New to practice nurse out of school for a year & a half & was offered ED position.

[murphyk12]

I graduated with a BSN Dec. 12'. Passed my boards Mar 13'. I was actively seeking employment for the past year with no luck & finally was just offered a position in the ED. It is a dream job for me as I want to pursue trauma nursing. I have had the opportunity to experience the ED a few times during clinicals & fell in love. So here's my dilemma. I have been out of school for so long that I'm afraid I'm going to look stupid. I don't start for a month so I have time to study, but since there is such a variety in ED nursing, I don't know what I should focus on. Cardio, stroke, etc. Or if there is a book I can get that would help. I would appreciate any feedback to help me prepare. I really don't want to mess this up & want to prove that I will be a great ED nurse.

[Sassy5d]

We all start somewhere. There will always be at least 1 nurse in every specialty who makes you feel like you are a moron, no matter how many years experience.

Review your normals.

Watch some YouTube videos. Stroke/tpa. MI's, chest tubes, iv insertions, abdominal pains related to quadrants. Seizure care.

There's always something to learn, try to relax. Nobody will expect you to be nurse knows all. Don't ever pretend to know things you don't.

[murphyk12]

Thank you for the great advice. I've been looking over lab values, basic meds, assessments, cardio, & neuro. I didn't think about abd pains. I will definitely go back to that. I have a 6 month orientation & will be getting ACLS, PALS, Critical Care, Trauma, & Telemetry certs. Im sure I'll be okay, just very nervous. I just have to build my confidence back up :) Thanks again!

[Altra, BSN, RN]

That six-month orientation will serve you well.

Remember too -- no one -- NO ONE -- is a "great" ED nurse for a couple of years.

Good luck to you.

[turnforthenurse, MSN, NP]

You cannot be expected to know everything right off the bat.

The ER is wonderful and exciting by the fact that you do not know what will be coming through those doors. Each patient is like a puzzle as you don't necessarily know what is wrong with them (though sometimes you do) and now you have to collaborate with the providers and figure it out. The ER is also known for having "protocols." So for example, someone coming in for chest pain will get the chest pain protocol initiated - that will buy them a saline lock, labs (CBC, CMP, cardiac enzymes), 12-lead EKG, cardiac monitor, oxygen, chest XR, chewed aspirin and nitro. Our docs are really good about us initiating care sets and ordering things to get the ball rolling. For example, if the pt has crackles in their lungs and has a history of CHF, I will go ahead and add on a pro-BNP level to their labs. For pedi fevers that have not been medicated, we can go ahead and order weight-based Tylenol or Motrin (sometimes both) so start treating that. If you are ever unsure, ask the provider.

We are te provider's eyes and ears. Oftentimes we see the patients well before they do so we need to know how to identify potentially emergent situations.

Everything comes to the ER, but some common complaints/disease processes I would brush up on would be: myocardial infarction, CHF, pneumonia, pulmonary embolus, CVA/TIA, DM, fevers, UTIs, lady partsl bleeding (especially if they are pregnant), SIRS/sepsis, pneumothorax, appendicitis. There are plenty of others. I always tell myself (and my orientees), "think about what the pt is presenting with and what is the worst thing that they could have? What will kill them first?" For example, if a pt who is 8 weeks pregnant comes with c/o some lady partsl bleeding and unilateral abdominal pain,automatically think an ectopic pregnancy. Learn to anticipate, but this can take time.

2 books I foun helpful: Fast Facts for the ER Nurse and Sheehy's Manual of Emergency Nursing. fast Facts gives you everything you need to know in an easy to read format and gives you the common things patients may present to the ER with. It also tells you what lab to anticipate. Great for new and older ER nurses alike. I think it is normally $25 but I found it on Amazon for $7 in excellent condition.

[turnforthenurse, MSN, NP]

Sheehy's is way more in-depth but still an excellent resource.

Carry around a little pocket-sized notebook to just write down things, even things you don't understand. You can research when you get home/on your off days. The learning never stops!

Don't be afraid to ask questions from your peers. In my opinion, no question is a stupid question.

[Ruby Vee, BSN]

That six-month orientation will serve you well.

Remember too -- no one -- NO ONE -- is a "great" ED nurse for a couple of years.

Good luck to you.

No one is a "great" ANY kind of nurse for a couple of years!