I'm New To ER...Share some tips please?

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Specializes in Emergency.

Hi all,

I have been a nurse for a little over 4 years. My speciality is tele/cardiac stepdown. I have been with an agency for the last few months, and 2 months ago, got an assignment to task in the ED of my local hospital. I loved it so much, and I guess they loved me, cause they requested me to work, and trained me on their computer system. I applied for a job, and got it, and I start next week. I am very excited to be a permanent part of their staff, I like everyone I have worked with so far, and I have wanted to be an ER nurse since before nursing school. I have gotten into the rhythm of the ED and have even participated in some traumas and codes (which are very different from the floor codes I have been involved in). They are looking forward to having me there, and I do have to go through a preceptorship, since I am not an officially trained ER nurse. My question is, what should I try to concentrate on learning? I know this is kind of a general question, but I have been taking patient assignments in the ER, but I feel like I learn somethong new every day, and in the ED we give drugs I am not familiar with, so how did you guys learn the ropes?

Any advice will help

Amy

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Specializes in Telehealth, Hospice and Palliative Care.

Congrats!!! I am anxious to hear what responses you get, as I am on day 2 of orientation for my new ER position. I wish I had YOUR knowledge! (I guess the matter is always greyer in the other nurse's brain!)

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Specializes in ICU, CCU, ER, PACU, tele, PSYCH.

depends on how may patients you have, our ed has 4-5 a piece. prioritize, get to know what docs want what and protocols for speeding up getting them in and out ie, lab draws, work ups , xrays. oh always make em put on a gown and usually pee in a cup will save ya some aggravation. get a good drug drip book or smart ph apps (medical wizzards em/icu suite) etc will save ya some time. you will get to know the frequent ones, lol.. Main thing is don't over rely on your techs if ya have them, they will make ya or break ya on how ya treat them. Be VERY nice to the secretarys. that is just a few tidbits, ask lots of questions to start and wear very comfortable shoes.

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Specializes in ER.

I try to get in the room before the doc, get my assessment done, start the line/labs, etc. We have standing orders and once you work with the physicians enough you know who wants what done. This way, I'm not waiting while he talks to the patient - I can move on to charting or seeing my next pt.

I also agree with everything rentalnurse said :D

One other tip - I bring small ziploc snack bags so I can eat on the go. Otherwise, I might go 12 hours without food.

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Specializes in ICU, CCU, ER, PACU, tele, PSYCH.

oh yeah forgot the important snacks, im a walking snack bar and drink shop in my bag. we have a policy of no drinks at the desk and break room is far away and who gets time to go there ( if ya cant get a bathroom break how are ya gonna go get a sip of drink) i carry a messenger bag and keep it under the desk, some places have policy of no bags at desk, they were trying that too.

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Specializes in Emergency.

Thanks for the tips! I just finished my last shift in the ER as an agency nurse, and I start next week as permanent staff. Last night was a real doozy though! I had 4 bays and I was busy ALL shift! Every patient was either critically ill or just really time intensive (1 insulin drip, 1 flash pulmonary edema on BiPAP, 1 BAD GI bleed with transfusion, and 1 AIDS with pneumonia), all high maintenance and "involved" family members! Talk about trial by fire! I had to stay 2 hours after shift to do my charting. I had so many post its and paper towels with notes on them, and trying to make sense of them after 12 hours nonstop was interesting to say the least, and they all needed to be admitted, and we just couldnt get beds fast enough, so I had to leave that for day shift. Thank God for the other staff because I would still be there if I had not had help! But, I loved every minute of it, which I guess only an ER nurse would understand...

Keep the tips coming!!!!

Amy

P.S. I agree with RENTALNURSE about the snack pocket!

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

I like to bring protein shakes so I don't have to try to do any snacky-finger-food stuff. Easier to consume a shake!

Welcome to the madness! :D

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AL7139, to help with organization make yourself a "brain sheet," just a sheet for each shift with boxes and lines that separate your rooms. you can make notes on it to make it easier to remember who's who.

You can design it however works best for you. It saved me in the early days when I would give report and couldn't remember the specifics of each patient.

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Specializes in peds cardiac, peds ER.

Hi Amy!! Thanks for the post, I am reaping your responses too. I have done peds tele for 5 years and yesterday was my 2nd night on orientation after transferring to ER (still peds, a level 1 peds trauma ctr). I love it! So different, but of course that's exactly what I wanted. I learned more in the last 2 days than I have in quite a while, I was getting stagnant and I am so glad I made the move.

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Specializes in ED.

Yes be nice to the ancillary staff, I appreciate all of them. This way when I need something from the STAT they will usually be there to help me.

Also figure out what docs are just plain mean and which ones are the nice teachers. I have a few meanies where hald my charting is covering my ass cause the doc does his cookbook medicine and sometimes just orders completely unnecessary stuff. Other docs will take a few minutes to explain what they are looking at or why they picked one medication over another.

Help your other nurses when you can, even if it is just starting a line on a STEMI patient. Hopefully they will jump in and help you when you have that crashing pt.

Eat fast and pee fast too :)

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Specializes in Emergency Nursing.

Kudos x 12 to the prior poster for the suggestion: "Get the patient into a gown and have them pee in a cup" This really WILL save you a lot of time.

Here are some other things I've learned:

-Anyone who comes in that doesn't have an entirely BS chief complaint gets locked and labbed. You never know which route your MD/NP/PA might go down. Trust me, I've had the twisted ankle turned into a possible syncopal event bla bla bla with a perfectly healthy 20 something.

-Everyone is NPO. I mean EVERYONE. Unless oral contrast is ordered etc...

-Question every order. Sounds simple enough, but with the volume of my ER, sometimes orders are written on the wrong patient!

-The key to keeping family members at bay is to keep them informed. Even if you poke your head in and say, "Hey! I don't have an update for you, but you'll be the first to know!" With that being said, actively seek out the status of x pt.

-If I have an ambulatory pt I'm walking back I make use of the time and ask about health hx, meds, and their complaint. That is, of course, with the utmost sensitivity depending on the reason for the ED visit. By the time I get to the room I can assess, place and IV, and be on my way.

-Before administering any med, ask if they have med allergies. The pace of the ED can cause this to be overlooked very often.

-Before administering a narcotic..."Do you have a ride home?"

I think the most important thing I've learned (being newer to the ED) is to watch out for yourself. Don't let the charge nurse stick you with two LVADs, a demented LTC pt, and a suicidal pt. Remember, you are liable for said patients. Speak up! Tell someone you don't think said assignment is safe before you assume care. A good leader will take your requests to heart. Also, know when to ask for help.

Good luck!!!

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Specializes in Hospice, ER.

make friends with everybody: techs, volunteers, dietary, cleaning staff. makes you life so much easier. if someone ask you if you need help say yes if you do. don't drown trying to be supernurse. listen to you gut.

"kudos x 12 to the prior poster for the suggestion: "get the patient into a gown and have them pee in a cup" this really will save you a lot of time." make this your mantra.

don't wait to start a line and pull a rainbow. er docs expect you to be proactive. get the ekg. run a urine preg if you need one. if you find out the patient is on a particular drug and needs a level run, tell the doc. they don't mind (usually). i witnessed a terrible situation where nobody picked up on the fact that a pt was on coumadin. lets just say i was glad my name wasn't on he chart. and if the doc gets mad, too bad. its your license.

don't say "its not my patient" "i didn't go to nursing school to give bedpans" "its not my job," because you will not last. we all have to help each other and stick together.

communicate to patients and their families. it helps a lot and they don't haunt the desk as much.

admit what you don't know. you can't know everything. if you don't feel safe, speak up. stand up for yourself. its your license, not the doc/charge/supervisor. yours.

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