New Grad ER Nurse!

NurseIndependa · Jan 29, 2016

ALWAYS be nice to your techs. They do so much for you. And when you are caught up with orders, offer to help others. They will see you going the extra mile & help you when they can (if they are decent people).

Breathe. Always prioritize. I had 4 patients today that all had orders. I constantly prioritized them so I got the most necessary stuff done. So one patient didn't get discharged right away. That's ok because my admitted patient had no outstanding ER orders when the floor nurse came to pick them up.

Document like crazy!! Yes, pain is subjective, but when someone says "my abdominal pain is 10/10" yet is laughing when you aren't in the room or sipping soda when they think you aren't looking, it's important to make note of that. "Pt reports 10/10. Pt does not appear to be in any acute distress. Upon entering the room, the RN found the pt eating a bag of chips and taking snap chats". Keep a note book in your pocket to document times you completed tasks if you get too busy to chart right away.

That's all I can think of right now. I worked today and my brain is fried.

ERnursebyday · Feb 1, 2016

Let's see.... I always say shoot high in a female when placing a foley if you are having trouble. I personally think it is much easier to straight cath or place a foley in a female. While the "hole" might be harder to find, you don't have to fight an enlarged prostate. Medication tips from ER: phenergan IV should be diluted bc it is harsh on the veins, when giving decadron IV push slow and let them know they might feel a burning sensation around their private parts (very common side effect that will go away), the only IM shot my ER gives in the deltoid is Tdap, IV Benadryl can make the patient cough while administering, administer nausea medication with narcotics ( I've had patients vomit as soon as the medication hit them).

abbynormal43 · Feb 1, 2016

Let's see.... I always say shoot high in a female when placing a foley if you are having trouble. I personally think it is much easier to straight cath or place a foley in a female. While the "hole" might be harder to find, you don't have to fight an enlarged prostate. Medication tips from ER: phenergan IV should be diluted bc it is harsh on the veins, when giving decadron IV push slow and let them know they might feel a burning sensation around their private parts (very common side effect that will go away), the only IM shot my ER gives in the deltoid is Tdap, IV Benadryl can make the patient cough while administering, administer nausea medication with narcotics ( I've had patients vomit as soon as the medication hit them).

That's perfect!! Thank you so much! How do you give IM Rocephin? On my capstone, my preceptor mixed it with lido instead of NS because it's painful, but I saw on Medscape that it's contraindicated. Thoughts?

ERnursebyday · Feb 2, 2016

I do mix my rocephin with lido!!

mdela · Feb 10, 2016

That's perfect!! Thank you so much! How do you give IM Rocephin? On my capstone, my preceptor mixed it with lido instead of NS because it's painful, but I saw on Medscape that it's contraindicated. Thoughts?

So I will say that usually if I am giving 250 mg Ceftriaxone/Rocephin IM, it is treatment for a suspected STD, and call me cruel - but I use it as a teaching moment and explain/educate my pts on the practice of safe sex while the painful IM injection reminds them that they do not want to return to this same outcome int he future. I have on occasion mixed it with lido but very infrequently and will mix with NS.

Regarding medications, many hospitals' will have a formulary of medication uses, indications/contraindications, administration, typical doses, any special instructions and what to monitor - created/revised/updated by the hospital pharmacists. Check if your hospital has a program called Micromedex, it is pretty much like having a medication book but updated frequently.

When you go through your orientation - you will learn your hospital ED's protocols. It is not all the same everywhere and you will sometimes feel like you don't know much at all during the beginning but remember -- there's a huge learning curve during orientation. School only provides you with the basics. Soak in as much as you can, constantly ask for feedback, ask questions when you do not understand why you are doing something. If you have a critical pt - take a few min at the end of the shift to debrief with your preceptor so that you can understand what/why you are doing during the care you provided.

Good luck in the ED!

abbynormal43 · Feb 17, 2016

That's good advice, thank you so much!

Jrhemming · Feb 17, 2016

I too just graduated in December and got hired at a small ER. I have been on the floor for about two weeks. I will tell you your head will be spinning for awhile. Yesterday was the first day I didn't feel completely over whelmed. Learn your charting system is the hardest task at first. It's hard to find where and when you should be charting things and in my case there's multiple places to chart the same thing and every one I work with does it a little different. Once you start getting the charting down its much easier to focus on your patients. It's a big learning curve and you will learn a ton fast. But don't be afraid to ask question and for help if your not comfortable. Whether it be with a skill or a med you don't know. No one knows everything and even the most experienced nurses have to look things up at times. Just try and relax and take it in stride when you make mistakes. Good luck

mjgernurse · Feb 19, 2016

I have always been in the ED as a nurse. My biggest advice to a new nurse is to lay your eyes on the patient before making any assumptions. I say this because sometimes EMS can give a report that paints one picture, when actually a totally different situation is occurring. For example, I received a report from an EMS driver who transported an 84 year old woman for "back pain". He made it sound run of the mill and lackadaisical about the situation. At this same time I was receiving another patient from the lobby sent by their PCP for admission due to cellulitis. Since I knew I had an admission on one patient, I went to them to line and lab them. 30 minutes later I made it to the older lady brought in for "back pain" who was triaged by the charge nurse. She was really hypertensive, writhing in pain and stated the pain was between her shoulder blades with sudden onset. She was not on the monitor, nor had labs been drawn by the charge nurse. After laying my eyes on her, I went straight to the doc and initiated the cardiac workup protocol. In the end, she had an aortic hematoma. She could have ruptured her aorta while I was in the other room. In the end, you are responsible for your own patients, and your own license. Don't forget that and always look at the patient yourself because even veteran nurses can get caught up in the hustle and bustle of triage and incorrectly evaluate a patient at first glance.