New ER nurse; brain sheet?...other survival advice/tips&tricks

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Hi guys,

I've been a nurse for 1.5yrs on tele, and I just got hired in the ED, will be starting next month! I'm aware it's not common for ER nurses to use brain sheets, BUT what did you guys use as newbies? There's going to be a lot thrown at me in the beginning, and I just wanna do my best to keep up. Any other advice/tips&tricks from folks that have been here would be much appreciated.

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Specializes in ED.

First off, congratulations on landing your job! That is very exciting.

I am very much still a newbie, I am just coming off of orientation for my first nursing job, so I feel like I am still in the thick of trying to answer all these questions myself.

During my first few weeks I tried really hard to keep a "brain" but the pace of the ED just moves too fast. If I kept a brain for each patient, I would go through a stack of paper a day. I also realized that all the information I needed was in the chart at my fingertips and the brain was really just a tool to organize and communicate information during a hand off, which would only really happen if the patient got admitted or at change of shift.

With this in mind I started trying to keep notes on the patients I thought would be admitted so that I could give a better report. For me, this morphed into just writing out a modified SBAR right before I called the floor to give my nurse to nurse hand off. Writing out this information helped me to give a coherent report to the flood and helped me to feel like I wasn't missing important details, which can happen when the department is busy.

Because I always give my hand off in the same way, with the same details in the same order, I now don't write out my hand off, I just look at the chart while im talking to the floor, and it seems to work.

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Specializes in Emergency Department/Trauma.

Congratulations on the new job! I'm old school and not actually sure what a "brain sheet" is... Is this like a report sheet? Where you write information on the patient? If this is what it is, in the ER we don't worry about the typical stuff they would think about on tele. ER nurses don't really care about skin issues, patient's full history, etc. Bascially we just care about #1-what are they here for, #2 are they sick? I work in a busy county hospital/trauma center. I know nurses are generally taught not to judge a book by its cover. However... I always judge my patient's for 2 things. #1-Are they sick or not sick? When I say this I mean, is something bad likely to happen to the patient if I leave the room for 30 minutes or more. #2- Are they likely to try to hurt me? I know this sounds terrible, but where I work it is not uncommon for patients who are intoxicated, high on drugs or with mental health issues to hit, kick or otherwise attack nurses. Not sure if this is helpful or not.... good luck in your ER career!

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Thanks! @MotoMonkey; super stoked! Haha what you're saying totally makes sense, and I'm sure ill figure that out myself real quick lol. Order is key. Thank you for your insight, and keep up the good work! Continue leveling up ??.

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Thank you @rn1255! I love ER nurses i swear lol; dig your answer. something tells me ima love this chapter? Thanks again ?

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Specializes in ER.

I assume you have computer charting. I use launchpoint on Cerner as my visual reminder as to my tasks and meds due, and which patients are mine. The nursing brain automatically prioritizes those tasks after awhile.

In a fast moving emergency, grab a paper towel to record times of meds and tasks to chart on later for a more or less accurate timeline.

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On ‎12‎/‎16‎/‎2019 at 5:08 AM, shakabrah said:

will be starting next month! I'm aware it's not common for ER nurses to use brain sheets, BUT what did you

Congrats, I myself will be starting next month in the ER. Most of the ED nurses I spoke too, they just stick to the chief complain and pertinent labs, imaging...etc.

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Specializes in Emergency Department/Trauma.

Yes!! ED nurses really only care about chief complaint, stable/unstable & concerning labs.

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On 12/21/2019 at 2:25 PM, rn1255 said:

Yes!! ED nurses really only care about chief complaint, stable/unstable & concerning labs.

All of which is in the computer.

I strongly encourage you to learn to use your system quickly and efficiently.

Motomonkeys progression and advice is a good way to go.

Other tips?

Go into the room as you are wiping the alcohol on your hands, introduce yourself by name, title and the reason you are there. "Hi, my name is Ermintrude, I'm one of the nurses here. I am going to start an IV, draw some blood, and give you some medication for your nausea." This takes exactly zero extra time, and establishes you as a professional while keeping the PT informed.

Don't go more than an hour without seeing a PT. When you do, document it.

When faced with a choice between good patient care and good documentation, make the choice that helps you sleep at night.

The patient who needs you most is probably the one that can't use the call bell. Prioritize based on the severity of the complaint, not the volume of the person voicing it.

We don't see people at their best. Cut them some slack.

Just because the cops brought him in, doesn't mean he doesn't have a boxcutter on him. Ask that the officer ensure there are no weapons before he or she leaves.

There absolutely is such a thing as a dumb question. Ask smart ones. If you don't know something, and can't sort it out yourself, ask. If you need help, ask.

Many docs are good teachers. Figure out who is, and gain some depth to your understanding of particular work ups and treatments.

When you ask another nurse why something is done a certain way, and the answer is "It's how I was taught", smile, nod your head, and then learn the right answer.

When dealing with other departments, be nice. When calling, be friendly. It makes the day go much better, and will help you in the long run.

If you aren't doing anything, ask a peer how you can help.

We see a lot of irrational people. Expecting an irrational person to act rationally makes no sense. (hopefully this does not apply as much to co-workers)

You can't control what comes through the door. You can't control how other people act. What you can control is the attitude you bring to work. Bring a good one.

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Specializes in ED main with cardiac secondary.

I went from cardiac step down to a very busy ED. The learning curve was huge. My top advice to my preceptees and my new staff are as follows:

  • the fast paced environment will take time to get use to and master. Don't get discouraged
  • Learn your charting system and what questions it asks in the power forms so you can ask them in one swoop and document later if need be.
  • accept you will always feel behind. Embrace it! Let it drive you to keep your head down and work harder and faster till you get the hang of it.
  • once you get over the shock and awe of the transition, take a couple weeks at home to think and learn about each disease process. Knowing the disease process and what labs/meds/rads are needed will make you work faster
  • The ED is a team, from triage nurse, ed tech, bedside nurse, charge nurse, physician, APP, rad tech, and everyone in between. Talk to your team and work with them. Talk to the doctor, share your gut feelings
  • trust your gut feelings!
  • finally, something that is overlooked is documentation. It may take five minutes but that is five minutes that saves you. Every time you leave a room make a nursing note [pt with chest pain complaint (pt sleeping upon entering room. upon waking complaining of 10/10 pain. PT is sinus rhythm on monitor with rate of 80 no ectopy. Informed MD Smith of pain. awaiting orders)]
    • make a word document of common documentation phrases such as the one you see above and just copy and past and change relevant details.
  • Take your break. There will always be something else you can do but you are human. You need to pee/poop. You need to eat and drink. You need to decompress after a rough code or getting punched. Document a sign off (gave report to RN Smith for lunch break) There you are covered if *** hits the fan. And if your ED is like mine at times, there is no extra nurse for break so you and your zone buddy or if you have a nice charge like me will cover your lunch. But always document.
  • Finally have fun. ED is a very exciting place

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Make friends with the Housekeepers; if you lose a pen, a stethoscope, etc... they are the ones that will have it or know where it is.

Take a lunch that does not have to keep cool or heated until you figure out the lunch and refrigerator and microwave situation.

The EMT's will take as many pillows as they can so keep a few tucked away if possible.

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