NEW ED NURSE and Requirements and Questions

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I am a Med/Surg RN for 2yrs and I recently just got a job in the ED at Well Cornell in NYC. To work in the ED, I have to obtain my ACLS, PALs, and pass the arrythmia test. I have some questions for those of you who have been through this process.

What is included in the Critical care course?

Is the arrythmia exam very difficult? I hated EKG strips in college.

When do they usually start teaching you about putting in IVs?

Any advice for working in the ED?

Was anyone nervous about catching wierd diseases?

Any responses would be beneficial. Thanks

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Specializes in Trauma/ED.

Critical care course? Do you mean ACLS and PALS? If so you learn how to run a code in these classes including what meds to give how much of the med and when to shock etc--the PALS is the pediatric version of advanced life support. You should take the arrhythmia class first (is what I did) so you are more familiar with the strips you are required to read in the ACLS and PALS classes.

Not sure about the IV question we always did our own IV's on the med/surg floor I worked on so I never lost my skills from school. Maybe they send you to an IV cert class like they have for EMT's?

The biggest change or adjustment I'm having is the pace. You really don't have time to "chat" with your pt's much. You have to get very problem focused in your thoughts and all your discussion should be about s/s and is your intervention working or are the s/s getting worse and you should talk with the doc again.

I also am not very confident with my EKG strips but this has not been an issue yet because the docs are right there and there is a lot of more experienced nurses around to help. As long as you can recognize a potentially fatal rhythm and as long as you know when to hook your pt up to the monitor so you can see this potentially fatal rhythm you should be ok.

We have another class that is required called the TNCC (Trauma Nurse Core Curriculum) which I believe teaches more about traumas etc--I am scheduled but not taken it yet.

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Usually it's a basic test, identifying PAC's, PVC's all the different degrees of heart block, calculating rates.

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I meant the basic arrythmia course that all new ED and ICU nurses have to take. Was it difficult for those of you who have taken it. I have not been in school for 2 yrs so im nervous

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Specializes in ICU's, every type.

well, more importantly, what type of ED is it and what length is the orientation as well as the staff ratios? My current facility teaches a 3 day basic dysrythmia course with a test at the end that you have to pass, then you're paired with a phlebotomist and need to do 25 draws. You learn IV's on the job, the painful way.

Being as new as you are to the fast faced ER envir. I'd ensure an excellent orientation (assuming it's not a ho dunk facility that farms everything out to outlying, then you're ok). The hardest thing you'lll encounter is that ER is purely task oriented, start an IV, draw labs, place on monitor, run tests, ekg's (the doc's read 'em not you), drop NG's, foleys, code people up the wasoo... so you need to know what you're in for... do you do peds? are you a level one? how is the trauma's handeled, drunks, psyc. patients.....

and to further answer your questions, any critical care course, is nothing but a benefit.... you'll learn IV's and you're skills as you go... ask for help, EVERY patient is AIDS and HEP B, just get used to wearing gloves at all times ... don't let those little granny's fool you and you'll be AOK, study those ryhthms durring the course.. it REALLY will come naturally after practice so will ACLS and PALS.

let us know how goes and take this great experience in stride, the ER is nothing but pure skills, adrenaline and chaos... period. know this, love it and you'll be ok.

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Thanks king of codes for all of the info. My new job is in a Trauma 1 ED. We treat pediatric, trauma, burn, sub acute, acute, and psych patients. I took my ACLS course and passed, so thats 1 step out of the way. It funny you mentioned the "lil old grannies" because that is one of my biggest fears about going to the ED. I am terrifed of getting a needle stick. Is this common?

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Specializes in Alittle of everything but mostly ER.

The critical care course I had to go through (way back when) involved both ICU, CCU and ER nurses. We were taught alittle about alot of things-- EKG's, rhythm strips, A-lines, Swans, Intubating, Ventilators, chest tubes, etc. It made us all alittle more rounded. I don't know if they still do this with everything being so specialized now.

When I was new, sometimes it was difficult to learn how to prioritize my patients. Just because some patient is loud or demanding doesn't mean they get all your attention. The quiet "good" patient on a stretcher may be your sickest.

The best tip I can give you is to keep up with your documentation. Whether you still use nurses notes or computerized charting, don't let it wait because you will forget......and sometimes forgetting things may come back to haunt you in a lawsuit.

Enjoy the ER! It's a great place to work and never boring!

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Thanks king of codes for all of the info. My new job is in a Trauma 1 ED. We treat pediatric, trauma, burn, sub acute, acute, and psych patients. I took my ACLS course and passed, so thats 1 step out of the way. It funny you mentioned the "lil old grannies" because that is one of my biggest fears about going to the ED. I am terrifed of getting a needle stick. Is this common?

You shouldn't have to worry about needle sticks in the ED than you would on any other unit. Take precautions, don't get lax in your standards and you should be fine.

As a matter of fact, we've seen more needlesticks from nurses and techs from the floors than in the ED in our hospital.

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