RN Grad starting fresh in the ED!

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I passed my NCLEX a month ago and was recently was hired in an ED.:yeah: I inquired during my interview how and why this job would be offered to a new grad and the manager explained that the hospitals ED is well staffed and they can take the time and energy to train a new grad, my orientation is 14 to 16 weeks. Other thread posts have suggested that a new ED nurse won't feel comfortable until a year or so of practice anyway, gotta learn somehow.

I would like an experienced ER nurse to fill me in on some key points to know/practice/study/familiarize with before I start orienting and following my preceptor. I know some of you have worked with and possibly even precepted for a new grad in your ER; what annoyed you or frustrated you about specifics they didn't know or were completely oblivious too?

I'm a little nervous to start if you can't tell, but excited and confident I have what it takes. I'm high energy and like surprises. I also don't like to look like a fool or have to play guessing games, especially in that acute of a setting. :coollook:

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Specializes in Trauma/ED.

14-16 weeks seems a little short for orientation of a new grad...most places I've been involved with have at least 6 month orientation/internship. Do they have some web-based modules you will be doing or some class time? It is extremely difficult to learn everything at the bedside and requires a very good preceptor with a lot of time. However, I don't want to dissuade you, some of the best nurses I work with started in the ED. You will have a much greater challenge ahead of you than you ever had in nursing school but it is a blast and I wouldn't work anywhere else!

Good luck and congrats on your new license and job!!!

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Specializes in Emergency.

I started in our mad house ED as a brand new grad and only got 8 weeks orientation. You'll be okay. Just know you are going to f-up royally and learn your coping skills now so you can move on and perform afterwards. Ask a ton of questions, even if you know you have already asked, if there is any doubt. Remember, it's always about pt safety. Whatever is best and safest for the pt is the right way to go.

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Specializes in Emergency.

As someone who's currently 11 weeks into a 16 week orientation in the ER, let me just say this: Ask questions.

I've found that virtually every RN, MD & PA in my ER loves to teach. Take advantage of that.

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I am preceptoring for 8 weeks. I totally agree with emtb2rn, ASK QUESTIONS and then ASK QUESTIONS. This is how I am surviving the ER. I love the ER!!!!!!! Good luck to you, you will get it.:D

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I've found that virtually every RN, MD & PA in my ER loves to teach. Take advantage of that.

How wonderful! I hope I feel the same way when I am a new RN, no matter what dept I work in. I think it is great that you are surrounded by people who want to share information/educate!

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g0od luck!

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

I'm a new grad in the ER, and I've had about 11 weeks of orientation at this point. I'm still with my preceptor, but she leaves me on my own unless I need something. Granted, this is the same ER where I've been a tech since early 2005, so I was already familiar with how things were done, etc. And knowing that I'd be transitioning into this role, I started peppering (pestering? ;)) the nurses with questions a couple of years ago, and I've paid attention. I've learned a lot from all of them!

But even with the ER experience as a tech, being a nurse is a whole new ballgame, and I expected that. I also seemed to be a "fecal attractor" for those first few weeks. LOL. I person couldn't come in and be my patient with a simple head injury without turning out to be a bleed. And some interesting patients, too, like a copperhead bite.

I start an ER fellowship tomorrow, and that goes until December; I got my ATT about 2 weeks too late to get into the July fellowship, unfortunately. But once I'm done with the fellowship, I'll be on my own. :) Although the great thing about our ER -- we're never truly on our own ... the teamwork is awesome. It's a great place to be a new grad.

Don't be afraid to ask questions. Seriously. I was told by my team leader and my preceptor that a common mistake new nurses make is to NOT ask questions when they're unsure of something; don't fake it if you don't know it. It's a strength to admit when you don't know something and to ask the question, rather than guessing and perhaps putting patients in jeopardy.

Oh, and ride the orientation train as long as they'll let you. :D

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Wow thankyou everyone, all of your advice was excellent! I start tomorrow, and feel more confident now :D I'm going to ASK ASK ASK and ASK some more. And if I don't know how to do something or don't feel completely comfortable get help, it's expected of a new nurse right. Thanks again.:yeah:

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Specializes in Emergency Dept, ICU.

1. Always double check your pills or vials you get out of the pyxis. There are allot of meds in the ER avail to you and all you have to do is accidently reach in a grab the wrong one, or have a pharm tech put the sux in cardizem drawer by accident.

2. Don't hesitate to call security if you need em, always be ahead of the game on this one. Cause once your behind, its trouble.

3.All because ems, Friends, family SAY they are a DNR from a nsg home, make sure you SEE the documents and all the lines are signed before you just let someone die.

3.The only way you are going to learn how to get good IV sticking abilities is too practice, don't let the patients scare you with all the "ohh noone can ever get me", "I need an IV specialist", "You only get one stick" bullsh*t.

4.Noone leaves the ER with an IV in that ain't going by ems, NOONE.

5. ER Doctors kill patients occasionally, unless you are there to step in with a friendly reminder of ....***, so if it don't sound right get it double checked.?!

6.There is a difference between TB syringes and Insulin syringes!

7.Don't ever give TPA, for the first time alone, on or off orientation without help of a fellow RN.

8.Chest pain patients should get an 12 Lead EKG before anything else you do (Short of triage (and that is debatable))

9.When you draw blood, get EVERY color tube wether you need it or not. Cause you will later.

10. If important drugs aren't premixed i.e. Dopamine, Epi, Vasopressin, Cardizem. Know ahead of time how to do it and what to mix it with. Because then ain't the time to learn.

Just some things to help get you started.

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Congrats on the NCLEX! I started as a new grad in the ED several years ago and have had a great experience so far. My advice is this...

-Look up every drug...multiple times.

-Shadow the docs and listen as they take historys and assess patients.

-Ask why they are asking questions that don't make sense to you.

-Make sure you don't get shorted on your orientation and push for as many weeks as you can. You are a new grad once...you deserve to transition successfully.

-Ask to have more than one preceptor....there is more than one way to skin a cat and it is great to have a few perspectives.

-Don't take drug orders from med students and verify new resident orders with your attending....all that inexperience is a terrible combo.

-Don't be embarrassed to ask questions.

Good Luck and Congratulations.

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good luck!!!

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