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And give them an empty very large 3 ring binder. I print out info about what we're caring for. I use 'up to date' alot. I highlight the important stuff and before they know it, they have made their own ED reference book

And a side note Do not let other staff dictate the type of patients you get. (if possible) I have had many charge nurses give me the "more complicated" stuff right off the bat because "this is a good one for her/him". If you don't build the foundation then the "good stuff or the "interesting" won't make sense. I know many times you get what comes in the door but it takes a preceptor twicew as long to do what needs to be done... explanations, etc. If you are able to take a few weeks to get the lesser acuity stuff to start, then when you get the level 2s and 1s, it makes sense

Where to start.... I have been precepting for 25 years or so. I find that to start, I just have the new associate work with me to watch what I do. Then we talk about the critical thinking that ED nurses do in all aspects of our care...from where we put IVs to the why's. I stresss the recognition of "sick" vs "non sick" appearance and always plan for the worst case scenario and how to rule out things using assessments and history taking. I go over the A-B-C method of assess and intervention of all patients. When ready and the new asociate has learned "my routine"-- I start by giving her 1 patient-- usually a level 3 or 4 ESI acuity. They focus on assessing and learning how to document their findings. I take care of the tasks of IVs, etc until they are proficient at the nursing assessment stuff, and then we add the IVs, etc. ENA has orientation modules as well that cover soup to nuts of systems assessment. Good luck

I have been an ED nurse since 1986. And yes, I still love it. The days where I feel that I made a difference in someone's life...what a great feeling Yes, ED nursing has become more of a 'exacerbation of your chronic problem ' type of nursing about 80 % of the time, but those days where you know that you and your care turned a critical patient into a stable one, or you made someone who was terrified and in pain; relaxed and feeling better, ready to face whatever needs to be faced... The feeling that I HELPED someone, truly helped, boy it gives me a high to this day I'm not talking about the everyday care we deal with, but those times where your adrenalin is pumping just as fast as your norepi is dripping in...and someone that was swiling the drain now is stable.... That's ED nursing.

We don't hold the narc until the ride is here--but we do ask the patient who will drive them home so we can give it--and then we give it, and if/when the pt is discharged, we have them call for their ride. (or taxi) Similiar to procedural sedation--the ride doesn't have to be here on site until they're ready to be discharged.

I'm with the "consult the legal beagles" here and develop a policy that is clear cut. Our ED also is--'no ride, no narc' rule. And yes, we get the tricksters. If they leave, we document that they eloped from the ED (similiar to AMA)--usually without notifying staff I am working on updating our policies in our ED, and this is one I am working on--when is a patient considered 'incapicitated' --fro drugs, alcohol, where the ED staff CAN detain them using restraints (the overtly OD'd patient or drunk as a skunk) but, they are not 'involuntarily committed" (we call it a 302). It is a very grey area and I am finding that we need to be VERY specific regarding lab data results, patient behavior assesments, fall risk, etc when developing this

search "demerol metabolites" using google and you will get some good articles

www.paindr.com/meperidine%20guidelines.rtf try this--it's a great little article about how the metabolites build up and can lead to neurological issues. now that they have dilaudid, fentanyl-which doesn't seem to have these issues, it is becoming best practice to avoid demerol use and use these other pharmocologicals instead

syringe pumps are great as well-- you can set it to admin over a certain amt of time-- so-- compazine which is 1 mg/min and you want to take a few extra minutes? set it for 10 min reglan, the same i have seen reactions from compazine and reglan. often they are related to the rapidness of the infusion a minute is a long time. often, when we stand there pushing meds, you may think you're taking 2-3 minutes, but in a busy ed and someone who's vomiting all over, you might be pushing it faster than you think and how fast are flushing your int? there is med sitting in that tubing. yes, a small amt but silly to take 3 minutes to slowly push a med, then squirt in zip the flush we give our phenergan, reglan and compazine in a 50 ml bag and run it over about 10 min. if there is a fluid restriction issue--renal patient, chf, etc, then dilute to 5-10 ml and use a syring pump.

Tylenol. Especially in the teens-- The danger is--they get no SE....right away. So, they don't tell anybody. And then their liver's shot And in others--Tylenol is the hidden ingredient...all the different OTC stuff that teens can get--many have Tylenol in it. It all adds up Alcohol. And then various prescribed stuff that they may use themselves regularly--from SSRIs, to narcs Street drug--varies. We rarely get 'one' flavor per person --often it's a mixed bag of coke, heroin, etc...

I think 2 patients at this stage, is doing well--but what acuity are they? If you find that you get caught up with 2, then ask for preceptor to give you a 3rd--so you can improve time management and priority setting. What is the 'normal' pt-nurse assignment there-- 1 to 3, 1 to 4? I find time management one of the most difficult things to teach and one of the more difficult skills to master! If you're caught up then accompany the physician/practitioner when he/she does their history/physical exam. I learned tons this way and many love to teach as they go. You should meet weekly with your preceptor and set goals for that week for you to strive for. Then meet at the end of the week to review your status. This way, you can express what you feel you need more exposure to, and your preceptor can tell you where you're at... Review protocols. Make sure you understand the WHYs of the things you are ordering or doing. That helps drive your education I remember when I first started in the ED. We were just starting nurse-ordering protocols (this was in 1986 BTW). Abd pain-- ordered CBC. The ED doc once asked me (new kid) Why are you ordering this? To say "Well, that's the protocol" would have been incorrect. Make sure as you are doing, you know WHY you are doing it...

To me--"ER" means Emergency Room-- and for most of us-- we are more than a room! We are a unit that specializes in emergency care of the sick and injured Maybe we should be EU nurses!

Healthcare crisis and its impact on Emergency Nursing--wait times, immigration, financial impact on hospitals, etc

Thank you so much. I copied your link and response and emailed it to her. I also told her that allnurses.com has great resources for nurses

Hello. I was asked a question by a friend who will be sitting for her state board exam in Feb. Her question was about showing proof of ID Now--does first and last name must be identical on both forms? Here is her question -quoted: "I am scheduled to take the NCLEX on Feb. 11th. Pearson VUE says that first and last name must match approved i.d. Even though divorced, I still use my married last name and my maiden name is still on my driver's license. Have you ever heard of anyone being denied taking their NCLEX b/c both last names are listed even though they are not hyphened"? I asked her to contact her state board as well. It's been a few (ahem) decades since I sat first sat for the boards-back then everything had to match. Thanks for your help