Published Apr 10, 2014
I have been a RN for a little over a year and my first job was at a state VA home as a RN, so my experience is a mixture of mgmt and med-surg. I was hired to work in a small 15 bed ED and 10 bed observation unit. I start my first shift in the ER on Friday. I know I can do this and I'm excited, I just feel like I'm going to be a bit behind the curve, coming from a LTC environment, but I'm super excited that the director hired me, so now I need to show her that she didn't make a mistake. Any tips, hints, or helpful insights to calm my anxiety about the transition.
You are a bit behind the learning curve... but pretty much everybody is.
For example, our hospital closed one of its ICUs and a couple of the nurses from there came down to us. These were skilled critical-care nurses who could handle the sickest patients around... and yet, they completely floundered in the chaos of the ED and none of them lasted.
ED is mostly a matter of rapid-fire re-assessment and prioritization. You may feel overwhelmed at times but you need to make peace with the reality that you can't always do it all at once so you need to develop your judgment about what is urgent and what isn't... and when to holler for help (there's no shame in asking for help).
As an example of the latter, just a few days ago I relieved a nurse in a pod that had just been opened with four new patients. As I was just getting started, I heard two different docs telling patients, "OK, we'll get some blood, do some x-rays, and give you some medication to start feeling better" -- I was now looking at four patients on whom I needed to start lines, draw labs, one who needed an i/o cath, and two who still needed to be assessed and written up.. and vitals for everybody. I called the charge nurse and simply said, "I'm getting buried here so we either need to get some help in here or fall behind." Another nurse was sent in for 15 minutes and that's all it took to keep from getting overwhelmed.
That judgment takes awhile to develop but if you don't get it, the ED can eat you alive.
A couple of books that I own and recommend:
Sheehy's Manual of Emergency Care
Emergency Nursing Procedures
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