New graduate, new ER nurse.

Boomer MS, RN · May 19, 2016

Good luck on those Boards! And also congrats on being hired in an ED. I am not one of those who thinks bypassing med-surg as a new grad is a mistake. Ok, I'm biased...I went straight to a Level I as new grad , and my older daughter also did, although she was in a 4-6 month training program at a Level !. I think your "attitude is everything". Well, almost. You are going to get some great advice and pointers from other nurses here.

In a not so small nutshell:

Be willing to learn

Don't be arrogant

Learn to be a team player (I loved the ED b/c for the most part in the four places I worked, we were a team)

Go home and read about the diagnoses and disease processes.

Listen, listen, listen to what others say. You may learn how you DO NOT want to do some things. That's OK.

Ask lots of questions of other nurses and physicians. You will figure out who likes to share knowledge and who may not

If you have an educator, use him/her as a resource

Expect to feel lost, stupid and scared at times. No worries.

Expect to be at the bottom of the totem pole and not to expect to get day shift and be a charge nurse in three months. Yes, I've witnessed that on more than one occasion.

Be respectful and kind to your preceptor(s) Communicate with him/her.

Do not be lazy; have to say that is one of my pet peeves.

You will feel more comfortable with time. Try not to fret over struggling with skills. Even the BEST IV nurses miss sometimes. It's equally important to know why the patient needs that IV.

The employer will help you navigate the required courses such as ACLS and PALS and maybe others.

I highly recommend joining the Emergency Nurses Association very soon. The journal comes every two months and is excellent. I think it is about $120/year to be a member. After sometime, perhaps two years at the least, think about sitting for the CEN, the national certification exam for Emergency Nurses. Some Emergency departments require all or a certain percentage of the nurses to have their CEN. Getting carried away a bit, forgive me. I am excited for you, and I don't even know you!

Some new grads shine more than others initially, but it is the long haul that counts. Listen to and share funny stories. ER nurses can have the blackest and funniest sense of humor. One last caveat: Moving patients from your department to the floor or the ICU can be challenging because of thoroughput problems that occur everywhere. Be respectful of the floor/ICU nurses. They are just as busy.

One step at a time. Pass those boards. Carry on and good luck. ER is a ball.

TheCommuter, BSN, RN · May 19, 2016

Moved to the Emergency Nursing forum for more responses.

emergencynursy · May 19, 2016

Thank you! That is so helpful! I appreciate you taking the time to give me some pointers. :)

ERnursebyday · May 21, 2016

I love the ER and I hope you do too! Some pointers:

1) Ask questions. Personally, I never hesitate to ask about something I do not understand or don't feel comfortable doing. It's a constant learning environment.

2) Wash in, Wash out í ½í± Even if your hands are dry and cracked like mine.

3) Urine is like gold in the ER. Get that urine sample right off the bat. It works if you say to the patient "I'm going to take you to the bathroom now" instead of asking them if they can give a sample. You'd be surprised how many patients tell you they can't pee when you give them an option. So frustrating!

4) Vitals, vitals, vitals! Take them often. Automatic blood pressure machines can be off. If the BP reads a crazy result (ex 200/112, 72/42). Retake it manually!!

5) Trust your gut. If you feel like something isn't right (patient declining, medications ect.) Ask/tell someone!!! Don't worry about feeling inferior. We had a nurse run propofol gravity. Obviously did not turn out well!

6) IV skills/blood draws are all about practice!! And you will def get that in the ER. Don't get discouraged.

7) Medications to brush up on:

-Dilaudid, Morphine (push slow and let patient know they will more than likely feel heavy or hot in the head first)

-Zofran

-Phenergan (very harsh on the veins, dilute in a flush before giving, and slowly)

-Decadron (push very slow and let patient know they might feel burning in the crotch for a min, very common side effect but will go away)

-Cardizem

-Insulin (subq vs IV)

-Toradol (be cautious with the elderly and kidney function)

-Antibiotics (Vanco, Rocephin, Levaquin, Erythromycin ect.)

-Versed

-Propofol

-Lasix

-Prednisone

-Heparin, Heparin drip (get coags back first)

-Narcan

I could go on and on lol.

neilprogers · May 26, 2016

How awesome, a brand spanking new emergency room nurse!!! You should've gone and worked the floor for a couple of years first.....NOT!!! If you want to be a pilot you don't take dance lessons. I hope you are as fortunate as I was and are surrounded by a bunch of mama and papa professionals (nurses,medics,doctors,ancillary staff) who are willing to teach and think outloud so you can pick up some skills, seasoned thought processes and those hard to come by pearls of wisdom. Never say "I know" when someone is explaining something to you- even you do know. Treat your medics, techs, and ancillary staff like gold. Especially medics and techs. The better you are to them the better they'll be to you. Show respect always- that's the key to professional generosity- most nurses are givers, if you show the effort,desire and humility of a hungry nurse- they'll feed you all day. Show arrogance - they will starve you out.

Boomer MS, RN · May 26, 2016

How awesome, a brand spanking new emergency room nurse!!! You should've gone and worked the floor for a couple of years first.....NOT!!! If you want to be a pilot you don't take dance lessons. I hope you are as fortunate as I was and are surrounded by a bunch of mama and papa professionals (nurses,medics,doctors,ancillary staff) who are willing to teach and think outloud so you can pick up some skills, seasoned thought processes and those hard to come by pearls of wisdom. Never say "I know" when someone is explaining something to you- even you do know. Treat your medics, techs, and ancillary staff like gold. Especially medics and techs. The better you are to them the better they'll be to you. Show respect always- that's the key to professional generosity- most nurses are givers, if you show the effort,desire and humility of a hungry nurse- they'll feed you all day. Show arrogance - they will starve you out.

Love this! Sounds like a youngish and enthusiastic (fairly) new ED nurse speaking here. If not, all the more kudos. Carry on and thrive, emergencynursy. And have some fun too.

neilprogers · May 26, 2016

Love this! Sounds like a youngish and enthusiastic (fairly) new ED nurse speaking here. If not, all the more kudos. Carry on and thrive, emergencynursy. And have some fun too.

16 years, burnt out and then decided to be part of the solution and not the problem. My angle is we can do it better and faster - in that order- up the proficiency and the efficiency to make for better outcomes.

pockunit, ADN, RN · Jun 4, 2016

How did your test go, do you think?

MedicFireRN · Jun 4, 2016

Medications to brush up on:
-Dilaudid, Morphine (push slow and let patient know they will more than likely feel heavy or hot in the head first)
-Zofran
-Phenergan (very harsh on the veins, dilute in a flush before giving, and slowly)
-Decadron (push very slow and let patient know they might feel burning in the crotch for a min, very common side effect but will go away)
-Cardizem
-Insulin (subq vs IV)
-Toradol (be cautious with the elderly and kidney function)
-Antibiotics (Vanco, Rocephin, Levaquin, Erythromycin ect.)
-Versed
-Propofol
-Lasix
-Prednisone
-Heparin, Heparin drip (get coags back first)
-Narcan
I could go on and on lol.

You can also ask the pharmacy- our pharmacy sent us a list recently of the 21 meds that constitute 71% of the meds administered in our ED. That's a cool, focused way to study up on the most common meds you use.