New Grad Entering ER

Posted

Hello everyone

I've been on this site for years and I have now passed nursing school and this is my first time making a thread. I am SO nervous about starting my new job in the Emergency Department. I accepted a position with a residency program and I was wondering if anyone has any advice to give to a new grad. Is there anything that I can do in the meantime to prepare.... any situations that stands out to you all that you have learned from? Any advice is helpful!

bitter_betsy

bitter_betsy, BSN

Specializes in Emergency / Disaster. Has 3 years experience. 455 Posts

Keep your mouth shut and your eyes open.... kidding... Sort of.  

I was once told that if your mouth was open, your ears were closed and you weren't listening.  It is important to take in everything that is going past you.  I was in a residency program and I learned a lot.  Most days there was so much information I felt like my head was spinning. I still feel like I don't know anything on a daily basis - but my performance shows otherwise. There will be a lot of information moving past you.  Don't try to take it all in immediately.  I still reread my residency stuff and I'm still learning from it.

I think the thing that helped me the most, was to write down what was wrong that I had with my patients in the beginning and a really brief overview of what I did that day.  I mean like 5 minutes writing after shift no more.  My goal was to keep my patients alive during the shift.  Not that I didn't care what was happening with them at the time, I just didn't have time to look up everything that was going on in the moment - and still keep them alive.  On my days off, I would go back and learn about what was wrong.  The experience was recent in my head and I had time to kind of put the story together.  The next time I had a similar patient, I felt a little more confident.

I have since learned that there are "hand" IV people and "ac" IV people.  Don't think that you have to be like everyone else and be comfortable getting an IV anywhere.  In an adult ER, go for the AC.  I put a 20 in almost everyone's AC, unless I was sure I could get an 18 if they needed it.  Most of your scans won't require more than a 20 and the majority of people do still have an AC.  If not - turn that arm upside down and look on the bottom side.  If you stick that sucker - just make sure you stick it going the right way. You will quickly learn who needs an IV and labs when they show up in your room.  There are some things you will get comfortable with very quickly.  Other things will take a little more time.

If you really don't get along with your preceptor the first week - figure out why or ask for a new one.  Don't be shy.  My preceptor was awful and I was forced to stay with them until her husband got covid and ended up on a vent.  Then life got so much better for me.  A new preceptor made all the difference for me.

Don't think you need to know everything on day one.  They expect to train you, but they also expect you to have initiative.  Take care of your patients first, then help others.  Don't be afraid to ask for help.  Don't be afraid to clarify.

One of my defining moments with a charge nurse was on a day when I needed to choose a dose of medication.  I was given a range in the orders, but I had no idea where to start.  I went to my charge nurse and asked.  I laid out the scenario and his answer was "use your nursing judgement".  I got a little bit angry and said "I don't have nursing judgement yet".  I pulled myself together and asked if we could discuss it in more detail so he could teach me.  He did, and it actually changed our relationship moving forward.  I would explain what my guess was and he would help guide me - it ended up being a great teaching moment for both of us. The moral is - don't expect yourself to know something you don't know and don't just guess.  Nursing judgement is learned from being in a situation.  You have to start somewhere, but you don't have to do it alone.

You may cry in the beginning because it can be overwhelming.  It's OK. You will learn and you will be successful.  ER nurses are a special breed of humans.  Welcome to the family.

RuralMOSchoolRN

RuralMOSchoolRN, ADN, RN

Specializes in ER/School/Rural Nursing/Health Department. Has 16 years experience. 95 Posts

How exciting! I was also a new grad going into the ER. 

I agree with bitter--watch a lot, do the things you feel comfortable doing from the start, ask if you have questions, and don't be hard on yourself.  I went home crying in my car a bunch the first month--but then a lightbulb turned on and I started "knowing" what I was supposed to be doing and got better at things like difficult IV, setting up spinal taps and chest tubes, etc.

Things you can do before you go.  Review ACLS drugs and rhythms.  There are tons of great Youtube videos now!  Also, review steps and drugs for setting up a chest tube.  Get a really good pair of shoes and break them in prior to working in them.  

A lot of the things my preceptor taught me are still in my head--like the room ekg leads (smoke over fire, clouds over grass--the leads were black, red, white, and green).  She was also great at scanning the ER and if there was something new that we hadn't seen she would grab it for our rooms or send me over to the nurse that had that patient to learn what was going on.  As we got closer to me being on my own she was great at fully giving me my own patients (she would float for the floor unless I needed her) but also coming over and asking if it did xyz or needed help with x or whatever while still letting me swim a little in the deep end (hope that made sense).  

Lastly, don't get overwhelmed.  The ER is fast paced, usually people at their worst.  Narrow your view (at least in the beginning) to the tasks you need to do for your patient, don't take things patients say personally.

 

Nicole336

39 Posts

On 1/23/2022 at 5:33 PM, bitter_betsy said:

Keep your mouth shut and your eyes open.... kidding... Sort of.  

I was once told that if your mouth was open, your ears were closed and you weren't listening.  It is important to take in everything that is going past you.  I was in a residency program and I learned a lot.  Most days there was so much information I felt like my head was spinning. I still feel like I don't know anything on a daily basis - but my performance shows otherwise. There will be a lot of information moving past you.  Don't try to take it all in immediately.  I still reread my residency stuff and I'm still learning from it.

I think the thing that helped me the most, was to write down what was wrong that I had with my patients in the beginning and a really brief overview of what I did that day.  I mean like 5 minutes writing after shift no more.  My goal was to keep my patients alive during the shift.  Not that I didn't care what was happening with them at the time, I just didn't have time to look up everything that was going on in the moment - and still keep them alive.  On my days off, I would go back and learn about what was wrong.  The experience was recent in my head and I had time to kind of put the story together.  The next time I had a similar patient, I felt a little more confident.

I have since learned that there are "hand" IV people and "ac" IV people.  Don't think that you have to be like everyone else and be comfortable getting an IV anywhere.  In an adult ER, go for the AC.  I put a 20 in almost everyone's AC, unless I was sure I could get an 18 if they needed it.  Most of your scans won't require more than a 20 and the majority of people do still have an AC.  If not - turn that arm upside down and look on the bottom side.  If you stick that sucker - just make sure you stick it going the right way. You will quickly learn who needs an IV and labs when they show up in your room.  There are some things you will get comfortable with very quickly.  Other things will take a little more time.

If you really don't get along with your preceptor the first week - figure out why or ask for a new one.  Don't be shy.  My preceptor was awful and I was forced to stay with them until her husband got covid and ended up on a vent.  Then life got so much better for me.  A new preceptor made all the difference for me.

Don't think you need to know everything on day one.  They expect to train you, but they also expect you to have initiative.  Take care of your patients first, then help others.  Don't be afraid to ask for help.  Don't be afraid to clarify.

One of my defining moments with a charge nurse was on a day when I needed to choose a dose of medication.  I was given a range in the orders, but I had no idea where to start.  I went to my charge nurse and asked.  I laid out the scenario and his answer was "use your nursing judgement".  I got a little bit angry and said "I don't have nursing judgement yet".  I pulled myself together and asked if we could discuss it in more detail so he could teach me.  He did, and it actually changed our relationship moving forward.  I would explain what my guess was and he would help guide me - it ended up being a great teaching moment for both of us. The moral is - don't expect yourself to know something you don't know and don't just guess.  Nursing judgement is learned from being in a situation.  You have to start somewhere, but you don't have to do it alone.

You may cry in the beginning because it can be overwhelming.  It's OK. You will learn and you will be successful.  ER nurses are a special breed of humans.  Welcome to the family.

Thanks so much for your response and sharing what you have been through! I will be sure to ask question once I get started, my out rotations to the ED were only two short days and it went by fast. IV's will be something that I will have to work on, I still haven't started one yet and that makes me nervous. I'm thinking of watching some videos and hopefully that will prepare me a little for when the time comes. I do know the ED works as a team so that in itself makes me feel better. I just hope my skills and knowledge will come through and I can help as many people once I get in there and start working. And I will remember what you have said about my preceptor, our training is for 14 weeks and I really want to make the best of it. 

Nicole336

39 Posts

On 2/1/2022 at 3:46 PM, RuralMOSchoolRN said:

How exciting! I was also a new grad going into the ER. 

I agree with bitter--watch a lot, do the things you feel comfortable doing from the start, ask if you have questions, and don't be hard on yourself.  I went home crying in my car a bunch the first month--but then a lightbulb turned on and I started "knowing" what I was supposed to be doing and got better at things like difficult IV, setting up spinal taps and chest tubes, etc.

Things you can do before you go.  Review ACLS drugs and rhythms.  There are tons of great Youtube videos now!  Also, review steps and drugs for setting up a chest tube.  Get a really good pair of shoes and break them in prior to working in them.  

A lot of the things my preceptor taught me are still in my head--like the room ekg leads (smoke over fire, clouds over grass--the leads were black, red, white, and green).  She was also great at scanning the ER and if there was something new that we hadn't seen she would grab it for our rooms or send me over to the nurse that had that patient to learn what was going on.  As we got closer to me being on my own she was great at fully giving me my own patients (she would float for the floor unless I needed her) but also coming over and asking if it did xyz or needed help with x or whatever while still letting me swim a little in the deep end (hope that made sense).  

Lastly, don't get overwhelmed.  The ER is fast paced, usually people at their worst.  Narrow your view (at least in the beginning) to the tasks you need to do for your patient, don't take things patients say personally.

 

Hi RuralMOSchoolRN! I have a feeling that I'm going to be stressed out for a while as well and that puts me on edge some. Thank you for sharing the things that I can review ahead of time! I will certainly look into these things and try to have them under my belt. It sounds like you had an awesome preceptor who gave you the chance to be hands on and do things on your own. I hope that I can be blessed with the someone similar. How do you handle family members and patients when they are pushy or impatient... have you came across many difficult patients?

Goodneighbor52

Goodneighbor52

Specializes in ER. Has 12 years experience. 6 Posts

Your residency program should prepare you to become a full fledged ER RN. Listen to your educator, review the material that you are taught during the residency daily and consider studying for the CEN. When you have questions, be sure to ask them. 

Edited by Goodneighbor52

AlwaysTiredNP

AlwaysTiredNP, MSN, APRN, NP

Specializes in Emergency Medicine. Has 10 years experience. 29 Posts

Congratulations and welcome to the ED 🙂