Tips for keeping your RN license safe in an ED setting

ninjago · Jun 28, 2011

I always check my medication orders, the pyxis, the medication itself, the patient name before I go the patient. Once I am ready to give, I check the med order, pt's ID band and DOB, Seems like a lot of steps but once you are used to it. It becomes in auto mode.

When in doubt, don't be afraid to ask questions. I don't care what the other nurses think of me or my questions. It is not their license at stake but mine. Am just glad that most of my co-workers are ready to help and we have good teamwork!

Don't rely on memory. Always write down time and events in a piece of paper especially if you don't have the chart right in front of you at that moment. I learned my lesson well.

A drug book is there for a purpose, if there's none which is very rare then call and ask the pharmacist. I usually bring my own, just in case.

Medic/Nurse, BSN, RN · Jun 28, 2011

• One person can do one thing at a time for one person. Even in the ED.

• Develop good habits and routines - sure, there are short cuts - but, when it matter - it matters.

• Be deliberate.

• Ask questions.

• Never assume.

• Be honest.

• Find yourself spinning? - take a time out. Take 15 seconds - collect your thoughts and go forward with purpose.

• Folks go to their comfort zone when stressed - make your comfort zone as safe and big as possible (take the class, look up the answer, do things the same way each time for each patient, need better reasons "not to" than "to" do something)

• Be better today than yesterday and better tomorrow than today.

• If you are not learning something every day - you are missing something. Find out what it is.

• If your 6th sense if telling you "to" or "not to" do something - don't reason yourself out of it - that little voice has saved me and many, many patients. Heed it - or ignore it at your peril.

• You will make mistakes. Own them and never make the same one twice. Recognize, care for the patient, notify who needs told (MD, charge) and go forward.

• Recognize your limits.

• There will always be patients that complain even though there is nothing you could/would do differently - just accept it and do your best. The ED sees it all and "experienced" patients that are good at manipulation will spot you before you recognize them - be fair and CYA. Witnesses are always good. Set limits and let the "tough"ones know them.

• Treat all with respect and expect the same. Working in the ED does not give anyone the right to abuse you.

• Ask for help when you need it.

• Offer help to others when you can.

• Don't be afraid to use reference materials - it does not mean you are a bad nurse - it just means you are being certain.

• Memory can be iffy and stuff will start to run together - find a way to keep good notes that works for you.

• Document, document, document - if you are weak - seek help if needed and develop this skill well.

• Assessment is the most important skill you have (then documentation) - anyone can do a "task", but what sets the good apart is if you know why that task is necessary or not!

• Never shy away from the "tough" patients - you will need to learn - there is only one way that happens.

• Take the classes and opportunities that are offered - even if on your time and dollar - they will pay for themselves.

• Join and get involved in ENA.

• Carry Liability Insurance independent of your employers coverage.

Go forward and be a great ED nurse - clearly you must have what it will take. Good luck.

:angel:

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Jun 29, 2011

In addition, never expect your employer to treat you fair. When you get called into the office, your manager has already decided what outcome he or she wants. Ask for time to review the evidence of the earth shattering offence so that you may provide a correct and thoughtful answer. If they insist on treating you like the spider to the fly, just tell them to hurry up and get to the grissly ending so you can get on with your life.

Above all else, remember that you were already looking for a job when they hired you.

miss81, BSN, RN · Jun 29, 2011

"If your 6th sense if telling you "to" or "not to" do something - don't reason yourself out of it - that little voice has saved me and many, many patients. Heed it - or ignore it at your peril."

Totally agree NREMT! That's the best tip yet!

Remember, Doctors can be wrong! VERY WRONG... Don't be afraid to look it up for yourself and question them when you find that they are wrong! Especially with drugs and dosages for kids!

Esme12, ASN, BSN, RN · Jun 29, 2011

* One person can do one thing at a time for one person. Even in the ED.
* Develop good habits and routines - sure, there are short cuts - but, when it matter - it matters.
* Be deliberate.
* Ask questions.
* Never assume.
* Be honest.
* Find yourself spinning? - take a time out. Take 15 seconds - collect your thoughts and go forward with purpose.
* Folks go to their comfort zone when stressed - make your comfort zone as safe and big as possible (take the class, look up the answer, do things the same way each time for each patient, need better reasons "not to" than "to" do something)
* Be better today than yesterday and better tomorrow than today.
* If you are not learning something every day - you are missing something. Find out what it is.
* If your 6th sense if telling you "to" or "not to" do something - don't reason yourself out of it - that little voice has saved me and many, many patients. Heed it - or ignore it at your peril.
* You will make mistakes. Own them and never make the same one twice. Recognize, care for the patient, notify who needs told (MD, charge) and go forward.
* Recognize your limits.
* There will always be patients that complain even though there is nothing you could/would do differently - just accept it and do your best. The ED sees it all and "experienced" patients that are good at manipulation will spot you before you recognize them - be fair and CYA. Witnesses are always good. Set limits and let the "tough"ones know them.
* Treat all with respect and expect the same. Working in the ED does not give anyone the right to abuse you.
* Ask for help when you need it.
* Offer help to others when you can.
* Don't be afraid to use reference materials - it does not mean you are a bad nurse - it just means you are being certain.
* Memory can be iffy and stuff will start to run together - find a way to keep good notes that works for you.
* Document, document, document - if you are weak - seek help if needed and develop this skill well.
* Assessment is the most important skill you have (then documentation) - anyone can do a "task", but what sets the good apart is if you know why that task is necessary or not!
* Never shy away from the "tough" patients - you will need to learn - there is only one way that happens.
* Take the classes and opportunities that are offered - even if on your time and dollar - they will pay for themselves.
* Join and get involved in ENA.
* Carry liability insurance independent of your employers coverage.
Go forward and be a great ED nurse - clearly you must have what it will take. Good luck.
:angel:

I couldn't have said it better myself. Take your CEN, TNCC, ENPC,CCRN.....educate, educate, educate. I even took EMT classes to understand the field and immobilization in less than perfect circumstances. I studies the paramedics protocols in the region I worked in because they vary.

Personalized........Make the ED doc write every order. Do NOT take a verbal order under any circumstance.....unless your are begining CPR. Know your policies at the facility you are working by heart and follow them closely. Listen to your inner voice....if it doesn't seem right it probably isn't. If your first response is Oh,OH! proceed carefully. Childrens dosages are like them.........SMALL!

Good luck

Esme12, ASN, BSN, RN · Jun 29, 2011

I ran across this......very tongue in cheek and a bit adult humor at times but a good reference..

http://www.impactednurse.com/pics4/ED_unscrewed.pdf