New Grad Nurse Starting in Tramua 1 ER

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Hello fellow nurses,

I am a new grad nurse that got hired at a Trauma 1 ER unit, day shift. I am looking for any advice, tips, and words of wisdom for working in the ER as a new grad. I was hired in the ER after my 3 month preceptorship in the same ER. I would say I am very fast learner. I ask questions if I don't know something or look it up. I can't imagine working on any other floor. For a while, I didn't find my place on any of the other units as a nursing student till I worked in the ER. I knew right when I saw what the ER was all about, talked with the nurses and worked with patients, the ER was my place. I love the autonomy, uncertainty, face paced work environment, team collaboration and diversity of patients. I am excited to start working but would love to hear from anyone with work experience in the ER! Thank you in advance!

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Specializes in ED.

Please do a search on this subject. It has been discussed ad nauseam on here for years. Loads and loads of info to be found.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

OP, I thought, "Good thing you're a runner!" :D You'll be running! Congratulations. :)

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Specializes in Med-Tele; ED; ICU.
I love the autonomy

Lots of great things about the ED but autonomy isn't one of them. Instead, you're working with the physicians in close and continuous collaboration.

I call ED nursing, "nursing for cowards" because you've always got a doc readily available if things start to get dicey.

I've seen much more autonomy in the various ICUs as well as specialty procedure areas like GI and IR.

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Not to be rude but I find that comment quite insulting. Yes, we do have a doc on board if things "get dicey." However, our higher volume, patient turnover, and degrees of acuity do not allow docs to see them immediately. That's where critical thinking kicks and see what we can do as nurses based on our medical directives and scope of practice within the hospital. Say that again the next time the Ed in your unit is dealing with 2+ codes with just one Ed doc available.

Mind you as well that an on call medicine or MRP is quite available just a phone call away in the floor as well. There is also CCRT (or something similar) in the floor of things starts hitting the fan. There is no real autonomy as every nurse are following orders under a MRP. Only ICU have more leeway in terms of order sets to deal with unstable situations. Even then, the MRP should be aware of crashing patients in ICU. Did you know the ED tend to hold ICU patients for hours or even days? It's true.

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Specializes in Med-Tele; ED; ICU.
Not to be rude but I find that comment quite insulting.
Oh, chill out and don't look for reasons to be insulted.

It's a tongue-in-cheek commentary on my personal experience in a busy pediatric and adult trauma center as well as the 7 adult ICUs to which I've floated there. It's nice to have the doc available in person rather than a phone call or page away.

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Specializes in Med-Tele; ED; ICU.
Say that again the next time the Ed in your unit is dealing with 2+ codes with just one Ed doc available.

And I'm curious: How many times have you honestly had 2 codes running in parallel with only a single provider?

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
And I'm curious: How many times have you honestly had 2 codes running in parallel with only a single provider?

Personally I have had it happen only once since 2005 when I started working in an ED, and that was in a freestanding ED with only one provider on shift. Crazy day!

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Two weeks ago

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OP - It's awesome that you were able to do an ED preceptorship. Work hard, learn all you can about the conditions you will come across, and strive to really understand what is happening with your patients; anticipate the direction of their course of care. That's how to do ED nursing, in a nutshell.

Best of Luck! Come back here and let us know how you're doing!

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There is many great things about both units. Obviously, I am not speaking of true autonomy, as in nursing we rely on physician orders. I would say ICU nursing is based on a great deal of algorithms, protocols and standing orders. From what I have seen, ICU nurses work with the across the board the sickest patients and many times there is not a MD on the unit when things get dicey. So ICU nurses have to make decisions based on critical judgement possibly with or without an MD to save a patient. While, ER nurses most times have an MD on the unit readily available. However, I do think certain nursing units are more "autonomous" than others like ICU, ER, home care, and L&D and this is what I was stating. I do recognize that ER nursing are working closely with doctors with continuous collaboration between professionals and that is another reason why I love the ER.

Keep doing you Kindaback!

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