If there was one piece of advice...

calicamper · Mar 22, 2005

For Dixielee especially, thanks for taking the time to write up this advice. I start working in an ED in October. Very much appreciated your suggestions, and everyone else's.

Get yourself an ER related pocket resource book. The one I have was about $20, and is called Emergency Critical Care Pocket Guide, ACLS version. There are other more expensive ones, but this one is fine for me.
You can take a drug book, but it will be easier if you have a PDA with some good drug programs. Epocrates is free to download and there are others you can buy. You have lots of quick drug info at a glance. You can also have drip calculations, etc instantly. In the ER you don't always have the luxury of flipping thru a resources book.
You can get a good PDA with 32 mg RAM for under $200, very well worth the money!
Don't be afraid to say, "I don't know but I can find out", and do it! Keep a small notebook with you, pocket sized, and when you get little pearls of wisdom, write them down. I also keep a pocket calculator with me, it is quicker than the calculator on the PDA. I also keep a little cheat sheet taped into the door of the calculator that has common names of intubation drugs, some docs may ask for Sux and some anectine....they are the same drug. Same with pavulon and pancuronium, vecuronium and norcuron. This will save confusion when you need things in an instant.
When you are in your first code, pick one place to be an observe all you can. Or place yourself in a position to push drugs, or hand drugs from the cart, or record. Don't try to do everything. Stay in one place and learn that area well, but watch everything and learn. Stick around for the post mortum care. You will learn a lot by asking questions at that time.
Realize that most emergency dept patients are NOT emergencies, and will not die if you do not jump immediately. In reality if you did not care at all to most of them in an entire shift, they would not die! They might be miserable, but they will not die. Do what you can when and where you can. You can not start 3 IV's at once, but you can prioritize who gets one first. Keep commonly used IV supplies in your pocket, i.e. alcohol swabs, tourniquets, extra catheters, Yes, your pockets get full! I like the cargo style scrub pants, because of the 2 large pockets on the sides and still use my scrub top pockets for other stuff. Once you decide what goes where, put everything in the same place every time, and you will not have to fumble for things.
Also realize that even the most experienced nurse will have questions about certain things, so don't be afraid to ask questions. I worry about new grads who think they know enough rather than those who are a little insecure. If you are not insecure, you are probably dangerous.
Most of all, try to enjoy the adventure. You will see things people in other walks of life can not even imagine. You will see the best and worst of humanity. You will see situations turn on a dime, so be ready. Never take anything for granted. The little old lady who looks sick but does not complain is usually in much worse shape than the ones who scream, yell and demand care. Watch out for the quiet ones, they will come back to bite you on the butt!
Good luck, you will be terrified much of the time in your first year, don't worry, they can kill you, but they can't eat you!

TinyNurse, RN · Mar 28, 2005

I NEED to reply because I want to help.

I started at a 9 bed ER and then moved to a level II where I was taught to "go with your gut"

I now work in a level I, and i take this advice with me everyday........ and it has never done me wrong..............

so......."go with your gut" has been my best advice ever......... do you think they need labs/ekg............and make sure you are confident and go with your gut

Peg804 · Apr 7, 2005

Welcome to the wonderful world of ED nursing. The best piece of advice I can give you is that you can only do what you can do. You have one brain and two hands. You can do one thing at a time. Don;t try to do everything. Take a look at the big picture. Remember most people that present to the ED do not really need to be there. But those that do deserve the very best that you can give them, and the others can wait. ED is by priority, that is just the way it is. Use your coworkers, maybe they cannot do the tasks for you, but remember that they are there, and you are not alone. Most importantly remember people die, no matter what we do, or how well we do it, they die. Young or old, it is their time, and there is nothing that we can do about it. Do your best, that is all that anyone can ask of you, and all you can ask of yourself. Good luck

MrsWampthang, BSN, RN · Apr 7, 2005

Develop a tough hide to protect you against the patients, family members, friends of patients, and most of all, the ER docs that will yell at you like it's your fault something didn't get done fast enough. Never take it personally either.

Watch out for the quiet patients, they're the ones that are the sickest. When someone tells you they feel like they're going to die, believe them and get the code cart! They're probably getting ready to go toward the light! :chuckle

Wearing all white is almost a sure guarantee that you are going to get vomited or bled on! :chuckle

The loudness of the patient's complaint is directly inverse to how sick they are. :chuckle

All bleeding stops......eventually. :)

I'm sure I will have plenty to add after I have thought about it some more!

Good luck in the ER!!!!!

Pam :balloons:

grammyr · Apr 7, 2005

We have a little bell at the triage desk for after hours visitors. The number of dings on the bell are inversely proportional to the severity of the illness.

ER-RN-2B · Apr 9, 2005

I just found out today I have a job in a level 1 trauma center when I graduate! I am scared to death and excited. The director during my interview said that the best thing to do was to never be afraid to ask questions. I have heard it's important that you don't go in acting like you know everything or try to be too confident. If someone wants to teach you something you already know, just let them, you might learn something new.

Altra, BSN, RN · Apr 11, 2005

I have soaked in every word of this thread -- after much consideration, I'll be taking a job in an urban ED after graduation. I currently work as a tech in a smaller hospital's ED and I've realized how much more I enjoy the ED environment than other clinical units, although I've learned TONS everywhere I've been for clinicals.

It's especially encouraging to read that FEAR is to be expected, 'cause I've got a major knot in my gut! :chuckle Nothing ventured, nothing gained, I guess.

Thanks to all of you who have posted! :bow:

grammyr · Apr 11, 2005

And always remember that no matter how long you have worked in the ED, there is a lesson to be learned everyday cause everybody has a different story.

Welcome aboard!!!! you are gonna love it!!

PatrickJ · Apr 11, 2005

One fast bit of advice that means so much with so few words

Measure Twice, Cut Once

The above replies are wonderful bits too.

:)

Patrick

cheripa · Apr 13, 2005

Thanks for all the advise. I have been getting negative feedback when I tell nurses that I tooka job in the ED. This is very discouraging... After reading your posts, I have a lot more confidence that I am making the right decision. :balloons:

ImaERtraumaRN · Apr 13, 2005

Thanks for all the advise. I have been getting negative feedback when I tell nurses that I tooka job in the ED. This is very discouraging... After reading your posts, I have a lot more confidence that I am making the right decision. :balloons:

I can totally identify with this. I have come to the conclusion that I would probably encounter this no matter what area I chose. Some nurses say that you shouldnt specialize until you have had some med-surge under your belt. Others will tell you that since the ED is a world of its own that you may be better off being "molded" into one rather than transferring in. The bottom line I have walked away with is this - work hard, make sure you demand plenty of orientation and training and follow your heart. So thats what I am going to take and run with!

Peg804 · Apr 14, 2005

Don't listen to those who discourage you for taking an ED job, it is the most wonderful place to work. The people you work with will become your extended family, much stronger than those who work on the floor. You will learn from each other. I am thankful that I work in the ED I do, I can rely, and you will too, on those you work with. the formality with MD;s is not there, yes they are the doc. but. atleast where I am, there is an "we're all in this together" feeling, The docs actually ask for ideas, especially with arrests, medical or traumatic. You trully gain an entire family. It is hard work, dinner is an afterthought eaten while standing in the kitchen, etc. It is never the same, unlike the floors, you have to know alot about everything from the neonate (rate) to the geriatric, medical to trauma, etc, But it is the greatest place with the greatest people I can imagine. Good luck to you, ignore those that do not support you, get all the education you can. If I can do anything for you or answer any questions (I am said by some to be old-can you believe that-I do not) let me know-if nothing else I am here for support,