amyjm333

We have medics in our ER in northern Indiana. They can do almost anything and RN can do except some meds. They can: Start IVs including EJs (nurses can’t) Draw labs. Run EKGs Hang fluids and give almost all meds. Intubate if the physician needs assistance (or just wants them to do it.) They are highly utilized in our dept and we love our medics! They function almost as a nurse but without all the documentation of assessments and communication with patients and providers.

My very first day in the ER an ambo brought in an 8 year old girl with a stubbed toe. Her parents followed in their private vehicle. Medics were shitty and I was shocked. That was almost 6 yrs ago. Since then I’ve learned that people come in to the ER for some of the absolute stupidest reasons you could imagine and that common sense is not common at all.

I have a few simple tips that I feel might help ? 1. One of the most important things to know as a new grad is that the large majority of your patients are NOT going to be there for what we as health professionals consider truly emergent situations. Always keep that in the back of your mind. 2. Prioritize and reprioritize often. Treat the patients with life threatening conditions first and the rest can wait. 3. Pain in and of itself is not lethal. 4. Although you may be 4:1 in your department, your charge and team members will likely not place more than one 1:1 nursing (“ICU patient”) with you at a time. 5. Emergency nursing is a team sport! Ask for help when you need it and offer to help when you have time!

In the ED our standard is to initiate Seizure Precautions (bed rails up and pads placed), blood glucose taken, seizure time and length recorded, VS, verify suction is available, MD notification with med orders if applicable.

I would take the above advice and talk to the director in your current hospital’s ED. They are often happy to hire nurses with experience- even if it is not in the ED. At least that’s how it is in my state. We hire even new grads, so a nurse with a year or two of tele is valued! There will be a mindset change necessary to transition to the ED from floor nursing, though. When our patients walk in, we are starting from scratch. We don’t have diagnoses and all testing is yet to be done. I have not done any floor nursing so I don’t know how long that mental switch actually takes, but several of my most beloved coworkers came down to the ED from the floor and they’ve all expressed that “it’s very very different” and that they had to change the way they thought and how they prioritized patient care. Good of luck in your transition! Being an ED nurse rocks!!

My other small piece of advice is to focus on the truly emergent patients. Most people in an ED on an average day are not at risk of dying, but some are- focus on those. Good luck to you!

Ten patients is too many! I’ve got a few years experience as an ED nurse and we get 3 patients. There are times it’s so busy I feel rushed and time crunched. I’m pretty sure if we had ten patients each and every nurse in my department would quit. (Not saying you should do that). My only suggestion is to MAKE TIME to go over those results. Also, get yourself some form of standard organization going on. All patients may end up waiting longer but I have a feeling your dept isn’t going to notice. With ten patients, no one has the time to criticize you!

Our ESI 3s generally get labs (according to complaint), rad studies (again, according to complaint), a bag of fluids and appropriate meds to control symptoms. Once tests are resulted we either dc them w/ referral to specialist, or work on admitting them. I can’t say I feel they clog up the department, as many end up having legitimate complaints confirmed by labs and/or X-RAY/CT. I feel that the level 4&5s are the ones that should visit one of the local urgent care clinics, and could use a bit of drain-o. ???

Your kids are your responsibility.

Get yourself a PCP.

As a new RN in the ED, I made my own "cheat sheet" - it included all the things I needed to know in order to enter the info into my triage without getting any "hard stops" or things we MUST know to complete the triage screens in our EMR (first net). I would then document on the back of the sheet any meds or whatever else I needed to remember to chart. This is basically what I used. I am now able to recall all of the triage info and just write down VS & any verbal orders the MD gives me when we are both at the bedside. Or I chart at the bedside in real time. It gets easier with experience, but my cheat sheet helped when I was a brand new RN in the ED?

We staff 1:3. But when we get a truly emergent patient our zonemotes absorb our other two patients while we are 1:1. Charge also helps out wherever anyone needs it. And we usually have a throughput RN as well who helps by discharging patients, catching nurses up when needed, cleaning rooms, etc. We have amazing teamwork in our ED.

Hello! I know I'm a little late to the party, but I want to tell you firstly, do not be disheartened or discouraged. As nurses, PAs, NPs, Docs, we are all on the same team! I read through all of the previous responses and bits and pieces of each rang strong in my mind as being ways our processes could improve. I'm gonna take the lazy route and just list what I think would be beneficial for all :) Please keep in mind that I am coming from an ED where the PAs and NPs usually provide care in our "Fast Track" area and see mostly 4s and the occasional 3. 1. Entering all of your diagnostic and med orders up front makes the nurses' time management easier. If your facility allows, entering med PRN orders could save you and your nurses time and energy. For example, order the ibuprofen, then put the lido patch and Tramadol in as PRN. The nurses on your team should be reassessing the pts after pain meds are given anyway, so it is not a must that they be reassessed by you as well. This can serve multiple functions: it saves you time, and shows your nurses that you trust their nursing judgements, and promotes a team/collaborative care atmosphere. You can always say, "hey Sue, I'm gonna throw in orders for pain meds for room 29, let's just start with the Ibuprofen and if she needs more the orders are there." 2. If possible, order PO meds. Unless you have a reason not to. 3. As for over-doing the workup, as a nurse I personally feel that if it makes sense, you should order it. Nurses usually only go batty when we see a urine ordered for a foot lac or an abdominal CT with oral contrast and an IV for a kid who presents with abdominal pain x2 hrs (after eating fried Oreos), no home meds given, and is jumping around and sneaking Cheetos from moms purse. 4. I don't think it's at all necessary to be overly friendly with the nurses you work with, but I do believe if you help foster a team approach, everyone will have greater satisfaction. I personally love the providers who talk to me about what they are 'thinking' about a patient (when time allows of course) and allow me to be more than just a 'task completer'. It feels so much more colaborative AND it makes me feel more comfortable to ask for education from the provider. Just My Humble Opinions :)

Hi there! I am a newer ED Nurse and there are a few tips/tricks/notes that I feel can help any new ED Nurse: 1. Realize that a very large percentage of ER nursing is not dealing with actual emergent patients. You will be kept very busy with patients there due to conditions that are best dealt with in a primary care setting. 2. Learn to anticipate orders. In many ERs there are policies which guide the treatment of our patients. For example, nearly every person complaining of abdominal pain above the umbilicus will get: EKG, IV start with a 20g or larger in a sturdy vein like the AC (for Possible CT contrast dye), standard blood labs, CT scan, and urine sample will need to be provided for urinalysis. For a cough, our patients get: Blood labs, urinalysis, chest X-ray. These are just examples but my point is that many ED orders are ordered by the docs in a predetermined "set", based on policy, so knowing what your organization's policies regarding standard orders can save you lots of time and steps. 3. You will be busy! The plus side to this is that time flies in an ER. A 12 or 13 hr shift is not bad at all when you don't have time to be "bored". 4. This should probably be #1, but never be afraid to ask questions. What I find helpful is to ask coworkers when I need an answer for something but to always follow up by actually reading the policy regarding that specific situation. Which leads to #5 5. There is a policy for EVERYTHING. Lol. Be sure to learn early on how to access your organizations policies and procedures. 6. Always assess and re-assess. Not only does this assure that you are aware of your patients status, but you are assisting in the through-put of the department. The more the docs know about the pts condition, the easier it is for them to make a decision once the tests are back about how they want to dispo the patient (meaning make a decision about if the pt will be admitted/transferred/discharged). This helps move pts out of the Department. 7. Learn how to get information quickly from your patients. This is a skill I am still working on myself. It is important but can be difficult to get the proper and relevant information from your patient without going overboard. It is a learned skill to be able to recognize and draw out the important stuff while moving quickly past the irrelevant info the patients often want to talk about. Listen closely to the specific questions more seasoned nurses ask during their initial assessments and you'll get the hang of what is important to ask. 8. Never be afraid to help your fellow nurses. Emergency nursing can be overwhelming to even the most experienced nurse when there is tons to do and not enough time or hands to do it. If you make a habit of helping others, the favor will be returned. I have only been working in the ER for about 11 months, so I have lots to learn still, but I absolutely love being an ER RN!! Good luck with your new position! I bet you will love it too! Just remember not to get discouraged. It's ALOT at first for all of us. You just have to push past that discomfort and eventually you will have some sense of confidence in your abilities to get things done (or find the resource who can!).

I love the idea of always having a doc nearby! 🤓🤓🤓

I'm a recent grad and let me tell you- unless you have worked in healthcare prior to nursing school, you likely will have absolutely no idea what area you want to be in until you experience some of it through your clinicals. You might think you want to work in X area, only to find that you do not enjoy working in that area at all. I started school thinking I wanted to work in L&D or ICU. Once I got to spend a little time in each of those areas I quickly realized neither were for me. I recommend studying hard, never missing a clinical and ALWAYS being willing to jump into the mix when opportunities are offered at clinical. By the last semester you will probably find one area that you just REALLY enjoy and can't get enough of. Let that lead you. Don't let Mom convince you that money is the most important thing. As a new nurse you will be paid pretty much the same wherever you go (for example ED, Med-Surg, Mother/Baby) . It's the years of experience that increases your pay more than the specialization (unless you go on to advanced practice, but that is a bridge pretty far away that you really don't even need to think about just yet). Good luck and enjoy your studies. Your heart will lead you to where you are meant to be!

I would suggest applying NOW to the places you would like an opportunity at. I started applying at the places I wanted to work four months before we graduated. I was hired three and a half months before I graduated. I think (at least for me) applying early and getting that interview before they were swamped with Spring applicants who had just graduated is part of what got me in. I also elected to do their extern program where you basically function as a tech until you pass the NCLEX and begin RN orientation. I totally agree with finding a hospital that does a residency too, though. They're way more likely to hire a new nurse. Good luck í ¼í½€í ½í±

Thank you for the reply. I hope others chime in too. This actually got my wheels turning thinking about how it is also super important to be available to help the team, and not be long gone for any extended amounts of time. Thanks for your input!

Hello! I am a new nurse and I had a question about in-room charting in the ED. We have computers in every room in our ED (well actually throughout the hospital). Do you all chart in the room or do you prefer to chart at the nurses station? What are the reasons why you choose to do it the way you do? Are there benefits to being in and out quickly when doing the initial assessment? I know that at clinicals we could chart either place and up until the last semester I always charted at the nurses station. That last semester I decided to try something different and do all my charting in my patients' rooms. I found that I loved doing it that way for a few reasons: it seemed faster, and I got to spend a few more mins with my patients. I also felt that I was doing a more complete assessment as there were things in the EMR that I could simply ask my patient about, but would not have returned to the room to get the information as it wasn't vital to the patient's care. I want to be as efficient as possible in my new role as an RN, and I totally believe in working smarter not harder. Do you have any insights you can share with me?

Heya Frank! How abouts you jump in and we get outta here?!

I am a new graduate nurse and have begun working in the ED. The other night, we had a patient (not my patient) who was a frequent flier and was seeking pain meds. The patient's nurse (who is also new to the unit, but not a new nurse) was about to discharge the patient and asked an experienced nurse if they give referrals or if we even had any pamphlets or information to provide this patient who obviously needs help. The answer was no, we have nothing. We provide nothing. I have pretty tough skin, but my heart sunk for this patient. I have wondered many times since that day what I MYSELF will do when presented with an addict of the obvious or admitted sort.... So here is my question...what do you all do? Do you have a policy regarding this? Do you provide information of your own to your patients?

It sounds to me like you may be having some general anxiety issues. It happens sometimes for unknown and/or unexpected reasons! Go see your primary care provider and tell him/her what's going on. I'll share my story with you: Several years ago I lost someone very very close to me when he committed suicide. It was a rough time, but by the grace of God I got through it. Fast forward 7 years and I was in my second to last/final semester in nursing school clinical. It was psychiatric nursing, & I found myself experiencing horrible anxiety each and every time I pulled up to the clinical site. I kept thinking I was going to see someone hurt themselves in the same way my loved one had died (via hanging). It was an irrational thought and I knew it, but the chemicals in my brain wouldn't comply with my sensible thinking. I visited my PCP and he suggested I take a low dose of sertraline (and informed me that he takes it too...said he would get anxious a lot about keeping patients waiting, etc...). Well, that medicine turned out to be just what my body needed. The anxiety disappeared, my occasional insomnia completely stopped, & I have never felt more myself than I do now. So, my point is....maybe you just have something physiological going on. Go see your PCP. :)

Thank you for the info! I was just offered a position in the ED and I am so excited. I asked alot of questions in my interview and it really seemed that the unit is very collaborative and full of many, many nurses who have a true passion for teaching newer nurses, so I am thrilled to be starting once I graduate in May! (I'm actually starting in March as a extern/tech, just to get my feet wet until I'm licensed). Wish me luck! Any tips appreciated!!

I will be graduating in May and am interested in emergency nursing. Can any of you tell me what the culture is like in your ED? I am confident that I can learn quickly and understand the steep learning curve, and believe my personality is best suited to this kind of nursing. But, I have one reservation- I don't want to work with a bunch of cut-throat, gossipy jerks. It's not that I have thin skin, bc I don't. I just prefer to work with a smart, collaborative, supportive team who can count on each other. I'm an older nursing student (30's), and if there is one thing I have learned in my life it is that you can't be happy if you're surrounded by negativity and/or mean-spiritedness. Should I worry?

Yes, I am thinking perhaps Valpo did not get updated A&P grade since I just re took it this last semester. That is the only reason I could think of...Either way, I would have declined since I did get accepted into the S Bend program. :)