Just got a job as a new grad in ER - need advice

[tonytorres717]

So I just graduated nursing school, and I got my dream job in the ER. I had 2 semesters of experience at the hospital, with occasional rotations through the ER. I instantly fell in love with it and knew that's where I wanted to be. The hospital has a very successful internship/preceptor program that I will be a part of.

I am mostly excited, but also nervous (as expected i'm sure).

I have a few questions and concerns as well as areas of improvement.

Hopefully you can help me out!

What is the "flow" of the ER like? On med surg floors it seemed to be more systematic, but in ER sometimes I got lost with what needed to be done. Granted, I was a student but I would just like to have an idea of how the ER "flows". Like how does the patient care process happen from admission to admit/ discharge? This is vague, I know. But hopefully you get what im saying. With the chaos of the ER, what keeps you level headed and focused on the task at hand?

-In your opinion, what habits do I NEED to get down as an ER nurse? Or let me rephrase, what habits have saved your butt? This can be a general answer or more specific.

- Lastly, If I feel uncomfortable with a certain skill or procedure, what is the best, safest, and fastest way to learn said skill? Any tricks of the trade?

-If you have any other advice for a new ER nurse, feel free to let me Thanks everyone! :)

[Lev, MSN, RN, NP]

Congratulations on your new job!

I came from med surg and went to the ER. The ER too is systematic. There is still documentation, there are still policies to follow. Even codes are systematic in a sense. Follow ACLS (ok try to follow it) and at the end every patient gets a vent, an NG/OG, a foley, at least 2 lines, and an ICU bed. The difference is how often you may need to stop what you are doing and go do something else more important at the time based on your constant prioritization because you are dealing with a wide variety of patient acuities. In the ER, prioritization is embraced. And while we still have some customer service stuff we need to follow, it is way better than it is on the floor. Because this is the ER. And the E stands for Emergency.

The number one habit that has saved me is to document as I go and not move on to the next patient until I have finished with the first one...unless patient number two is a critical patient. In that case, I stop whatever I'm doing and go straight to the patient who needs me.

The way to get good at skills is practice. Do not look to do things fast at first. Focus on doing it right. With practice comes skill and speed and you will be able to do it well quickly and without thinking about it.

[tonytorres717]

Thanks!! You really gave me some good perspective in regards to prioritization :)

[Bobjohnny]

There is some good advice on prioritize tin already posted. A good preceptor can teach that some as well. Example: it is more important (most of the time) to check in a new patient than to discharge one.

As for skills, it's the same as always: see one, do one, teach one. There will occasionally be times you follow the do one, teach one model.