questions about working in the ed

Hi,

I have been a Tele RN since getting out of nursing school 1.5 years ago. I am thinking of making a change to the ED in about 6 months when the training programs begin at my hospital. I would like to hear from nurses about their thoughts on working in the ED and what skills/traits a person needs to work in the ED. My hospital is a teaching hospital and from my understanding for some of the RNs in the ED at my hospital the pts are more medical rather than trauma pts.

Thanks

Beth

Beth,

Hi How long will your precept/ orientation be? If your hospital is not trauma level patients, then your experience should be fine. I think you will adapt without too many problems. We have a 6 month precpt/ orientation for new grads in our ed. And I may add our new grads are working out just great. in fact they are more inquizitive, and eager to learn, and sadly more enthusiastic about their jobs then some seasoned nurses, who are bitter and burned out. Er can be very very demanding, and burn out can happen even though there is little to no trauma. I hope this helps. I love my co workers and the ER. I hope you'll enjoy it too. GOOD LUCK!

Beth, I Have Found The Most Valuable Skill In Er Is Critical Thinking. You Have To Know What You Are Doing And Why You Are Doing It, And When You Should Do It. In Our Er, Sometimes It Is Up To The Nurses To Initiate Patient Care While Waiting For The Doctor ( But Only Where A Protocol Covers You ) Because The Doctor Gets Tied Up.

You May Find That Taking Er Geared Education Such As Tncc (provided By Ena) May Help You Decide If You Want To Venture To The Er. I Precept At Least Twice A Year, And Have Found That Most People Either Absolutely Love Or Hate The Er, There Are Not Many In Between. Good Luck.

ER is working in constant chaos--Think of trying to put a jigzaw puzzle together with no picture to guide you--in ED-people come in and with your assessments and history-you start to piece together the problem while intervening at the same time. Telem nurses usually have a good cardiac /resp background- brush up on critical care drips and PEDIATRICS!!!

Recommend also ACLS ( if not currently), PALS, APLS, ENPC, TNCC (just because it's not a trauma center doesn't mean trauma doesn't come thru your door!) Make sure you have a good preceptor/mentoring program--It is your responsibilty to make yourself an ED nurse- join ENA-go to seminars, read the journals. Good luck

Anne

Beth,

Hi How long will your precept/ orientation be? If your hospital is not trauma level patients, then your experience should be fine. I think you will adapt without too many problems. We have a 6 month precpt/ orientation for new grads in our ed. And I may add our new grads are working out just great. in fact they are more inquizitive, and eager to learn, and sadly more enthusiastic about their jobs then some seasoned nurses, who are bitter and burned out. Er can be very very demanding, and burn out can happen even though there is little to no trauma. I hope this helps. I love my co workers and the ER. I hope you'll enjoy it too. GOOD LUCK!

HI,

Sounds like you have experience in the ER. I hope maybe you can give me some advice.....I graduate in May. I have a PT job as an RN Extern in the ER in a small hospital. I have seen everything so far except a GSW - I do everything they want me to do except for meds and IV's.

I want to do ER when I finish but I am wondering if I should do ICU or a Med Surg Floor when I graduate first? I want to be a good nurse...I want to know what I am doing and have good assessment skills....I have no problem with seeing / helping with trauma's and the RN's Tell me now that I am doing good and they dont' see why I would need to do my mentorship anywhere other than the ER. But I know - that being an Extern is going to be different than being a nurse. What do you think?

Hi Beth,

I agree with needsmore$. Though your hospital is not a trauma center does not mean you won't see trauma. I work in a hospital that is not a trauma facility but is the only hospital in the county. We see trauma.

I strongly recommend you at least do TNCC. It will help you organize the chaos...... at least in your head. You'll find you have a constant priority list playing in your head the whole shift :)

After doing this for 20 years the best advice I can give to someone new to the ER is know your limits. Know when you're in over you head. It's OK to ask for help and it's OK to look things up...... use your resources.

Good luck to you and if you like it, the chaos is what keeps you coming back for more! :rotfl:

sam

Hi,

I have been a Tele RN since getting out of nursing school 1.5 years ago. I am thinking of making a change to the ED in about 6 months when the training programs begin at my hospital. I would like to hear from nurses about their thoughts on working in the ED and what skills/traits a person needs to work in the ED. My hospital is a teaching hospital and from my understanding for some of the RNs in the ED at my hospital the pts are more medical rather than trauma pts.

Thanks

Beth

I have been an ED nurse for over 16 yEARS. this statement is not true. Depending upon where you live and how your EMS system is set up, there will be a designated Trauma center. However, any hospital anywhere can get a trauma patient especially if the main trauma centers or other hospitals are on divert.

Percentage wise, the cases can be medical, surgical, pediatrics, etc. YOu need to be well rounded and knowledgeable about all things. A telemetry nurse is limited in her/his thought processes. You need to take some clases first to know what you are getting into. Brush up on your assessment skills because you may be the first patient contact and you have to know what you are dealing with as well as the physician.

I have been an ED nurse for over 16 yEARS. this statement is not true. Depending upon where you live and how your EMS system is set up, there will be a designated Trauma center. However, any hospital anywhere can get a trauma patient especially if the main trauma centers or other hospitals are on divert.

Percentage wise, the cases can be medical, surgical, pediatrics, etc. YOu need to be well rounded and knowledgeable about all things. A telemetry nurse is limited in her/his thought processes. You need to take some clases first to know what you are getting into. Brush up on your assessment skills because you may be the first patient contact and you have to know what you are dealing with as well as the physician.

In my opinion, critical thinking skills #1. The patients you see will be a broad variety, everything from flu, UTI, SOB, Chest Pain, to hip fractures from nursing homes, Codes, MVC's, drunks, addicts, psych. They will be also a wide range of ages, neonates to the geriatric population.

You do have to be well-rounded, and you need to be able to prioritize (sp).

Also, another important thing I tell all my new nurses, know where everyting is. That sounds trivial, but what good is it to know why to insert a chest tube if you don't know how to set up the tray and even where the heck the pleural-vac is?

Rollins makes an EXCELLENT point about knowing your equipment!! Use down time to stock your areas (if you can)--open up those locked code carts and check them--I orient new staff and they spend a shift doing nothing but restocking the dept and checking code and specialty carts-We have a GREAT nurse who is our "inventory" specialist who works this shift with them. When I first started in the ED in mid 80's-the ED nurses stocked their assigned areas-from linen to bedpans to O2-monitor stuf, etc. It was a great way to learn your equipment. Now- we have "techs" who stock to help-- many nurses no longer stock-saying it's the "techs responsibility"- WRONGO! As the nurse you are responsible for making sure that you have what you need to care for your patients , you know how it works, and if it's not there or broken and a patient needs it ASAP- you could be help accountable if the pt suffers because of this ---Good luck

Anne

Been a nurse for 10 years...spent 4 in med/surg/tele/onc..6 months in Surgical ICU and 3.5 years in Suburban ED (Bordering a major city)..Now I am in an Urban level 1 trauma center ED and have been for the last 2 years...Things I've learned...My time was well spent regardless of how painful med/surg seemed at the time :smackingf ...best thing I ever did...taught me time manangement...in a more controlled setting...it gave me the basic assessment tools...taught me how to learn the difference between sick and not sick as most patients are stable when you get them, you can more readily tell the difference when something goes wrong...taught me how to prioritize my tasks in a controlled setting...The challenges...ER nursing is its own world...it's exciting :w00t: , its frustrating , its challenging :smiley_ab , and its always in constant motion :roll ...it's one of the only fields you get to work closely with almost everyone, from radiology, to respiratory, and even the docs...You learn and teach so much back and forth it can be a wonderful learning experience...I agree with the statement you either love it or hate...I have met many of nurses in my career...some are "ER Nurses" and some are "Nurses working in the ER." Continuing ed is the key ...you are not taught how to be an ER nurse in nursing school...you need to be motivated to learn...in 10 years I can still say, I learn something new every single day I work...Most ED's require you to have BLS, ACLS, and PALS at bare minimum...although TNCC is required for any RN that works in a trauma center, I don't feel it is necessarily geared towards ER nurses as it covers many broad trauma related topics b/c it is also being taught to ICU, General Trauma floor and rehab nurses, virtually any nurse in a trauma center that will come in contact w/ a trauma pt...I definitely recommend APLS or ENPC...great peds courses for ER nurses....also PHTLS, although a pre-hospital trauma course...it is very appropriate for the type of care ER nurses give to trauma pts....ATCN is also a good trauma course, taught in conjuction w/ATLS (The doctors version of trauma life support). The next thing is.. :chair: don't be afraid of your shadow..the only way to learn is jump right in...we call it baptism by fire...when in doubt..ask questions...that's how you learn...we all learn together...I am a new staff preceptor...and its great, because it keeps me on my toes...I have to look stuff up all the time, I have no less then 7 books in my bag for reference...so never feel stupid for asking questions and its okay to say you don't know something, or how to do something...I much rather be told by a new nurse they aren't sure of something or aren't sure how to do something and have them ask for help then go do it wrong and cause harm to someone...They put that :redlight: "EMERGENCY" :redlight: sign out there for a reason...just cause you aren't a trauma center doesn't mean someone won't get shot and dropped off at your front door by the "concerned friend, that doesn't know anything" You have to be ready for anything...because you will eventually see everything...and if you don't see everything, you'll either meet someone who has, or hear about someone who has...Definitely know your equipment...where it is and how it works..Treat everyone the same...easier said then done, but I close my eyes and imagine that's my grandmom laying there bucking the vent...be a patient advocate ...that's what you are there for...Good luck with your future in nursing!