New Grad in the ER

Specialties Emergency

Published

Hello everyone! A little info! I recently received my first RN position at a local small town emergency room in January. This "hospital" is categorized as a critical access facility. Since it is critical access we typically have one RN and one CNA on duty for our shifts 06-1800, 1800-0600, an on call radiologist and a lab tech. We start all IVs on patients and draw most labs, in addition to giving all other care. 5 bed facility with 2 trauma bays. With summer comes a fairly large increase in patient numbers. It seems like most days (or night) all beds are filled with varying degrees of critical patients. I received about 10 shifts of orientation before I was released to the wolves lol. As this is my first RN position it gets pretty stressful at times and I feel like I don't quite measure up to a lot of the ol' timer nurses there. I love what I do, and wouldn't want to change it for

the world. Im 24 years old if that matters at all lol.

My question is what can I do to better equip myself for day to day emergency room activity? I have my ACLS, and PALS Certification and am enrolled in a TNCC course that starts next month. I've been reading my TNCC book, and have purchased two Emergency room nursing books which I've read cover to cover. What else can I do to prepare myself and feel better equipped? I've recently been looking into a certified emergency nurse class but it's pretty expensive. I'm more than willing to pay the fee if you believe it's worth it. Any advice you can give me would be much appreciated.

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You know the nurses you talk about in your post that you want to measure up with. Study them-see what habits, tips and tricks they have that make them effective and incorporate them for yourself.

You are doing great with the studying and certifications but ER is as much about how you structure things in an ever changing environment as it is the knowledge base. The time management skills and prioritization I learned in the ER is a big part of my current career.

Don't ever overlook the most valuable resource that is someone who was where you are now who made it to where you want to be.

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Specializes in Cardiac, ER.

I can't imagine only one RN,....are there others close? What happens when you have a code? I work in a level I trauma center with 68 beds, so obviously we have a lot of staff, but even when I worked upstairs we always had two RN's even if there was only one patient.

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Specializes in Emergency.

BrnEyedGirl, I had the same question. It seems like they are living on the edge there. And then to be a new grad with a 10 shift orientation, I think I would be very scared. Hopefully, there are other resources available for that day when two GSW hit the door at the same time, or.....

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Med-surg is right next door to the ER, and usually have 2-3 nurses on staff who can float over for a bit if needed. Our policy is to have them come for every code. At night there is usually only one nurse on med-surg so it's a bit harder to utilize them if needed.

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I agree scottaprn, all the info in the world won't help if you don't know how to utilize it. I sometimes come in on my days off to observe some of the nurses that have been doing ER care forever to watch how they prioritize and handle situations. Everyone I work with is awesome and loves to teach. It's a big help being able to be someone's shadow, and just observe from a non-orientation standpoint. That way I can fully absorb their specific style. Have any of you taken the CEN course? Any recommendations on that one?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Wow...you are in over your head...((HUGS)) Those little ED's can be fine but when the feces meets the fan it's CRAZY! I have worked one on a few occasions and I am an experienced ED nurse and they can be challenging.

I would take the CEN course. It is worth it for you. I wouldn't test yet but I would take the course. I would also look into ENPC, Emergency Nursing Pediatric Course, for kids...you will find it valuable.

How close is your access facility?

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I passed the CEN by just studying the CEN manual from the ENA. I took it after a year's experience in the ER. I was a new grad in the ER as well.

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Specializes in OB, Postpartum, Nursery.

Wow, I have had ten days of ER internship at Level 3 hospital....no way would I be ready to be alone and on my own. You are a brave soul!!!

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I work in a tiny ER also, and I must say that I'm surprised they hired a new grad. Although on the other hand, those tiny ERs can be hard to staff, and maybe there was something about you that made them want to give you a chance. Plus you're probably cheaper than a traveler.

In addition to taking the CEN class, I'd suggest taking Prehospital Trauma Life Support. I'm sure TNCC is probably what your facility requires for your trauma certification, but I've taken both and found the PHTLS to be much more valuable to me as a nurse working in a tiny ER.

My words of wisdom- Know your resources and use them when you need to. Don't try to be Super Nurse and do it all on your own. When you feel the tide shifting, be proactive and get some help. Be organized. It's true that the priorities in the ER are constantly shifting, but you need to maintain a certain amount of organization or things will devolve into chaos, and once that happens, you're sunk.

Best of luck to you! I hope you continue to come back and update us on how things are going!

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Specializes in ER - trauma/cardiac/burns. IV start spec.

I graduated Nov. 23, 1993 and began working in the ER Nov 24, 1993. I was "on my own" on nights after 3 shifts. I worked a level 3 but the ER Doc's liked to pretend we were a level 2. We had 19 beds when I began. Nights had 5 RN's, 2 PCT's, a unit clerk, one Doc and one PA. We were divided on 2 halls and one was in triage. Our ER was part of a rotation for ER of the Day so every night was not jumping. 2 out of 3 nights we were busy. For me it was sink or swim. The charge nurse had 10 years, one nurse had 3 years and the other 3 of us were new. Talk about scared. I got over it quickly when we got an over-dose and it was mine. My first and the patient over-dosed on pyridium. No one in the ER had a clue so while the Doc was reading his med book I was looking up the antidote. I was very nervous and felt panicky inside. The Doc took be aside and told me that I was doing great but "take a deep breath, close your eyes and exhale". She made a full recovery.

We have 2 eyes, 2 ears and one mouth. Listen and watch twice as much but also remember - the only dumb or stupid question is the one you do not ask. All nursing is constant learning but you can focus too much on the books and not enough on the practice. Open yourself to learning the flow of the care, follow protocol, double check all meds. You will be a great ER nurse. Relax. One of the best ER nurses I ever worked with was a man that had been in nursing 28 years, he worked days and Docs would call and request that he be their patients nurse and he never passed CEN but he could take care of anything. I trusted him to take care of family.

You have been there for a year - you are also an "old-timer" now. I know you feel like a baby but you are not. Anyone that can do a year in that small an ER - hats off to you. Just keep an eye on the number of patients and call on your help. If you have a nursing supervisor on at night maybe they can call someone in early (we did that sometimes).

Hang in there, good luck and bless you.for all the care you give.

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Congratulations on landing a job!! It will be tough, but if you are willing to a persistent learner, you can be successful. I personally would not reccomend taking TNCC until you have been an ER nurse for one year (the algorithims might be difficult to understand if you have limited trauma experience)...in fact most classes in my state do not allow enrollment without one year. Other wise, study! study! study! Good Luck!

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