New in ER

[RiverNurse]

Hi all,

I made my way through my first year in nursing - yea! I've decided to give myself two yrs to work in different environments then make a firmer decision on which area of nursing I might like to be in. I am in ER now, just went there a few weeks ago. I am half way through orientation.

The other night, I made a huge faux pas (the second in two nights consecutively with the same doc). A pt came in with ETOH and a banged up shoulder. I wrote an order for an xray - one of the docs signed the order. Pt comes back from xray - chart stays on my desk. Here I am thinking that since the doc had signed the order for xray - that he'd "accepted" responsibility for the pt and was going to see the pt. Not so. It was a full hour before the doc saw that pt - I asked if he'd seen the pt and hadn't. I ended up holding the chart... Well, doc blew up - justifiably so.

right now I'm just licking my proverbial wounds. I'll get over it. I am a little discouraged tonight, though, wondering once again (a rare thing these days - LOL) if I can actually do the work (Yes, I can). What can I do to "learn" to think like an ER nurse? I do like the work. Also, I have a problem with IV sticks - and I'm beginning to get "the look". Any tips, advice?

And, LOL, yes... I'm hanging in there.

Many thanks!

RiverNurse

[Larry77, RN]

IV's...just keep practicing maybe talk to someone you like who is really good at them and get some personal pointers (also there is a lot on IV tips if you do a search). On little mistakes like you mentioned we all have done them and lived through it, you will too. I know they don't seem that small to you but nobody died so they really aren't that big. With the doc that's been involved on both, you may have to work a little to gain his/her trust but you will as your skills and knowledge grow...just wait for the first time you save their butt.

[JoshuaAdamsRN]

It sounds like you just need to get a clearer idea of what the advanced nursing protocols are for your department and what's expected of you as a nurse. If the doctor signed the order, I think you could rightly expect that he or she follows up on the results. Collaboration and clear communication is key.

For the IV starts, do you have difficulty locating the vein or actually cannulating it? Knowing your anatomy is helpful in picking an appropriate vein. A lot of students and newbies make the mistake of going too deep and at too high of an angle. When I went to a new hospital and begin using a different type of catheter, it was almost like learning to start IVs all over again. One of the tricks I learned to help form the "muscle memory" of cannulating is to take a urinary straight cath and tape it at two ends to the desk. You can use it over and over again to practice inserting the needle and then pushing the catheter in.

Good luck =)

[Hilinenursegrl]

I just started in the ER 6 months ago and it is also my first nursing job out of school. I'm not sure how things work in your ER but here the nurse goes to triage and take vitals and get h/p. If an xray had been ordered, the tech will let us know when the pt is back and I let the doc know to go read the xray. It is not my job as the nurse to go look at the xray, I wouldn't even know what to look for. The doc will then go see the pt and I will assist if he needs any, then I do the dc papers. Sounds like communication failed in several areas in your situation.

As for the IVs, I am just now getting comfortable with them and I feel that was what my problem was, I just didn't feel confident enough so they scared me. Talking with many of the nurses whom I graduated with, I find that several of them have never done, or done very few IVs because they either have an IV team or the pts come to the floor with them already.

Another useful tip, don't be scared or intimidated by the docs, I had to learn that the hard way, after I established my confidence and place on the ER team things ran much more smoothly. Good luck and don't lose faith!