New ER nurse, but old Cardiac nurse

Esme12, ASN, BSN, RN · Sep 10, 2011

What hints would you like?

Take TNCC, ENPC and any triage cources you can find.

MassED, BSN, RN · Sep 11, 2011

there's a small handbook (it's at work) that has a plethora of info from cardiac rhythms/algorithms, stroke algorithms, frequent ACLS meds, braslow meds, etc.... I think it's called critical care guide for the ER... something along those lines. I had gotten in on Amazon, but many places have it... has a lot of useful information.

jlr820 · Sep 13, 2011

Hi,

First, your prior experience in cardiovascular nursing will serve you well. You already have experience with assessments, rhythm interpretation, etc so that's good. What you have probably noticed is that the pace is different, as is the range of patients that you are dealing with. You will deal with such a range of patient acuities, ages, medical backgrounds, etc that it will sometimes boggle your mind. Thus, I suggest:

1. Assessments in the ED are more or less complaint driven. You don't necessarily need to do complete head to toe assessments on EVERY patient. You will learn who needs more thorough/more frequent assessments with time. You will also discover that you can do a fairly comprehensive assessment in under 3 minutes for most things. You should also become familiar with what some call "doorway" or "across the room assessments"...quick visual appraisals of how a patient "looks" as they are entering the room. Much can be learned about a patient's condition with what I call an "experienced glance." This is handy for those many times when I am in a room doing something for a patient and I can see the triage nurse placing another patient in one of my rooms. A quick visual tells me if I need to go and assess that patient right now, or if it can wait for a bit.

2. What is a priority in the ED changes sometimes minute to minute. Always be asking yourself "Who is the sickest patient? and What do I need to be doing next?" Efficiency is a watchword in emergency nursing. You really can only learn this from experience. That said, however, you are only one person and there's only so much that you can safely do at any given time. Know when to ask for help (and know that teamwork is essential in emergency nursing.)

3. Get used to using protocols to begin orders/treatments/lab tests. Hopefully, your ED has protocols that can be initiated by an RN before the physician sees the patient. This can really help to save time and streamline the care of patients if it will be a bit until the doc gets into the room. Learn what protocols you have and use them appropriately. This will be different from the floor, where you had to get an order for everything you did.

4. Always be wary of pediatric patients, especially infants. Kids compensate quite well, and they can go to hell in an eye blink. So, even if they "look good" right now, keep that healthy index of suspicion and reassess frequently. Also, listen to parents/caregivers. If they are telling you that the kid "isn't acting right" believe it.

5. It's easy to "write off" an intoxicated patient as being "just drunk." Be careful, and assess these patient's appropriately. Many times, these people have underlying medical conditions that are masked by their intoxication. Some also have underlying injuries (including head trauma from falls or assaults). Thus, don't simply leave them to sleep it off. Make sure you have assessed them fully (and this means that you will probably have to undress them to properly assess for any occult injuries.) and monitor them accordingly.

6. Similar to #5....it's also easy to write off what we tend to call "frequent fliers" (those patients who seem to be in the ED more often than the people that work there). I once read in "Emergency Nursing Secrets" that these people need proper assessments each time they present to the ED lest you ignore or miss a possibly life threatening issue.

7. Crazy people get sick too.