New grad 3rd week into ED Orientation program seeking tips

[ED_RN52]

Hello All!

I hope everyone is doing well. Im currently just finished my 3rd week of orientation to my ED. I will be working nights, however during my 12 week orientation I'm doing 6 weeks days, 6 weeks nights. So far I absolutely LOVE IT. This is my happy place. Each and every day I learn so much, that sometimes it can be a little overwhelming but I'm at that point where I'm truly just trying to be a sponge and soaking it all in.

Our ED is very very busy with high acuity level of patients. I'm still trying to get the ropes of things and learning the protocols and order sets for conditions. My question to all of you is tips for time management skills within the ED.

I'm learning as much as I can and understanding the ABC's of things with prioritization, acute vs chronic etc. Its just when Im in the room I feel like I'm going too slow? I'm not sure if its because I did all my clinicals at a completely different hospital system than the Cleveland Clinic, and I'm not 100% used to navigating epic charting system yet? Or if I'm just being too hard on myself. I have the determination and drive, I know it takes a while to get there... I just want to succeed. Any advice is greatly appreciated.

Thank you!!! :)

[PeakRN]

The ED is like nothing else, and it will take quite a bit of time to feel like you are up to speed to everyone else. I would far prefer (and trust) a nurse who can take 2-3 patients and understand them than than one who takes a full pod but I can't trust to see who is sick. Speed comes with time, you probably are slower than experienced nurses and that is okay.

Tips to get faster? Practice. Eventually you will learn the charting system (epic is great). You will learn to multitask assessments and skills. You will learn to anticipate the providers.

I cannot emphasize more how much I would prefer a nurse come to me with a sick patient than one who will take 6+ patients. If you can do that the rest will come with time.

[Lunah, MSN, RN]

As a new grad, you are going to feel goofy and slow for a while, like your smart hand is tied behind your back and you are doing everything with your dumb hand. It just takes time and practice! My number one tip for a new grad in the ED: seek knowledge. Books, websites, podcasts, other nurses and physicians, techs, everybody has something they can teach you. As a new grad in the ED, your education doesn't start and stop at the ED doors.

You will look back a few months from now and be surprised how far you have come. Best of luck!!

[DayDreamin ER CRNP]

We tell our new grads that it takes a year to feel comfortable with the patient load and charting. It takes three years to be fully competent and five years to be proficient and considered "seasoned."

As long as I've been coaching new hires, I find this to be fairly true. There are exceptions to every rule but the ER is not like any other department in the hospital and has its own set of challenges in a consistently changing environment.

It also depends on the type of ER. If it is a L1, it may take months or years longer to become proficient at everything that might roll through the doors. In a non-trauma ER, you might never see some really sick-as-stink patients that a larger facility might encounter. I had one new hire that came from a much smaller ED and she had never once seen a heart alert in her two years at the other facility. While she has cared for a cardiac patient and shipped that patient to us, she never had to do X, Y, and Z before getting that pt up to the cath lab.