New grad ED nurse

rndiver82 · Feb 27, 2012

I started my RN career in the ER and worked in the ER as a tech for 2 years prior to that. You are correct that it is a different environment, but you are used to seeing critical patients, which will come in handy.

As a level 2 trauma center (the same level I started in) you are going to see pretty much everything, but there will be patients you will have to transfer to high level of care centers (there are usually neuro patients that the facility does not have a neurosurgeon available, they were the most often transferred). So really, there is not one book that you can read because you are going to get educated on pretty much anything that comes though the door. The biggest difference you will see: NO patient care has been started. You will be doing everything, and everything we do impacts that patient throughout their hospitalization. So be very proficient with sterile procedures, make sure to check your little frail elderly people for pressure sores and have your preceptor go over the benchmarks your facility follows when it comes to cardiac patients, stroke patients, pneumonia, etc. Because if there is something missed and it can be traced back to something you omitted in the ER, or you fall outside the benchmark, you get a talking to and you can actually cost the facility reimbursement money. Its not fair, but that is the evolving world of ER.

One more piece of advice: DEMAND ENOUGH TIME IN ORIENTATION. My orientation was 2 WEEKS. That was it. I was the 7th new hire, 5th new grad to start in that ER, however because I had 2 years of tech experience in an ER, they decided I did not need as much orientation as everyone else who had zero ER experience. I was terrified. Now, while I was extremely lucky to have been blessed with wonderful co-workers who were very helpful and a nurse manager who was an absolute wonder to work for, I would not wish that on another newbie. Looking back I shudder and envy those who get the longer orientations because it would have been so much safer and less stressful for me. I recommend to the new nurses I orientate to take the full allotment of time (my facility has a 12 week new grad orientation program that is wonderful) and if you don't need the full amount of time, at least you still have that safety net in place for added support because I guarantee once that net is gone and you are on your own, you will have the most amazing brain fart in existence and think you forgot everything you learned because the realization that you really can kill someone if you do something wrong is going to hit you full force. Don't let this scare you away, I think most new grads have this, and if they don't I think they just don't want to admit it.

ER is very challenging and a very demanding place to work. BUT, you see your patient improve, sometimes right in front of your eyes, and you will never have the same two shifts in a row with the same patients you saw the day before, doing the same thing you did, nearly the same care and what can become a very boring job. If you get bored in the ER, you have issues.

nurse2033, MSN, RN · Feb 27, 2012

You are right, this will be an experience. You could start by reviewing study material for the CEN. It has all the basic core knowledge you will need. Good luck.

VICEDRN, BSN, RN · Feb 27, 2012

There is an introduction to ER course offered by ENA that will also help you study for CEN.

I personally learn better by doing and retain information better when I can apply it to a particular patient care situation. Perhaps your time would be better spent gathering needed supplies and enjoying yourself?? ;-)

thedon781978 · Feb 28, 2012

Thanks for the input. our orientation is 10 weeks total, 2 weeks classroom, 1 week riding around with ems(which is kinda cool) and 7 weeks with a preceptor. I had planned on utilizing the entire time. I will look into the CEN stuff as i want to be as prepared as possible. thanks again

inthemood · Feb 28, 2012

I'm a new grad who is just finishing my orientation in the ED in a small community hospital in a suburb of LA. We are BUSY as all heck! We are very close to several level 1 and 2 trauma centers so we don't get too many severe traumas but we get everything else. My advice:

BE CURIOUS... ask whatever comes to your mind. Your coworkers will have no problem explaining things to you. You will quickly find out who you communicate well with. Build mentor/mentee relationships with the nurses you work best with. And stay away from the know it alls.

If you are in DOUBT... ASK!

Go back and read the basics from school... fluids and electrolytes, aseptic technique for Foleys, basic dysrhythmias, oxyhemoglobin dissociation curve (I think that one's REALLY important).

Don't freak out! Although I still kind of am! hahahaha take it one day at a time. Go home each night and maybe make a quick note about something that you didn't know. Sleep on it. Then when you are awake and fresh, grab some coffee and do some reading about it.

Lastly, join ANA and ENA. The Journal of Emergency Nursing is great!

Oh, and learn lung sounds with your RT. Learn proper nasotracheal suctioning technique. And use an SBAR sheet to organize your reports. Good luck

brainkandy87 · Feb 28, 2012

Never be shy. If there's something interesting that comes in, ask the nurse and/or physician taking care of that patient if you can assist.

Lauryen828 · Apr 11, 2012

Congrats, I work in Med Surg and I cant wait to be able to work in ED