New nurse who accepted a first job in ER

scattycarrot, BSN, RN · Jan 25, 2008

I have recently graduated nursing school and my first job as a RN is in an emergency room. At first I was ecstatic, but now I am kind of worried that it may be overwhelming. I've worked as an ER tech for the last 4 years so I'm not worried about starting lines or anything else technical, but I just don't know where to start with organizing my care and doing through assessments, and doing a through intake interview. I hope these are all things I can learn quickly on the job. Is it wise that my first job be in an ER?

Firstly, congratulations on graduating and on your new job! Now, to your question. You will find that people have very frim ideas as to whether you should go straight into the ER as a new RN. I think it depends on the individual and I would say that with 4 years tech'ing under your belt, you have a huge advantage over those newbies who don't and do sometimes struggle with the ER pace and stucture. It is natural to be nervous and good that you are, as that means you are going in without an attitude and with an understanding that you have a lot to learn. Remember that no new RN going into any area really knows much about organising their own care as this really isn't a skill you develop until you are doing it. Its now that your learning curve climbs steeply. And, likewise, with your assessments. You will find your own style, pace and rhythm and that might take a while. You just have to be patient with yourself and listen to your mentors and learn from them.

I assume you will have a period of preceptorship? Make the most of it and ensure that your preceptor knows what your concerns are and make a gameplan to tackle them.

It might be useful to think about the most common complaints that come through the ER, eg..acute MI, stroke, GI bleeding, ACS, etc... and sit down with your mentor and go through your assessments on paper or at least, do this at home on your own. Picture yourself with a new patient and think through what you would do. Make notes about what are the priorties for each condition. For example, with an acute MI, its MONA(montior, oxygen, nitrates, aspirin). Then, when you see these patients in real life you will be more aware of whats imprtant and whats not.

just remember that you have a great grounding for the ER and you know what to expect patient wise, and thats a great start. I am sure you will be fine.

Good luck!!!!!

SDS_RN, RN · Jan 25, 2008

I think that no matter where you start you have a lot to learn as a new nurse. I started out on surgical and pediatrics for a little over a year before transfering to the ED a few months ago and honestly it did not help me out as much as I had hoped.

I think that starting in the ED is fine because no matter where you start it takes time to find your stride and confidence. Just make sure you use your orientation to the fullest extent and never be afraid to ask questions. I think it's a good idea to do what scattycarrot recommended with the envisioning yourself caring for the pt and what you should do. Make note cards w/ assessment skills needed for the basic and most common tendencies in your ER and then go through them w/ a coworker and find out what else you need.

I have only been in the ED for a short time and have experienced more there than I have in the last year of working on surg/peds. If I could have I would have prefered to start out in the ED but my facility requires at least 6mo on med/surg before xfering to a different dept. Good luck to you and congrats on getting through school and your boards!!!!!!

precious33 · Jan 25, 2008

Nothing is wrong about where you start .All the ER nurses started somewhere,afterall you gain experience.

Congrats on your new job.Take notes ont the common conditions read a lot on the management and don,t hesistate to ask questions.

northshore08 · Feb 1, 2008

Great suggestions everyone--I also have to recommend you ask for an ENA-based orientation. The ENA has an orientation program that has recently gone on-line, but it includes 26 different teaching modules for every kind of problem. I just finished precepting a new grad with ERT time under her belt just like you. Like you said, the skills are easily grasped and you sound like you have a solid basis for practice.

The good thing about the modules is that they cover theory and prioritization of care. If the folks at work do not know what you are talking about, go to www.ena.org and start looking around. You will find the resources you need.

And if your unit does not have an updated IV drug book, you buy one for you to use. Look up every drug you give for side effects, timing, compatibilities, etc. When it comes to meds, don't always rely on your coworkers. I can't tell you the number of times I have stopped seasoned coworkers going out the door of the med room with the wrong dose or dilution or something. And the scary part was they said, Well, I've been doing it this way, or This is what somebody told me to do. Really pretend that every patient you treat is your beloved family member. How careful would you be?

One more thing. Adrenaline is not always your friend. It is very easy to get all excited and flustered, especially when everyone else is too. Remember this. "Take your own pulse first." It means to take a deep breath and think, what is first. ABC. When you are able to practice calmly but quickly, you will help all those around you, including the patient and family.

Good luck to you and enjoy your new job! And help a tech or two...remember you used to be one. :redpinkhe

AfloydRN, BSN, RN · Apr 13, 2008

I won't write a book. The most important part is being organized. Learning how to prioritize care is your best friend. I went to ER right out of RN school and I am still there. You have to be strong, stand your ground and do not get discouraged. Go home at the end of each day and think about what you learned. You will be amazed.