I am a new green as green can be R.N. with no prior health care experience. I'm bright eyed and bushy tailed. So, I just got hired at a hospital around where I live and started the job on Monday. I totally didn't think I could get hired as an emergency nurse, but I DID! I am on a lengthy orientation and feeling excited, nervous, scared, happy (you know, the jump for joy kind), curious, knowledge hungry and on top of it all...I feel like I know nothing. Nursing school gives you the basics, but the stuff you need to know about any nursing, let alone emergency nursing, is incredibly enormous! It's both humbling and invigorating...all at the same time. I am looking forward to being part of the team.
So far, I like the people, the environment, the culture and all that.
What I am hoping to spark here is a discussion on other's experience as a new nurse starting out in the emergency department. What happened? Anything good? Anything you want to tell me about what I should do, not do, keep in mind, etc?
What about you seasoned nurses? Do you think nurses should have med-surg experience prior to being hired as an emergency nurse? Or do you think it's good to be hired green? Why?
I think I asked enough questions to get the ball rolling.
I too am a fresh RN in an ER. I really enjoy the ER but lately I have felt overwhelmed and disappointed. Half of our day shift has quit and our hospital is for sale. To top it off, my preceptor also quit, her last day will be this week. So i'm in lingo because there isn't enough experienced staff according to our director, that is stable enough to pair me up with. Apparently administration has this NO divert policy. On one day, there were 8 patients to 1 nurse, this is one of the reasons why some of our staff is leaving, they feel it is unsafe to practice under these conditions, and now all that is left is RN's with 1 to 3 years experience. I feel very scared, and I dread going to work, sometimes there are only 3 nurses on shift when there should 5 to 6. I love patient care but I need some encouragement or something, I hate feeling dread. I will appreciate any advice.
Apparently this is not an uncommon situation as I found out today. A few nurses leave, the rest of the nurses feel short staffed and more begin to leave and it only worsens the problem (this is in an ED I know of).
I am not sure of the solution to this expect to keep ratios at a safe level by hiring enough staff. Easier said than done apparently.
I started out as a new nurse in the ED a year ago, and I've made it through unscathed for the most part There were definately tough times, and many times that I've hated my job...but I wouldn't change it for the world. I had a great orientation period, and am very lucky to have wonderful people to work with. I've never felt that I'm left hanging on my own. There's always someone there to help me out. And over the months I've found that I can help others as well. I've learned so much. There are things I handle easily now that would have had me on the verge of tears 6 months ago. I wouldn't necessarily advise the ED to all new grads, but if it's the place for you, it can be great. Good luck to you! :)
I think another asked this simular question. If you think ER is where your heart is then stay there. With a decent internship and a good precepter to help put that knoledge into perspective, you can do just fine. Floor and unit experiece helps in many cases but it can also be a liabilty. HUnker down , study your material and make sure your precepter is showing you the ropes and not just coasting on your efforts through the shift. Dont be scared to say you need to keep it slow for a good long time till you find your rythm/way of doing things. Just dont forget, it's the ER not a floor pt and dont sit on the pt, and more important don't be shy to ask a question.
I just started in the ED in December, but had done some work in LTC and M/S, but only per diem. They had an extensive "new grad" program for new ED nurses too, which included classroom time and floor experience.
My advice is to first be willing to admit you know nothing. I had nurses that started with me also, but had lots of M/S experience or whatever, and thought they knew it all. They didn't. I was used to doing full head-to-toe assessments on my pts. That wasn't what we were supposed to be doing in the ED, so it was hard to get out of that (not talking about the trauma pts now, just the ones coming in for a sprained finger or dislocated shoulder or cold sx, etc). But that being said, you have to be able to learn what are some good ways to do things and what are not.
Just a "for instance", blood cultures x2 are something we do all the time. However, my instructor told us you'll see a LOT of nurses doing them wrong, and they KNOW they are, but are trying to "save time" or are just plain lazy. First, they aren't doing them 15 min apart - just labeling them as such, and a lot of time, are pulling them off an existing IV line, which is not going to culture the blood, but the line itself. They should be done on 2 separate sites 15 min apart, and unless the IV line is brand new and the blood drawn off it right away upon insertion, a butterfly stick should be done on 2 separate sites. I can't tell you how many nurses (and paramedics who work in our ED) would draw 20ml all at once off an existing IV line. I know we're all busy and it saves time, but it doesn't help the pt, and the results may be erroneous. So be open to learning - learning the right way, maybe learning some short cuts (eventually, but learn the right/textbook way first) and learning the wrong way so you know what NOT to do. Does that make sense?? lol
(BTW, I'm not saying this to be flamed! I know I'm new to the ED and don't know much, but this was just an example of something we were told and I also saw).
Take advantage of "down time". It very rarely gets slow, at least where I was, so I decided during those times I would learn a new rhythm strip, review a certain protocol, learn some new drugs, etc.
I also always kept by IV drug book and Drug guide with me. I looked up drugs I had never given before, and would do that until I'd given the drug several times. I kept a notebook with me and would write down notes, then would review them later.
Ask lots of questions. Practice all of the common skills needed in the ED until you can do them in your sleep. Part of our ED school was just doing skills for about 7 or 8 shifts. All we did was blood draws, IV's, catheters, 12-leads, NG tubes, etc. If there is one skill you need practice on, ask everyone to let you know if they have a pt that needs that. Don't shy away from what you don't do a lot or don't know.
Well, I've written a novel, but congratulations! I'm still learning too, and don't be afraid to tell people that you've never done that before, and would they guide you through it or ask for help. Most of the nurses and techs and docs I've worked with are more than willing to help!
There were definately tough times, and many times that I've hated my job...but I wouldn't change it for the world. I had a great orientation period, and am very lucky to have wonderful people to work with. I've never felt that I'm left hanging on my own. There's always someone there to help me out. And over the months I've found that I can help others as well. I've learned so much. There are things I handle easily now that would have had me on the verge of tears 6 months ago. I wouldn't necessarily advise the ED to all new grads, but if it's the place for you, it can be great. Good luck to you! :)
frenchfroggyAPRN, MSN, LPN, RN, APRN
95 Posts
Don't be afraid to ask a question. The only dumb question there is , is the one you don't ask and do something wrong.