Tips and tricks for new grads in the ED

ClimbingNurse · Apr 12, 2004

Yeah, I'd be interested to hear from you guys too. What (if anything) can we do to avoid being deadweight when we graduate. I am planning on going straight to the ED when I graduate and I'm doing 2 things to try and prep myself:

-I'm going to take ACLS very soon (and about a year before I graduate). Depending on how that goes, I may take PALS too before I graduate.

-I'm going to get a tech shift in the ED next Fall and I might be able to do one of my clinicals there as well.

angel337, MSN, RN · Apr 12, 2004

i am a ED nurse and was a ED tech for 3 years before i graduated. the best thing that will help you as a new ED nurse is to learn as many skills as you can (phlebotomy, IV's, ortho splints etc..). being competent in these skills will help you get through your day alot easier. also KNOW your cardiac drugs and dosages. another tip is to double check any order you are not familiar with with pharmacy and of course look it up in your drug book. pay close attention to patient allergies because very often you are doing things so fast you can easily make a mistake (and the MD's also sometimes forget to check allergies). and last but not least ASK questions and take your time learning. know one expects you to know it all and you will be respected for seeking out information instead of pretending to know something you don't. ED is a rewarding experience. i don't regret one day that i started my nursing career there.

Stitchie · Apr 12, 2004

i am a ED nurse and was a ED tech for 3 years before i graduated. the best thing that will help you as a new ED nurse is to learn as many skills as you can (phlebotomy, IV's, ortho splints etc..). being competent in these skills will help you get through your day alot easier. also KNOW your cardiac drugs and dosages. another tip is to double check any order you are not familiar with with pharmacy and of course look it up in your drug book. pay close attention to patient allergies because very often you are doing things so fast you can easily make a mistake (and the MD's also sometimes forget to check allergies). and last but not least ASK questions and take your time learning. know one expects you to know it all and you will be respected for seeking out information instead of pretending to know something you don't. ED is a rewarding experience. i don't regret one day that i started my nursing career there.

Angel, thanks for the insight. I'm glad that I have some of the instincts you mentioned. I rely on our techs to really really help me and I truly appreciate every single thing they do.

How long will it take before I realize, think, feel that I'm not hopeless at this? I really love the learning, have no hesitation about questioning an order/double checking an order with the attending (we get lots of interns) and I always ask directions before I transport the patient. (sometimes RN's have to do it themselves...) I work PM's, very busy shift, I love it I love it I love it!

TaraER-RN · Apr 12, 2004

I started out in the ER three years ago as a new grad...don't let anyone tell you that just because you are a new grad that you don't belong there. Its true that having some experience under your belt may help you with some things, but I have seen some less than functional nurses come to the ER from other depts and don't do even half as good as those that are new grads, but that said there are some new grads who also don't belong in the ER. Expect to be frustrated for about a good year or so...you need to be able to run your butt off while still keeping track of all your meds etc in a safe manner. I think the dumbest thing I see new grads do is not ask questions, those that think they know it all are the ones who will not make it. The ER is one of those areas where you have to depend on everyone around you..and if you're not vocal you won't get the help you need. Make sure you get a hard preceptor too...someone who will really test you...this is an area where you want someone to be hard on you, so that when you're put on your own you already know what you're getting yourself into. I personally found that communicating with the docs a lot really helps, ask them what they think is going on with a specific pt., Like what are they waiting for, why do they think the pt has such and such...it really helps your learning process. Make sure you are always taking of your sickest pts...prioritize prioritize!!!! you will be slow in the beginning, accept it and move on...go as fast as you can while still being safe...you will get faster and you'll learn how to multi-task yourself (which is the major thing besides prioritizing that is important in the ED)...Good Luck!!!!

angel337, MSN, RN · Apr 12, 2004

taerRN, you are totally correct when you say having a hard preceptor is very important. it is also important that a new grad in the ED get all the experience they can before they get off orientation. don't refuse to do anything... just do it because you will be soooo glad you did when you encounter it again. in one week i had a rape kit, a guy who OD'd and ended up in ICU because he didn't respond to narcan and i had to perform a peritoneal dialysis/antibiotic washing on patient. ok this may not sound like much but most ED nurses don't do dialysis so my peers were like "oh my god..i haven't seen that since floor nursing years ago" or "i never did that". luckily the patients daughter was a nurse and she was very familiar with the procedure. i am very grateful to her for teaching me. the rape kit was overwhelming because well what i chart or don't chart can negatively/positively affect the patient so i just wanted to make sure i did it perfect. i may have to go to court for that one. and finally my OD guy(sigh..) he ended up getting 3 rounds of atropine and a dopamine drip. we worked him forever. originally he was supposed to go to a nurse that was more experienced but they felt that i would really benefit from the experince and i did. it was exciting and now i feel pretty comfortable with titrating dopamine. for nurses with a lot of experience this may seem like minimal stress, but for a new grad it is BIG time stress. i enjoyed every minute of it, because one day i will be a preceptor and i love teaching new things. never, ever a dull moment in ED. love going to work

Stitchie · Apr 12, 2004

Sorry, I didn't mean to hijack the post. I found it insightful, and timely.

Any med you're not familiar with, especially before you're off orientation, have your preceptor or charge nurse go with you. Cardiac meds work quickly and can be downright scary if you're not being carefully guided while giving them.

I think a little fear in general will keep you on your toes. It had done so for me.

I also ordered a book from amazon.com called Nursing Emergency Secrets. It isn't very huge and is written in plain, readable language. I'm just starting it.

The advice about asking the docs what's going on is also very good advice. And taking yucky patients. They are great learning experiences. I have felt overwhelmed by all the knowledge/learnimg and all of the different skills we do in the ER.

jaimealmostRN · Apr 12, 2004

Thank you for contributing! Stitchie, I'm going to order that book right away. So to summerize (and keep the hints coming!):

1. Know your Cardiac drugs

2. Have someone more expirenced in the room when you start unfamiliar/cardiac drugs

3. ASK LOTS OF QUESTIONS

4. Ask for a demanding precptor

5. Never decline a difficult patient/proceedure

(all of these hints posted by the above posters)

Keep it coming guys! :balloons:

veetach · Apr 13, 2004

Just a few more ideas:

As a new grad understand that there are things you dont know. Nothing turns me off faster than a new grad who "knows it all"

Ask questions, no question is stupid, except the one you didnt ask.

Find a good IV medication drug book, it will be invaluable to you. Brush up on those meds you cannot give IV (ie vistaril) the docs might order it to be given IV

Be willing to do anything that is asked of you. I would never ask my orientee to do something that I wouldnt do, RNs DO make beds and clean up vomit and put on OCL's. And take vitals signs and draw blood etc etc etc... Please dont leave these things for the techs to do.

remember at the end of a very busy, frustating day, the elderly confused man who has soiled himself and his bed, is someones father. treat him with respect and care, clean him up and make sure he has a dry bed for the oncoming shift.

Good luck with your jobs in the ER. work hard, laugh out loud and cry if you need to, it will keep you sane....

ang75 · Apr 20, 2004

Jump in with both feet. In the ER it is either sink or swim. But if you have one single inkling of doubt...ASK! No stupid questions right?

fab4fan · Apr 21, 2004

As a new grad understand that there are things you dont know. Nothing turns me off faster than a new grad who "knows it all"

Amen. Amen. Amen.

newgrad2004 · Apr 22, 2004

I heard of a new grad not in ED but once being told pt couldnt swallow PO meds being told to push them thru "the tube". The new grad crushed them and pushed them thru the PICC line instead of the g-tube.