New grad ER nurse in need for advice!

ScrappytheCoco · Apr 30, 2015

I started as a new grad in the ED two years ago. It was not my dream unit but I wanted to work to avoid becoming a old new grad...so I settled in for the ride. Though it wasn't my favorite unit, the knowledge I acquired there is absolutely priceless. Here are my thoughts:

1. Ask tons of questions. At this point you literally cannot comprehend how much you don't know, so ask anything and everything, there is no such thing as a dumb question. It could keep you from killing someone. Get a little notepad and keep it close so you can write things down...there are SO many different kinds of patients and exceptions to the rule in the ED, it's difficult to remember all the little details especially when you're just starting out.

2. Stick anyone and everyone you can. Babies, dehydrated grandmas, frat boys with ropes for veins, everyone. Good IV skills/phlebotomy skills are a must for the ED and they only come with consistent practice. My preceptor went around the ED telling everyone if they had an IV start to let me do it. I was terrified....but 2 years later I am confident and can get a line on most anyone. If someone is doing an atypical start, like a scalp line in a baby or an EJ, go and watch a few and then attempt it when your preceptor feels you're ready.

3. Get involved with the critical patients whenever you can as quickly as you can. I was a wallflower when I first started. I remember feeling literally crippled with fear when we would get a code or a big trauma or a patient who went downhill fast. Be present, ask the other nurses what they need you to do, and ask lots of questions when it's over. Once you get confident with the unstable ones, you can do anything.

4. Read anything and everything you can about cardiac rhythms and cardiac drugs. Pinterest is loaded.

5. Ask your preceptor which of the doctors are good teachers. There are many of them and the knowledge they will pass along to you is invaluable.

6. I don't know your personality but you have to have a tough exterior to make it in the ED. I don't mean being rude and hard, just the ability to let things roll off like water off a duck's back. Emotions run high in the ED. Patients are scared, angry, intoxicated, in pain, psychotic, etc and you can't let the things that they say hurt your feelings. Be as kind as you can, but also know when you need to be assertive. That will come with time.

7. Don't take work home with you. You will see things that will absolutely break your heart. You can cry about it on the way home or step off the floor for a few minutes and collect yourself, but don't dwell on it for days. Don't be afraid to speak to a chaplain or counselor if it's really bad. Every now and again you can even go to a patient's funeral if it helps you. I did a few times when the family filled the department in on arrangements. I did lots of yoga, shopping with friends, running, etc to de-stress. It is an absolute must. Take care of yourself, eat healthily, and don't let your stress drive you to unhealthy habits.

Good luck! If the ED is really where you want to be you will love it. Never a dull moment, always the opportunity for a great adrenaline rush, and learning opportunities around every corner.

jarielle22 · May 2, 2015

I started as a new grad in the ED two years ago. It was not my dream unit but I wanted to work to avoid becoming a old new grad...so I settled in for the ride. Though it wasn't my favorite unit, the knowledge I acquired there is absolutely priceless. Here are my thoughts:
1. Ask tons of questions. At this point you literally cannot comprehend how much you don't know, so ask anything and everything, there is no such thing as a dumb question. It could keep you from killing someone. Get a little notepad and keep it close so you can write things down...there are SO many different kinds of patients and exceptions to the rule in the ED, it's difficult to remember all the little details especially when you're just starting out.
2. Stick anyone and everyone you can. Babies, dehydrated grandmas, frat boys with ropes for veins, everyone. Good IV skills/phlebotomy skills are a must for the ED and they only come with consistent practice. My preceptor went around the ED telling everyone if they had an IV start to let me do it. I was terrified....but 2 years later I am confident and can get a line on most anyone. If someone is doing an atypical start, like a scalp line in a baby or an EJ, go and watch a few and then attempt it when your preceptor feels you're ready.
3. Get involved with the critical patients whenever you can as quickly as you can. I was a wallflower when I first started. I remember feeling literally crippled with fear when we would get a code or a big trauma or a patient who went downhill fast. Be present, ask the other nurses what they need you to do, and ask lots of questions when it's over. Once you get confident with the unstable ones, you can do anything.
4. Read anything and everything you can about cardiac rhythms and cardiac drugs. Pinterest is loaded.
5. Ask your preceptor which of the doctors are good teachers. There are many of them and the knowledge they will pass along to you is invaluable.
6. I don't know your personality but you have to have a tough exterior to make it in the ED. I don't mean being rude and hard, just the ability to let things roll off like water off a duck's back. Emotions run high in the ED. Patients are scared, angry, intoxicated, in pain, psychotic, etc and you can't let the things that they say hurt your feelings. Be as kind as you can, but also know when you need to be assertive. That will come with time.
7. Don't take work home with you. You will see things that will absolutely break your heart. You can cry about it on the way home or step off the floor for a few minutes and collect yourself, but don't dwell on it for days. Don't be afraid to speak to a chaplain or counselor if it's really bad. Every now and again you can even go to a patient's funeral if it helps you. I did a few times when the family filled the department in on arrangements. I did lots of yoga, shopping with friends, running, etc to de-stress. It is an absolute must. Take care of yourself, eat healthily, and don't let your stress drive you to unhealthy habits.
Good luck! If the ED is really where you want to be you will love it. Never a dull moment, always the opportunity for a great adrenaline rush, and learning opportunities around every corner.

Hank you so much for you help!! This advice is amazing!!

Duval916 · May 5, 2015

I agree with jrooks22 comments. I started as a new grad in the ED 7 years ago. The advice I took when I was a new grad and I still hold true today is to throw your pride out the door. Never be afraid to admit (to yourself) when you don't know something and always ask questions. You'd be surprised how many people will help if you just ask. Working in the ED is tuff and its impossible to know everything. ask ask ask. I still like to pick the doctors brains on their rationale for doing what they do. I also like to be in the room when the internal medicine examines the patient or when the specialist is in the room (cards, neuro, pulm, etc). even after all these years I still find myself doing things for the first time.

congrats on getting hired. I love the ED and wouldn't work in any other dept.

jarielle22 · May 5, 2015

Thank you! I will keep this advice close to heart and mind. I definitely will be asking many questions and trying to find my own flow as my first year progresses. Thank you all for your advice, it truly means the most to me.

cj0307 · May 8, 2015

I will give you the advise I give all my new grads. 1st trust your gut. You may not know what is exactly wrong but that something is. Bring it to your charge nurse or the Doctor. 2nd you never stop learning. I have been in the ED for 15 years and things change! We learn more about diseases, better ways to care for patients, improve on processess. Be open to changes. Finally, a saying I live by: Don't wrestle with pigs. The pigs like it and you just get muddy. Don't stoop down to their level when someone is trying to cause you grief. People are going to be nasty and rude, but remember it isn't personal. They are hurting and scared and have know idea what to do. Listen and help them understand. Sometimes you have to be firm but you can always be polite.

jarielle22 · May 8, 2015

I will give you the advise I give all my new grads. 1st trust your gut. You may not know what is exactly wrong but that something is. Bring it to your charge nurse or the Doctor. 2nd you never stop learning. I have been in the ED for 15 years and things change! We learn more about diseases, better ways to care for patients, improve on processess. Be open to changes. Finally, a saying I live by: Don't wrestle with pigs. The pigs like it and you just get muddy. Don't stoop down to their level when someone is trying to cause you grief. People are going to be nasty and rude, but remember it isn't personal. They are hurting and scared and have know idea what to do. Listen and help them understand. Sometimes you have to be firm but you can always be polite.

Thank you for the advice, I will be sure to always carry that with me!