New grad in ER.. ADVICE PLEASE!!!

ERNurse678 · Feb 11, 2005

Any advice or words of wisdom from the wise would be appreciated sooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooo much. I start my position as an RN ( ) in the emergency dept Feb 22nd, and I am starting to get nervous. I just grad. in Dec... Our ER is VVEEEERRRRYYY busy and in 07 it will actually be the largest on the east coast as it is being renovated and expanded everyday... My fear is that I will not have the quick assessment skills since I am a brandy new nurse.. I know it is critical to assess the c/c however I am also aware that the c/c is not always the chief problem... I am afraid that I might not pick up on KEY S&S.. I am confident in myself and I believe in myself.. but I hope that will be good enough to start.. Please share ideas or advice.. I can really use it from the vets!! Love to you all! Thanks

Well, just remember that you do know this stuff, if you didn't you wouldn't have passed boards. Try and relax and take some deep breaths before your first shift starts. Don't be afraid to ask questions. There is no such thing as a stupid question. The most important piece of advice I think I could give you is "GO WITH YOUR INSTINCT" If you feel like something is wrong with a pt, chances are you are probably on the right track. Get a good preceptor. If you end up not liking your preceptor, go to your nurse educator or nurse manager and let them know that you want to change, because your orientation period is so critical! Good Luck and you will do great!!!!

Trauma Columnist · Feb 11, 2005

Congrats. As a die-hard ER nurse, you'll love it. I work in a large level one and believe me it really takes a year (or so with some of the pedi patients) to feel really comfortable. Ask questions, lots of questions and don't be afraid to keep asking. Find an experienced RN with a great attitude who's been there for more than 10 years and ask her/him to be your mentor (if your hospital doesn't have a formal mentoring program for your first year). Good luck and take care - get plenty of sleep and eat right.

dm2 · Feb 11, 2005

as soon as you can, try to get into one of the ENA's trauma nursing core classes, and their pedi classes. It helps put alot together quick for assessment and required action. Enjoy your first year and know learning will go one every day!!! Don't be too hard on yourself and utilize your coworkers as resources for their knowledge and experience. E.D. is a great place to work!

11:11 · Feb 11, 2005

As an ICU nurse who gets to pretend to be an ED nurse once or twice a week I can tell you this:

Ask lots of questions

Find some vets and stick to them. People you cant talk to, even the mean ones will help if you ask the right way and listen.

Take as many classes as you can, and certs.

Above all hang in there like a bulldog on a leg-

11

CEN35 · Feb 12, 2005

Im sure you'll do fine for being a new grad. I think there are three things to remember. (There are also multiple other posts on "New ER grad stuff in here over the last 7 years).

1) The first two years never stop trying to learn things, and pick up new things. That's the time when you will pick up the most. I was a new ER grad 9 years ago.

2) There is always something to learn, it NEVER ends.

3) Like most new grads (myself included, prior to my first two weeks of orientation), you think you have learned so much, and are as good as any other nurse out there. It's not true, and watching, learning, and remembering whaty you have missed in the past, will make you 200% better the next time around. Bottom line, experience will be your biggest help over time.

Goood luck! Don't get stressed!

:-)

CEN35 · Feb 12, 2005

Here I went back to a prior post I made concerning the same thing and just copied it:

Most places now days are hiring new grads, d/t the lack of experienced ones. The theory of a warm body is better than No body seems to be the trend.

When I started out of school, our ER hired one new grad a year. I took the position, against the advice of everybody. Everybody said, "you need a year of floor nursing first". I took it as BS. I jumped in and went for it.

I had 3 months orientation. It went great! After 5 months there were times, when I thought it wasn't for me and I couldt hack it. By 6 months, I knew I could.

There is a HUGE learing curve the first 6 months, a little less the second 6 months, a lot less the 3rd 6 months, and after 2 years I felt totally 100% confident and comfortable. Although the learning NEVER ends, there is always something.

I had ACLS, MICN, PALS, BLS, TNCC, and my CEN, within 2 years.

I wouldn't worry so much about trauma. It's blown up hype. In my opinion your medical cases, can take way more thought, and help build a base for you. A base that will help more, when you have a trauma. My ER position was at a trauma center. No biggie. Everybody gets all hyped up and anxious. 90% of the time it's not much. Most Trauma from our area is blunt force trauma, not penatrating trauma.

If I were you? Don't worry about it. Get into an ER with the hours and shifts you want 1st. Make sure they will give you a decent amount of orientation. Probably better to go to a place with some established staff. Since I have left our ER (one of the last of a group of 70, except for maybe 5?), it has been a revolving door of new grads.

Most important, never forget there is always more to learn, and nobody knows it all.

GOOD LUCK!!!

JennaeWantsOuttaHere · Feb 14, 2005

When I graduated Nse school (>10 yrs ago), jobs were tight and you took the job you could get. I ended up in the ER. I was suppose to have 6 months on a Med/Surg floor, but LA County Hospitals are notoriously short staffed. After 2.5 mos. I found myself in the ER full time. I got a whole 3 days of orientation. If I know now what I knew then, I would have been more freaked out. However, I love challenges.

The best advice I can give is ASK LOTS OF QUESTIONS!

Do NOT do anything you do not feel completely competent to do. Don't let anyone pressure you or make you feel like your not doing your job or pulling your weight. Stand firm. Just read the BRN policy and guidelines. You can get in deep trouble if you mess up...you can be sued and lose your job. Pay attention at all times.

Also, listen hard and fast to you intuitions. If you feel something isn't right, it probably isn't. I once let a specialist proceed with examinating an adults throat who had suspected epiglotitis. I was new but felt something wasn't right. I spoke with my charge nurse, the attending and the specialist. They all assured me everything would be okay and proceeded to look down that man's throat. The worse happened....his epiglottis snapped shut! They ended up having to trach him and nicked an artery. He nearly died right there in front of me. If I would have stood up to all those "experienced" staff, the man wouldn't have had to go through that...nor I!

Follow your instincts. At the very least if you are wrong...the patient and your license are safe. As I now say...better wrong and safe, then right and sorry.

Good luck, sweetie. You'll do fine. Hang in there! :Melody:

Namaste....jennae

nursemeow · Feb 14, 2005

Thank you sooo much for the advice... I will absolutley use it and need all I can get of it... Orientation is 3 mos (yikes wish it was more) and than they weed you off "slowly." We'll see about that. I am very excited to start and am unsure how to prepare... I just went in a took the pharm. and math calc. test at the hospital.... woowoo! Well thanks again! I respect and appreciate all of your time answering this thread!

nurseerin · Feb 22, 2005

Any advice or words of wisdom from the wise would be appreciated sooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooo much. I start my position as an RN ( ) in the emergency dept Feb 22nd, and I am starting to get nervous. I just grad. in Dec... Our ER is VVEEEERRRRYYY busy and in 07 it will actually be the largest on the east coast as it is being renovated and expanded everyday... My fear is that I will not have the quick assessment skills since I am a brandy new nurse.. I know it is critical to assess the c/c however I am also aware that the c/c is not always the chief problem... I am afraid that I might not pick up on KEY S&S.. I am confident in myself and I believe in myself.. but I hope that will be good enough to start.. Please share ideas or advice.. I can really use it from the vets!! Love to you all! Thanks

I'm a new grad in the ER, too, so I know the position you're in. My suggestions: ask LOTS of questions (don't hesitate...just remember it's for your knowledge, the patient's safety, and usually people want to help you succeed), realize you do know things, and find a senior nurse that you admire and pick their brain. There are a couple of nurses I work with and am always asking them things...how they got to where they are now, advice, education, etc. People love talking about themselves and they usually are flattered when you ask them questions to better yourself as a nurse. It shows that you're serious about being a great nurse. A little forewarning...you're going to have a few days where you feel completely overwhelmed and just want to break down (especially if you work in a busy ER like I do). Or you'll go home and in the middle of sleep, you'll wake up thinking, "I can't believe I forgot that", or "I should've done that", etc. My advice: learn from this. Every day will be a learning experience and you can do with it what you must. If you want to be an excellent nurse, take each experience and learn from it. You'll probably make mistakes (hopefully they'll be very small mistakes that don't make a big difference), but you must learn from them. If you don't feel comfortable doing something, ask a senior nurse for advice or help. I have found that all the nurses I work with are great resources and they love helping new nurses (contrary to the thought that old nurses eat their young...I have not had that in my ER but have seen it in many other places). Just remember to take a deep breath and keep breathing (no pun intended). Good luck to you!!!

Underbedmonster · Feb 22, 2005

This is a great thread! I graduate in December, and am thinking seriously about going into the E.D. instead of Med-Surg, but have been very worried that I won't be quick enough. I loved the ONE day we had for the E.D. in clinicals, but it wasn't horribly busy. I really enjoyed the day I spent with the ambulance crew, as well. This thread has been very encouraging, since I hear "do a couple years on the floor first" all the time. I think I would burn out very quickly on Med-Surg. Repeatedly trying to move large people with no assistance (amazing how the hall clears out) is not agreeing with my back during clinicals. Thank you to all the encouragers out there, and best of luck to the OP!

nurseerin · Feb 23, 2005

I say go ahead and do ER if that's what you really want. The vast majority of nurses I spoke with while in nursing school said for me to do med-surg first. I knew 100% that I would not be happy on the floor, and that emergency nursing was where I truly wanted to be. That is so important in a career...loving what you do and where you work. I don't think I'd like nursing at all if I had started on the med-surg floors. It's just not for me. I'm sure that some people are better off having the floor experience first, but I have found the support of coworkers in my ER to be amazing and that has helped me tremendously. I don't think I made a mistake in my choice (hopefully that doesn't change). Smiles and good luck!