New ER Nurse

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So I've been a nurse for a year now. I've been on a medical surgical floor but I now have the opportunity to transfer to the ER. I shadowed a few weeks ago and love it. I didn't think the ER would be for me but the pace of it and the excitement was a rush. I also want to work down there because I am not growing on the floor I'm at anymore, not challenging at all.. and I want the chance to grow and learn all the things! I submitted my application. I wanted to ask anyone for advice for a new ER nurse.. and what anyone would suggest to maybe look up and study? Or tips on how to stay calm? Confidence, etc? 

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Specializes in Med-Surg, Geriatrics, Wound Care.

ER is not med-surg. The ER is there to treat the sick, and many of your patients will be sick. Prioritization is important and quickness. And getting labs and IVs. Yes there may be techs, but IV/labs are more important than waiting to find someone that is available to do it. Sepsis workup and quick antibiotics. Cardiac workup and timely labs. Stroke workup. Etc. Your patient that is screaming in pain from a stab wound not the priority (people don't die from pain).  Will also depend on how your ER works and what their "focus" is. They may prioritize things like getting discharges out and patients to the floor. Some may do teamwork (like if you see anyone with the discharge, anyone can send them home with the paperwork).  Priorities are no longer getting your "med pass" done, the ER doesn't stock all the floor meds. Boarding patients will be annoying.  Basic priorities. You now gotta do what you can to keep your patient alive.

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Specializes in Emergency/med surg.

accept that you are going to be nervous AF at times you may panic at times but you have to get a good poker face - I also came from the floor to the ED and almost thought I wasn't ready - my first time pushing adenosine I wanted to run out of there screaming and crying of how afraid I was - but my preceptor gave me no choice- she basically shoved me in the room - accept the fear, and roll with it -- roll your sleeves up and get in there - turn your fears into strengths that is the ONLY way - the zoll-defib used to scare the crap out of me too - so during codes I volunteered to have that as my role - If u don't face your fears they will define you - I also had a wonderful amazing group of mentors that taught me. Be ready to learn - be ready to be afraid - learn IV skills/ learn cardiac/resp- brush up on labs so you can anticipate what the docs want. Ask questions all the time - and also be prepared to have to earn trust of your colleagues - once you do its a lot of fun - it will be great! enjoy!

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Specializes in EM.

Welcome to our crazy world.

When I have new grads or even new nurses without EM experience, I share a set of 6 rote lectures. They are about the following.

1. Intubation: Why? a. low O2 b. high CO2 c. protect airway--that's it. What do you as the RN need to have ready MSMAIDS: Monitor, Suction, Machine (BVM, RT, or vent), Airways supplies (Glidescope, Mac, Miller, tube 7.0 7.5 8.0), IV, Drugs (sedation and paralytic), stylet.

2. ACS: What causes it? (know your patho phys) What do we do? Asa, O2, NTG, TNK. Lovenox, B-blocker, Benzo, Opiate, admit, transfer.

3. DKA: What causes it? (review the patho phys) What do we do? Find/treat the cause, fluids, insulin (slowly/carefully), obsessively follow the fingersticks, labs, and most important how the patient looks.

4. PE: It's been called the great masquerader for a reason. (review the patho phys) Maintain a high level of suspicion for SOB, CP, hypoxia, anxiety. Notice EKG changes (rare S1Q3T3), RR, and sats. These patients can die fast. What do we do? O2, Lytics, Heparin, Lovenox, new fangled oral anticoags, then dispo.

5. CHF: (review the patho phys). Yes there are many different types of CHF but focus on lungs wet patient not breathe so good. Goal get fluids off lungs and into urinal/foley bag. Give O2, nitrates then Lasix. Remember loop diuretics do little good when the vessels are empty.

6. Protocols: EM is being flooded with algorithms (sadly). First, learn 'if you are wrong in the DX.' the plan fails. Have seen tachy dyspneic patient aggressively treated for sepsis only to later realize they had a PE or CHF. That said, learn what order sets are used in your ED especially stroke and sepsis. Your docs are being pushed to use order sets, as the RN you need to know what orders you will see/do over and over again.

Final tips:

Unless the doc involved is an @&&, they will generally appreciate OMI: oxygen, monitor, IV and blood draw (for sick patients not sore throats).

After each of your first say 20 shifts, think of a patient and read about their dx when you get home. Takes 10 minutes but really locks in the learning.

Look at your colleagues. Who does well? Watch them, emulate them, talk to them.

“It may seem difficult at first but everything is difficult at first.” Miyamoto Musashi

 

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I can't imagine ANY med surg nurse thinking that they aren't "growing anymore." Med surg is so vast. It's endless ESPECIALLY as a 1 year nurse. Wow. Will the ER bore you too after you've worked one code but never paced someone? 

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