New Grad starting ER

Editorial Team / Moderator · May 6, 2010

Be a sponge -- soak it all up! Don't be afraid to jump in and help. Ask questions, and admit it when you don't know something. Good luck! :)

classicdame, MSN, EdD · May 6, 2010

try not to take things too personal. When people get stressed they forget to be polite, so try to let it slide (I am referring to co-workers. You probably already know patients will be stressed). Oh, wear comfortable shoes.

Faeriewand, ASN, RN · May 7, 2010

Ditto about the shoes. It makes all the difference.

PAERRN20 · May 7, 2010

I did it as a new grad. Only ever spent 4 hrs in the ER before accepting a job there. You'll be fine.

czechchickieeRN · May 7, 2010

I did it as a new grad. Only ever spent 4 hrs in the ER before accepting a job there. You'll be fine.

Same here, but only on week four and loving it. Keep your eyes and ears open - ask about everything you don't know, and expect the work to never be done (cuz something is always coming in the door.) When you start something, finish it right then, keep your charting up - it's so easy to get behind if you don't. Oh and have confidence when communicating with providers and other staff. The doctors and nurses have a differnt bond than they do on the floor, embrace it!

One last tidbit - if you need experience with skills, ask the other nurses to give you their IV sticks, catheters and NG tubes. It helps you both out! Have fun - it's the best nursing job out there!

-Christine

murphyle, BSN, RN · May 7, 2010

Congratulations to you! I am also a recent grad, nine weeks into my own straight-from-school EC job, and absolutely loving it. Here are a few pearls I've picked up so far:

* Soak up as much knowledge as you can. Since you're a new orientee, you aren't part of the staffing model yet, and that gives you a lot of leeway to go see things that you won't be able to as a full-fledged staff nurse. Follow a patient to the cath lab, watch a few CTs and MRs, ask the techs how to do your own "roadside reads." It won't count for anything medically, but it'll allow you to anticipate what the ECP might order for treatment.

* Never be afraid to ask for help - either up or down the "chain of command." We have two or three techs in our department who are better at starting IVs than I'll ever be, and those are my go-to people for difficult sticks. Likewise, another nurse once asked me for help to put an NG tube down a patient who'd been a bare-knuckle boxer in his youth and had a horribly deformed nasopharynx as a result. Neither of us could get it down, and so we wound up asking the ECP to put down a Corpak instead. He even had a tough time of it.

* Every shift has at least one of the following personalities: the quiet resource, the know-it-all, the loudmouth with a heart of gold, and the battleaxe bully. Learn who these people are, and how to differentiate them, as early as possible. Make friends of 1 and 3, avoid 2 and 4.

* ECPs are not people to be scared of. The vast majority of physicians do recognize that they can't be with 24 patients at once, and rely on the EC nurse's judgment for treatment responses and next steps. If your gut tells you that something isn't right with a patient, don't ever be afraid to give the ECP a heads-up (and if you have evidence to back your gut, all the better). If you do get snapped at by an ECP, recognize that nine times out of ten it's not about you. Don't snap back, just stay calm and move on.

* The triage nurse's judgment is not the be-all, end-all of patient priority - it is perfectly acceptable to re-classify a patient based on your secondary assessment. I did it with a Priority 4 I was assigned, c/o shortness of breath and pain/numbness in lower extremities, who the triage nurse wrote "panic attacks" on the face sheet. Turns out she had Factor V Leiden and a long history of thrombotic events, and her symptoms were highly suggestive of a PE. I bumped her up to Priority 2 and warned the ECP, and I was right - she had a couple of good-sized clots in her right lung and bilateral calf DVTs to boot.

* Learn to take care of yourself. Eat right, stay hydrated, get lots of rest on your off days, and save the caffeine for when you really need it. Exercise is also a great stress reliever. Park in the satellite lots, walk around the building on your lunch break, whatever.

Welcome to Emergency. You'll love it here.

AznMattRN · May 7, 2010

I just graduated from nursing school in December and went straight into ED. The biggest encouragement I've received from other nurses is this: "You will mess up, make some mistakes, and probably some big ones at that, but always remember from those mistakes and learn what you did right and what you did wrong."

I keep getting encouraged to ask questions, and nobody really ever looks down on me for not knowing something.

Good luck! ER nursing was the biggest stress I have had the last 4 months of my life, but things are starting to get better. Just go into work each day and try to learn something new.

GuatericanNurse · May 10, 2010

Just a question....HOW ARE YOU NEW GRADS GETTING JOBS IN THE ER?

Every posting I see they want 1-2 yrs acute care experience.....JUST TO GET INTO THE NURSING HOMES!

I envy you lucky lucky nurses out there getting amazing jobs as new grads, congratz!

AznMattRN · May 10, 2010

I got in the ER under an internship... I am having to deal with alot of BS with the internship other then working and learning on the floor, but it was a step into an area I was really interested in so I just had to bite the bullet

Italia13 RN · May 11, 2010

Great advice for the new grads entering the ER.

Hopefully you have a great preceptor who will teach you you the ropes of the ER and nurture you and take you under their wing.

Go in there with open eyes and ears and don't act like you know everything, because YOU DON'T! no one Knows everything!

The ER is a place of ALL PERSONALITIES and it's a very stressful environment. ER nurses I think are the toughest people to let you in and feel welcomed, along with the ICU nurses... i think it's the big head everyone gets thinking they are the best because they work in the ER/ICU... People are going to talk about you, especially being a new nurse starting out in the ER just let it roll, it will stop when the next new nurse starts... it's part of the Cycle just like starting any new job

Try to stay out of the politics as hard as it might be. TRUST NO ONE and try to listen and not say much about other people/managers/the hospital until you have a good feel on the people you work with.

Tough skin is a definite... something I am still working on. Doctors will yell at you making you feel like you know nothing but stand up for what you believe in. Be a Pt Advocate.

Have Fun! Starting out in the ER is going to make your emotions go on a roller coaster ride. First you are going to be Scared and feel like you know nothing, you will cry at times thinking you can't handle it anymore when you had a really rough day, you will get angry at people (Doc's other nurses, family members, even patients) you will feel happy and excited when you saved your first life : )

and the most important piece of Advice i can tell you

* Find a local dive bar that opens up at 7am so you can drink away a sucky NIGHT SHIFT if you work nights : )

WELCOME TO THE JUNGLE! :jester:

murphyle, BSN, RN · May 12, 2010

Just a question....HOW ARE YOU NEW GRADS GETTING JOBS IN THE ER?
Every posting I see they want 1-2 yrs acute care experience.....JUST TO GET INTO THE NURSING HOMES!
I envy you lucky lucky nurses out there getting amazing jobs as new grads, congratz!

I was recommended to Emergency by one of my old clinical instructors, who works in the department as a night-shift case manager when she's not teaching. (This occasionally has unintended amusing consequences, like finding rubber vermin on the WOW cart, or explaining to my patients why EC Care Management keeps prank-calling my SpectraLink. It's all in good fun, though. :jester: )

It also helps that the administration in my department has a stated preference for hiring well-qualified recent grads, as they feel that newbies 1) come with fewer bad habits from floor experience, and 2) are easier to educate since they're still in the "school" mindset.