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Ahh,such a late reply I hope youre liking DU as much as I did when I went there.I graduated in '11. It is such a beautiful school,awesome location and great nursing program--well when I was there.This was before the classes got waitlisted.Not a lot of people were into nursing when I was in the program so i didnt have to worry about waiting for a spot in a class.The program was pretty hard then and Im sure that the curriculum has only harder now.Youll love it.nursing is hard in general!Currently I am an ER nurse at a local level 1 trauma centers and I am grateful for DU and their help.If you have any questions let me know.I dormed there for 3.5 years and the last semester i was there I commuted from SJ and SF. Yes i have an insane amt of student loan debt but everyone in my class pretty much did too.Yes there are other schools that you can go to for wayyyyy cheaper but i appreciated the low student to teacher ratio and the helpful staff.

Wow i would be so stressed out!Someone linked my topic from last week and all the help from others w their comments have given me encouragement and hope.First off,I know everything seems so fast paced but ive learned to accept that THAT is the culture of the ER. Its going to be fast no matter what we do.If you have even 10 seconds before a patient comes try to anticipate what youll need.i usually go for the standard rainbow/type and screen/blood cultures if sepsis is suspected,ekg,etc.Sometimes I even call in lab/phelbotomist to come in when theres a difficult stick.and get as much practice as you can with IVs.I used to be so afraid of them on the floor because i was so baf at them but now im the first one people call when theres a difficult stick.go for the go to AC veins.a cool trick I learned from my crisis/resource nurse was to double tourniqet--one above and below the site im going to poke..and BAM youll (hopefully) see a nice plump vein.it really is all about team work in the ED so make use of ALL your resources.pull your float in your room if you have one,call your tech for that ekg...ive noticed if you dont speak up for help youll drown.do NOT be afraid to delegate.that has been my problem.but its so helpful when you have an ambulance rolling in,someone getting settled from the lobby and you have a septic pt where youre trying to get a line and a little old confused lady in the other.trust me.i know the anxiety from all of this.i am going through the same thing now.its scary that we have a 4:1ratio with things happening like that but ask for help.cluster care as much as you can and be proactive instead of reactive.it helps so much to be a step ahead of everything.any tips you have also would be helpful for me!hopefully everything works out on your end fellow ER friend!

Any advice on your end???im stuggling with possible differential diagnosis because my memory recall from certain diseases/disorders is a blur to me.

I agreee totally with this post.I am in the same boat as you.Some days I feel like Im drowning some days i feel like im barely getting by.Never have I felt like it was a great day. Its been hard transitioning to critical thinking because on the floor,all the planning for the patient was already done.I never had to anticipate whether or not this blood work is going be needed.or if they have this certain diagnosis.My preceptors have actually said Im always thinking abobe and beyond what their diagnosis would be.But I do try to narrow it down to a diagnosis more pertinent to how they present.As for charting.You can NEVER go wrong with over charting.You never know many years from now someone may bring you into court and you wont remember that patient.the only thing that would save your ass is you charting.im always automatically cycling my vitals into the computer,always documenting when i spoke to the doc and what was said,anytime a family member is acting out,etc.EVERYTHING NEEDS TO BE WRITTEN DOWN OR IT NEVER HAPPENED.save your ass now and youll thank yourself later.My hospital uses Epic and its a lot of buttoms but it took a while for me to get around navigating everything.itll get better. TRY TO CHART IN REAL TIME.theres so many times where ive mentally assessed and seen my patient but I have not put it into the computer.Better place it in asap before you get caught up in another room and next thing you know,5 hrs has passed by and if you havent put that assessment in,it looks like you never saw them.Of course you can back time.but its better to do it THEN than later. Be proactive and ahead of the game before it gets nuts.we both know the ED never is dead.its always a **** show.Any advice on your end? I noticed that i am very unfamiliar of certain diagnosis and still need to get a hang of thinking quick..really quick on interventions that need to be done.ive been struggling.my preceptors and educators grill me so much and already have said theyre concerned.im just a slow learner.its discouraging to know that theyre not that helpful.i want to succeed and i will not quit!

I agreee totally with this post.I am in the same boat as you.Some days I feel like Im drowning some days i feel like im barely getting by.Never have I felt like it was a great day. Its been hard transitioning to critical thinking because on the floor,all the planning for the patient was already done.I never had to anticipate whether or not this blood work is going be needed.or if they have this certain diagnosis.My preceptors have actually said Im always thinking abobe and beyond what their diagnosis would be.But I do try to narrow it down to a diagnosis more pertinent to how they present.As for charting.You can NEVER go wrong with over charting.You never know many years from now someone may bring you into court and you wont remember that patient.the only thing that would save your ass is you charting.im always automatically cycling my vitals into the computer,always documenting when i spoke to the doc and what was said,anytime a family member is acting out,etc.EVERYTHING NEEDS TO BE WRITTEN DOWN OR IT NEVER HAPPENED.save your ass now and youll thank yourself later.My hospital uses Epic and its a lot of buttoms but it took a while for me to get around navigating everything.itll get better. TRY TO CHART IN REAL TIME.theres so many times where ive mentally assessed and seen my patient but I have not put it into the computer.Better place it in asap before you get caught up in another room and next thing you know,5 hrs has passed by and if you havent put that assessment in,it looks like you never saw them.Of course you can back time.but its better to do it THEN than later. Be proactive and ahead of the game before it gets nuts.we both know the ED never is dead.its always a **** show.Any advice on your end? I noticed that i am very unfamiliar of certain diagnosis and still need to get a hang of thinking quick..really quick on interventions that need to be done.ive been struggling.my preceptors and educators grill me so much and already have said theyre concerned.im just a slow learner.its discouraging to know that theyre not that helpful.i want to succeed and i will not quit!

Thank you for the encouragement!this definitely eases my nerves seeing how many people have responded to my concerns here!I feel less alone and in less of a panic.I currently for the past month now have been using my days off to study study study!So far its been helpful!

I APPRECIATE YOUR RESPONSE SO MUCH! I am a visual learner so i HAVE to write thigs down and observe before I can do a skill/procedure. The ED has been so intimidating lately but I am determined to get through it even though I feel like this is hazing lol.I definitely take into account your advice ASAP!

Thanks for the advice!any pointers on how to shake the nervousness i feel when im overwhelmed with traumas coming back to back or pts coming in while one is already crashing? I know i can use my resources like my float nurse in my pod but not sure what else.

Oh no!I am interested in reading your response.I need all the help I can get!

Oh definitely.I wanted to cancel the vacation but i had already planned it a year prior.Since my trip,I have been regretting that time off.But gotta just buck it up and do my best to persevere,focus and study hard!

They actually have really worried me.They said that compared to everyone else in my group of 7,I am falling a bit behind.But in all fairness they allowed me to take a preplanned PTO vacay the first 2 weeks of orientation so I am behind my group by more than 72hrs on the floor.My preceptors-I have 4 which is irritating because every preceptor is different and expects different things from me.What I have been struggling with is thag clinical reasoning cycle and not being so caught up in tasks like I was used to my whole career.this is very new to me and im slow at it.In our trauma room,full load is 1:3 and our bravo room is 1:4 max.

Currently I am orienting to the ER at a level 1 trauma center.I am on week 7 of 12 now.I only have previous experience on an ortho/medsurg floor and worked at an allergy practice as well.I still think I am a fairly rookie nurse,only having a combined 4.5 years of experience.Only having about 2.5 of those years being at a hospital.Long story short.I AM STRUGGLING.The ER has always been my dream job and I still feel it is early on in the game for me to give up.I know the ER is ever changing and reprioritizing and recognizing little "clues" in a patient's status is crucial.Any ideas and tips on how to "think like an ER nurse",organization tips,"pearls of wisdom",encouragement,how to study/main points to review in regards to diagnosis/procedures...I have been so overwhelmed with reviewing info and handling a full pt load on the floor with my preceptor lately.I need help!Any advice fellow ER friends????

Yes, at my hospital they are requiring TNCC within the 1st year and I was informed from my educator that I have until April of next year to get the certification but the April class is full. My only other option was to take it this January. Thank you for you advice! This really helps. I have not received my TNCC book yet from my education office so I bought a used TNCC book (most recent edition) in the mean time. I will definitely dive into the book once it arrives tomorrow.

Hi all, I have been a nurse for almost 5 years now and I recently have transitioned from being a floor nurse to the Emergency room. It has been quite some years since I have reviewed for a new area of nursing and I am really overwhelmed right now. Emergency nursing has been my dream and I do NOT want to give up this early on in the game. I currently am in a 12 week training program in the ED and halfway though it. I have never felt so incompetent and nervous for work! At the same time, I am trying to study for my TNCC in a month and I do not know where to start and I feel like crying everyday. Can anyone help with some tips and direction? Anything would help me at this point!