newER

[reebokHCFR]

I have recently been offered employment at a local ER. I do not have nursing experience. I have been in EMS for 11 years, 7 as a paramedic in an advanced system (pumps, drips, paralytics, narcotics, etc). While I feel confident in my pt care and decision making, I am not familiar with anything hospital-wise. I know I will be precepted and all that, but I am looking to get a head start by asking for both general advice and tips and things that you wish you knew when you started in the ER. Thanks in advance.

[emtb2rn, BSN, RN, EMT-B]

thanks. that's a good point about multiple pt's. that will be very different. fortunately they have a 4:1 ratio where I'm going so it won't be as bad as a lot of them are.

Staff 4:1 or a hard set ratio of 4:1? Methinks the former. Which means it's a guideline. When everybody has 4 pts and the squad rolls in with cpr in progress as a chest pain and a new onset facial droop/slurred speech come into triage at the same time, you might see a modification to that ratio. Could be wrong.

[exit96]

Some good advice has been presented in these few posts. Some nursing experience will do you good, seeing how you are going to be an NP (nurse). Why skip laying a good foundation? :-), good luck.

[hodgieRN]

They will teach you everything that you need to know. You have to make sure that your thinking as a medic doesn't cross over into your thinking as a nurse. I've seen medics (that have become nurses) argue with certain protocols or methods of thinking because they did it differently as a medics. It's hard watching someone that can't get a pt tubed, when you know that you did it everyday in the field. You have to sit back and just be the nurse. But, there are things only you will be able to in the ER vs medics in the ER. So, it plays out.

Spend some time concentrating on the protocols, hoops, and politics of the hospital. There's always a paper to fill out, an order to sign, or some bundle that you have to initiate. Your autonomy will change and you have to make note of the things you can do and what you can't do. There will times when you will feel compelled to act, but you can't...you have to call the doc over. You can't do a needle decompression when there's a doc that can put in a chest tube. And, you won't have a captain that watches your back on the engine. The higher-ups will reprimand you for the smallest thing if you don't have a good charge or manager. Be ready for cattiness, people talking behind your back, and burnt out nurses that can't retire just yet. Don't sleep with anyone from work. If you have a good team in the ER, it's an awesome place to work. If you work at an ER that's falling apart, it sucks. Don't talk about your sex life until you have made some close friends. Some nurses can't stop themselves from writing people up. It can be very high schoolish.

Many hospitals are moving toward patient satisfaction as the sole indicator of care. The fact that you save someones life doesn't matter if you aren't smiling when you do it. Practicing becoming like a waiter that offers anything a client wants. It doesn't matter if you save the city from burning down...if a patient says that you didn't bring them pain medicine the moment they asked, you will be a candidate for firing. So, practice giving service with a smile because they even survey the patients that threaten the hospital for not offering a turkey sandwich. This is the new standard and we now have to adapt to bowing at the patients feet. Make sure you get familiar with these expectations or you are gone. Welcome to saying thank you while you are being abused.