2011

Hey Gurmo, good call! Worked for years in a teaching hospital, saw over and over that the people who thought they knew everything were incapable of learning anything. The nursing staff would figure them out fast. When new people were willing to listen and learn, the staff would go way out of their way to help them learn.

You'll get lots of IV practice in the ER. You'll have days when you can start them blindfolded, and days when your all thumbs. Never expect yourself to be superhuman. We all have our days, make mistakes, say the wrong things sometimes. Nowhere does it say you can be better than the rest of us! Via con Dios mi amigos!

Editorial Team / Moderator · Jan 13, 2011

Do not skimp on shoes ... be good to your feet, and your legs! Avoid junk food. Pack a lunch - it'll be healthier and save you money. Keep a couple of granola or protein bars handy for the days when you don't get a meal break.

Congratulations!! So exciting. :) My favorite book for the ED is Sheehy's Emergency Nursing: Principles and Practice. Fabulous book. Be a sponge!! Good luck!

Arr.enn2010 · Jan 13, 2011

new grad here also & i landed an ed job too! i'm excited & thrilled! i did my elective in the ed & loveddddddd it! if all goes well i should start the end of the month (i just passed nclex so i'm waiting on my official pass letter to be able to start) congrats to all my fellow "newbie" ed nurses! also thanks for all the info & advice~!

murphyle, BSN, RN · Jan 13, 2011

Congrats to you, LisLis!! I'm also a second-degree RN, started as a new grad in Emergency, and now have been out of school a year and in the EC about ten months. I love it down here, and I'm glad you're getting that opportunity too. :)

dthfytr and Lunah already nailed a lot of the big things for surviving life in Emergency, but I'll throw a few more out there:

1) Education, education, education - and not just in nursing, either. Read, take classes, do online modules, go to conferences, get all the education you can afford (both in terms of time and money). Your department educator should be your biggest resource here; failing that, go to your hospital's medical library. If your department will allow, arrange to spend time with your allied personnel (Respiratory Therapy, Radiology, etc) and learn how their jobs work. In EC, Respiratory in particular will quickly become one of your biggest friends. (They're also frequently very good at lung auscultation, so keep them in mind if you need a second pair of ears on a difficult chest.) On the subject of journals, you can either subscribe yourself or use your hospital's subscriptions where available. At a minimum you should be reading Journal of Emergency Nursing on a regular basis. You may also want to read an emergency medicine journal; just because it's written for physicians doesn't mean you can't glean useful info from it too! (Keep in mind that a lot of professional societies, such as the Emergency Nurses Association and the Society of Trauma Nurses, offer subscriptions to their respective journals as part of the membership package. ENA also offers discounts on subscriptions to ACEP's journals, which is nice.) Your department will likely require ACLS and PALS within a few months of hire, and may also require TNCC (Trauma Nursing Core Course) and ENPC (Emergency Nursing Pediatric Course) within a specified time frame, usually within a year. Even if they don't require it, go get those certs - they're a huge help in understanding the emergency nursing process. If you do well with those, you may want to consider going for your CEN once you get some experience.

2) Networking can make or break you. Every department will have at least one of the following: the IV wizard, the physical assessment guru, the walking library, the old-timer, and the pediatric specialist. Learn who these people are. Especially on elderly, physically compromised and pediatric patients, knowing who you can go to for help on a difficult line, procedure assistance or a "roadside read" is invaluable. You'll also want to learn quickly which physicians you can go to when a patient is showing ominous signs or just not looking right, and which supervisory/charge nurses will back you up if you're advocating for your patient and someone tries to fight you on it.

3) Don't be scared of resus. Everyone thinks that they'll freak out the first time they get called to a trauma or a CPR in progress, and 99.44% of them are right. However, the duration of that freak-out is much less than you think. Your brain will spend about two to five seconds (which will feel like an hour) going "OMGWTFBBQ" and then your training will kick in. You should attend your first few cases strictly as an observer - stand back with the scribe RN and watch the flow of the case. There is an accepted rubric for trauma/resus care, using the letters A-I (Airway/c-spine, Breathing, Circulation, Deficits, Exposure/Environment, Full vitals/Family support, Give comfort, History/Head-to-toe, Interventions). Try to tie everything you see back to this rubric if possible. Resus will start to make a lot more sense to you once you have some education under your belt, most importantly ACLS and TNCC (see #1 above).

4) Take care of yourself. Eat right (pack a lunch where practical; stick with the cafeteria's "healthier choice" options if not), stay out of the vending machines and away from the high-sugar pop and "energy drink" offerings, get an adequate amount of rest, and save the caffeine for when you really need it. Now is also a really good time to re-evaluate your health habits: quit if you smoke, start an exercise program if you're inactive. You'll want to focus on core strength, stretching, stability and body awareness - your back will thank you! Yoga and Pilates are great low-impact options, or you can do Crossfit for something a little higher-energy. You can also get in lots of "casual" exercise by parking in the satellite lots (weather and safety permitting), taking the stairs, etc.

5) Wise equipment investments: stethoscope, shoes, pocket drug guide (either print or electronic; either way make sure you get one with IV compatibility cross-checking!). I also recommend a good penlight and a pocket visual acuity card (handy for eye cases and CNS cases with visual symptoms). People tend to divide on the subject of pens and trauma shears. I invested in mine and love them; others swear by freebies.

Hope this helps! Best of luck to you!! :D:yeah: :yeah: