Tips to survive ER

If your EHR is Epic, don't acknowledge orders until you've done them. I have found that I will forget orders if I acknowledge everything at once.

Oh, and bedside charting. Once you leave the room, you never know what you might get caught up in! Lol.

Make sure you are a master at prioritization, ask more experienced nurses if you are unsure about what you should do first, why and how things are done. Though the ER is chaotic, there is an order of operations and flow. If you don't know, always ask, never assume. Cluster care, anticipate what you need with various chief complaints and presentations. Once you are comfortable with your skills and managing lower acuity patients, take initiative to learn the critical care parts of the ER. Also, try to always show empathy to your patients, even if they frustrate you.

I've found that taking an initial two minutes to show empathy, kindness, and overall sweetness on initially meeting my patients goes a long way. Wrapping them in warm blankets, providing an extra blanket for a family member, tucking them in and fluffing up their pillow all while fussing over them and buttering them up takes very little time and I've noticed that it sets an excellent working relationship between myself and patient/family/etc. From my experience they're typically less demanding, kinder, and more understanding when I try extra hard to make a good first impression because the nurse is so "nice" and they see that you're working hard and the unit is busy.

Whenever I'm caught up I will first make sure the nurses around me don't need help and then I will update my patients on what they are waiting for and the ER flow. I will also do a round to make sure that my patients and beds are clean, that their ice packs/warm packs are fresh, that their blankets aren't wadded up, that family doesn't need a glass of water etc then after that I will sit down and take a breather myself. Its helped me a lot when I've had a notoriously "difficult" patient or "frequent flyer" who has been known to give staff grief. I've only had one truly mean and frustrating patient and I've been working for 10 months now (knock on wood). Just be careful to set clear boundaries so you can still get your work done (ie barring a life or limb situation, I will help you after I am done with my other patient).

Also always ask questions if you're not sure. ALWAYS. And tell the patients what you are doing and why. If your patient is crumping or you have a concern tell those around you so that no-one is caught off guard if/when things go south. Communication is key.

Make sure you ALWAYS have 3 things when you walk into your room (1: suction, 2: O2 on the wall and in a tank under the gurney, 3: ambu bags at my facility every bed has adult peds and neonatal sizes).

Aside from that, everything else just takes time. Ask the nurses around you for tips. Once I established great working relationships with the residents I've also sometimes even asked them which is most important or what they want first when I'm not sure (ie I only have one line and have X, Y, and Z infusions, X and Y are compatible, Z isn't, so while I'm working on a second line for this hard stick patient do you want X and Y, or Z running? Do you care?). I don't do it often, but when I do I've received nothing but "thank you for asking" followed up with recommendations.

Edit: also be diligent in placing your patients into gowns. I've had multiple situations where I found something very concerning that the patient didn't mention while getting them into a gown. Know that clothes, home blankets, and even hospital blankets can hide some very important things if you're not careful and diligent on assessing your patient fully.

Update- I thank you all for your comments. I have definately improved a lot in the last month. I have gotten much better at focused assessments and critically thinking about what lab/radiology results can mean and what to anticipate for my patients. Also got much better at starting IVs! I also have not forgotten to make the patient trust me by doing little things for them. I've found that the little things do make them feel better. Also helping other Nurses when they are busy and I am caught up helps me practice skills and get better at them, such as starting drips. Also helping the PCA's with tasks helps me gain better relationships with them and I've noticed they are happy to help me when I need them. I've learned how to better communicate with the MDs, PAs, and NPs. Documenting is getting easier as I had to learn a new system. Now I am working on giving report on patients to the floors. Sometimes it goes smoothly, some Nurses on the floors ask questions which I dont know the answers to, but Im getting better at it. I also need to work on handling the traumas. I definately hold off on anything which Im not sure of and ask a more experienced Nurse or ask the provider who ordered it. So far I am loving the ER and I'm learning something new everyday. I'm glad I came to the ER!

That's a great update - Good for you!

Things will just keep falling into place. :)

I hope you don't mind me just adding on to your post instead of starting my own. I have been working adolescent psych for the last year, and am interviewing in the ER in a few weeks. I worry about many things especially medications, placing IVs and anticipating what will be ordered. I know all of these things can be learned with time, I just don't want to look stupid when I don't know these things immediately. Will the training and education be like nursing school all over again? I feel like I'm ready for the next step in my career, I just don't feel up to being ridiculed or be chastised for being too slow at some things.