Starting in the ER soon

[BigheartRN]

Hello Allnurses!It's been awhile since I've posted but here's the rundown. I am a nurse with 2.5 years experience (medsurg/trauma/ortho/ transplant/ that was all in one unit) and then I transferred within the same hospital to the trauma SICU. I hail from a level I trauma center in the inner city. I recently accepted a nursing position in the ER at a community hospital much closer to my home. I am super excited since ER has always been something I've always wanted to do. I'm really nervous due to the fact I have zero ER experience but I have safely managed a 6-7 pt. load on the floors, I'm pretty good with time management and usually get my charting done in a timely manner, my reviews have been great in my previous job and I do feel confident in the nursing skill I have acquired. I just wanted any advice from any experienced ER nurses out there. I was told my orientation might be cut in half since I have nursing experience ( 6 weeks instead of 12) and we have classroom time as well. What I feel most nervous about is - charting ( I know the ER is a fast paced kinda place and I don't want to fall behind--the hospital I will be working at is all computerized charting)-Protocols ( I'm so use to having a DR's order for everything/ and I've read posts where the ED has protocols in place where you do not need a DR's order for everything like placing an IV, obtaining an EKG, etc.. ) -time management ( as I said before I manage time pretty well and have dealt with many situations where patients and family are diffcult) I just don't want to fall behind.I know I'm walking into a position that has high expectations of me since I'm coming from level I trauma center where all the sickest patients are sent to, I'm just nervous and don't want to disappoint myself and my future team of coworkers. I am going to add that the hospital I am going to does not take traumas ( if we do we stabilize and fly them out to my previous place of employment) and I will be in the adult ED not the PEDS division. I have been told that the ED I am going to is a super busy place and our ratios are usually 1:5. I will add I have been brushing up on my skills before starting I purchased an emergency nursing orientation book I've been Reading and taking notes paying close attention on how to care for pt's with chest pain and stroke care protocols. I also bought a small pocket sized notepad that I will use as my "brain sheet" once in the ED. Any advice would be greatly highly appreciated! I'm super excited but oh so nervous at the same time. Thank you all in advance!

[TooterIA]

1:5? Ouch. If fully staffed, we are 1:4 and I usually run my ass off all 12 hours.

I came from an ED that only saw about 400 pts/month to my new job where we see 3500/month. I have only been there since June and these are my tidbits.

Dont be afraid to use your techs/CNAs/whoever you can delegate to. Your time will be better utilized assessing and providing care rather than taking the pt to the bathroom (unless no one else is available to do it, obviously).

Chart in the room, while you are doing the work. Or you will forget.

Double check pt labels, I have had several mislabed urines and been handed the wrong discharge instructions.

Teamwork, teamwork, teamwork. If you have a minute, offer help to others. You will learn in a heartbeat who will help you if you helped them. By the same token, if you are busy and someone is trying to pawn off their work to you, politely decline. Dont let yourself get behind trying to do someone else's work.

Easy ways to **** off the oncoming shift: not labeling your IV lines, leaving your rooms trashed, not having the patients in a gown.

Multitask. You see your patient needs an IV and meds? Grab your meds and fluids, then go in to start the IV and hang meds. Going in once to start in then again a minute later to give your meds is a waste of time.

Lastly, customer service. My patients are much easier to please and leave happier if I can grin and bear it, put on my smile, get them the glass of ice for the visitor, tuck the cover under grandma's shoulders, etc.

[missnurse01, MSN, RN]

congrats! when I started in the ER everything was so different than floor nursing it was weird. I probably got about a 6 week rotation as well, and the thing with ER is you never know what you are going to get, no matter how long your orientation is. The other poster had some great ideas. The other thing to help you learn more different pt management is when you have time follow nurses into the rooms where new procedures that you haven't seen are being done. sometimes that is the only exposure you will get before you have to do it yourself. The cheat sheet is a great idea. You will quickly learn that different types of complaints are just about all treated the same (ex: chest pain, abd pain, etc) The other thing is following your docs. Either on initial assessment or at the end when they explain to the pt what's wrong. You will learn a ton that way. Try not to get caught up in the charting! It's usually charting by exception, so if the complaint is only about one part of the body, and the pt isn't really sick, hosp protocol may be to only assess that particular part. each pt does not get a full head to toe assessment which will feel weird at first.

jump in there and good luck

[brainkandy87]

Easy ways to **** off the oncoming shift: ... leaving your rooms trashed, not having the patients in a gown.

Oh yeah, this. I was horrrrrrible about this when I started in the ER. I wouldn't clean up as I went and the only people I bothered putting in gowns were truly emergent pts, CP's, etc. Oh, how things have changed. Veteran ER nurses rub off on you (i.e. they tell you the way things should be). And if they don't (i.e. you don't take their advice), they'll let you know how much you suck.

Now I'm a big stickler for gowns being on, patients being on the monitor, and side rails up x 2 on everyone. And I can't stand a cluttered room or countertop. How mad it does drive me.

Tooter had a lot of great advice. I agree fully with the whole post. Know what you're going to need ahead of time and multitask. For instance, abd pain.. get the history and assessment done as you're putting in the IV and drawing blood. Tooter also highlights something I think a lot of ER nurses just forget to do: customer service. A happy patient makes for a much easier patient.

[happyinillinois]

Chart by exception and charting is the least priority. Teamwork is everything, & you will quickly learn policy and standing orders. Never heard of a nurse getting in trouble for putting in a lock & drawing labs. When in doubt, draw a rainbow. You will quickly learn chest pain protocol, abdominal pain protocol which will probably be 1/2 your cases. MD's often expect you to do way more than you are licensed to. Old firm and don't do it, because when it goes south you are on your own.