"Welcome to the Jungle"

Altra, BSN, RN · Jun 3, 2006

A couple of other things included in my orientation book that I relied on heavily: drip charts & info on how to titrate drips (by what increment, etc.), med cards for about 15 meds that new grads are unlikely to have dealt with in school except briefly in a critical care class, moderate/conscious sedation policies & procedures, and standing orders/protocols (i.e. this is what needs to happen in the first 30 minutes with a cardiac patient, a stroke patient, etc.)

Hope this helps. :)

Spritenurse1210, BSN, RN · Jun 3, 2006

So here's my idea...
I went into the ED as a new grad. I am thinking of trying to do a "ED for new grads" handbook for the place I work at. Something with some general info to help better orient a new grad to the ED, esp with some stuff they might not experience with orientation.
We have a book similar for a trauma class, and that's what got me thinking about it.
What would be some good points for this sort of thing? I have assessments, ABC's, IV tips and tricks, triage, OB, trauma. What else? I don't want to do a system by system type of thing, just common things a new grad might have to deal with (also including "Where did you say that was at?" for finding your way around the dept and "Goodbye and Farewell" for admissions and discharges).
Any help/suggestions appreciated.

:lol2: Good luck with that!!!

EricJRN, MSN, RN · Jun 3, 2006

What about talking to your current ER staff and getting them to write little encouraging messages or advice to the newbies? You could include a page or two of these quotes in the handbook.

student4ever · Jun 3, 2006

You might also want to put a note in about the differences between the ER vs. the floor - most new grads have had the majority of their nursing experience on nursing floors, where the focus is very different! I see new grads spending TONS of time doing TOTAL care on one patient and "forgetting" about the others because they have difficulty delegating, and are "trying to make the patient comfortable." Not to say that we shouldn't make ER patients comfortable as possible, but we are there to treat an emergent condition, and we have many people needing our emergent care. Spending a ton of time chatting with a patient and attending to their every desire while the med orders pile up on other patients is not effective ER nursing. Also, I don't know how many times I have pried a warm blanket or drink of water out of a new grad's hand and asked why they are giving the man with an ankle deformity a drink of water when he will most likely be going to the OR very soon! Or asked if they've checked the pts temp recently to figure out if they're really freezing or if it's indicative of a spiking temp before giving them a heated blanket to further increase their temp. These are comfort measures given to just about everyone on the floor, but we are very careful with in the ER. The docs don't write NPO on the charts - but that's because standard protocol is NPO unless otherwise specified. These are things that they just don't talk about when doing ER orientation it seems, but I think they are very valid points. Also, at most facilities, ER techs are allowed to do more procedurally than they are on the floor - delegate these tasks out so you have more time to concentrate on your meds and IVs!!! Why spend hours doing tasks your tech can be doing instead of sitting at the computer playing games? New grads have other things they can be doing with that time. That said, be good to your techs, and treat them with respect, and they'll do anything they can for you. I know, I am a tech. The nurses who treat me well and respect me and my job are the ones I will bend over backward for and help them with anything, and work my little tush off for.

Good luck with your handbook, it's a great idea!!!

Home Health Columnist / Guide · Jun 3, 2006

check out some of these websites for ideas ---why not have info online???

emergency nursing world: http://www.enw.org/toc.htm

codern2 homepage connection

burn out · Jun 3, 2006

The biggest problem I have when I get pulled to ER is remembering who gets what labs drawn and which ones for specific patients. For example what lab is it that is drawn when a women comes in with a possible miscarriage, it is not hcg? Also a list of all the cardiac workup and time frame for drawing each one.Also is a drug screen to be done by blood or urine sample?

liquidblue · Jun 10, 2006

drug screen can be done either by urine or serum, but in my facility urine is used most often.

when cardiacs are ordered, one is drawn upon admission, then 4hr, 8hr, 12hr, and 24hr.

vampireslayer · Jun 19, 2006

Get an IV started before giving anything that might compromise their pressure (I'm thinking specifically of giving nitro).

No matter how old or young, ill or apparently robust, if you give narcotics, put them on a pulse ox and cycle their BP at least every 30 minutes. Check their BP before giving it!

Swing by the bathroom and have the pt. give their urine sample before getting them to their room, undressed, all hooked up to monitors. Easier that way. You can use that time that you're waiting for them to come out to gather your pulse ox, BP cuff, gown, linens, etc.

If you're having trouble with IVs, sitting down can help a LOT.

That's all I can think of right now.

VS

RunnerRN, BSN, RN · Jun 20, 2006

When I was orienting, I kept a little notebook with a summary of interesting/new cases I had that day. It was a pain sometimes, but very helpful to be able to go back and say "okay, when I had the sickler, I had to draw XXY labs." Or little reminders like mixing the insulin drip (removing a cc of NS from the bag before mixing the 100U). There was just so much to learn in a relatively short period of time, and I've always remembered more if I write stuff down.

I really like the idea of typical labs for certain conditions. How about a brush up on psych patients? A lot of new grads don't learn everything they should about holds, restraint protocols, how to give an IM to a very ticked off psych pt, etc. Maybe a little note about the importance of undressing psych patients (best way to keep them from eloping!)

Great idea....wish I would have had one!

CoffeeRTC, BSN, RN · Jun 20, 2006

lol...I saw this title and chuckled. We call our one hall the "Jungle" (we have alot of screamers and fall risk) and the other one the " Island" (once you go down the hall you don't come back for a while)

Your plan sounds good.