Top Skills Every ER Nurse Should Possess

[mrnurse504]

Hi everyone & Happy Holidays! I am currently an LPN in Baton Rouge, LA; currently on the road to obtaining my ASN. Being the anxious & over-excitingly person I am, my goal is to someday become an Emergency Nurse. I have such a major level of respect for anyone who works on ER/ICU etc etc due to a past personal experience , which influenced me to pursue nursing. What skills, advice, or pertinent info should I familiarize myself with in advance before applying down the road ?

Thanks in advance to everyone who gives me their input!

[1fastRN]

I agree with everyone before me. I would like to add something though. Know the laws and SOPs of your hospital. You'll find yourself in some strange situations in the ER. It will guide you as to what you should do and cover all your bases. Examples: HIPAA, mandatory reporting requirements, special paperwork required for animal bites, psych patients, death protocols, etc.

These are good things to know, especially when the place is jumping and you don't have time to learn about it at that time.

At least familiarize yourself with them.

Good luck!

I feel so annoying when I'm in one of those situations.... like when a patient expires. There are so many phone calls to make and documenting to take care of. I'm always afraid to mess it up or forget something, especially because of the legality. I'm constantly asking my fellow RNs, "I did x,y, and z.... is there anything else I have to do?"

[PMFB-RN, RN]

You always have to cover yourself. (i.e. Pt is hypertensive but MD doesn't want to treat BP at this time. CHART IT!)

You gave a lot of great advice but this part shocked me. Did the doctor actually say the words "I don't want to treat hypertension"? If so I would put quotes around it. If not then how can you speak to what the doctors wants? Maybe they WANT to but other treatments take priority, or maybe treatment or hypertension is contraindicated at the moment, or maybe the anti hypertensive med is contra indicated for this patient at this moment. If any of those are true then you have just misrepresented the situation in the medical record.

Give depositions, or testify in court a few times and you will learn to stick to the facts as you know them. In the given example you only know that the physicians did not give orders to treat hypertension, not the reason why not (unless she said that, then you should put quotes around her words). A more appropriate way to document that interaction would be to say "Patient found to be hypertensive at 220/110, Dr. Smith updated by author at ____ (time), no new interventions ordered at this time".

I also like to avoid using "MD" as shorthand for physician since many physicians are not MDs.

[eCCU]

You gave a lot of great advice but this part shocked me. Did the doctor actually say the words "I don't want to treat hypertension"? If so I would put quotes around it. If not then how can you speak to what the doctors wants? Maybe they WANT to but other treatments take priority, or maybe treatment or hypertension is contraindicated at the moment, or maybe the anti hypertensive med is contra indicated for this patient at this moment. If any of those are true then you have just misrepresented the situation in the medical record.

Give depositions, or testify in court a few times and you will learn to stick to the facts as you know them. In the given example you only know that the physicians did not give orders to treat hypertension, not the reason why not (unless she said that, then you should put quotes around her words). A more appropriate way to document that interaction would be to say "Patient found to be hypertensive at 220/110, Dr. Smith updated by author at ____ (time), no new interventions ordered at this time".

I also like to avoid using "MD" as shorthand for physician since many physicians are not MDs.

PMFB-RN is correct. ....only stick to the facts...back in nursing school my legal class required us to attend a deposition. Just remember they blow up your chart for the entire audience. Trust me you dont want to be the one that writes non factual material in an evidence based career....biggest mistake nurses do while charting is "charting emotions"

Plus charting MD doesn't want to do nothing sounds like you don't get along with the MD which may be an issue if both of you end up in court on different sides!

:-) don't give the lawyers the opportunity to make you a scapegoat!

[Autry]

I agree with most of what has already been posted, but one thing I didn't see, that has made the biggest influence on my time in the ER, has been the ability to work as part of a team. You can be a nurse anywhere. You can get the skills you need to use for any situation and the book knowledge from so many sources, but the only place you can really learn to be a successful ER nurse is in the ER.

My first shift in the ER (after working 3 years on a step-down telemetry unit), my unit mentor asked me what the biggest difference was that I had noticed so far... and without hesitation, I replied "you guys help each other!". Don't get me wrong, I had a wonderful staff of folks to work with on the telemetry unit and still remain friends with many of them today, but the team-work in the ER is completely different from any other unit anywhere.

It's one thing to get assistance moving or changing a patient, or having someone there to help you with things you don't understand to begin with, but it's totally different when you get the cardiac red, the stroke alert, or the respiratory distress and all of a sudden, there are people helping you that you may or may not have even realized were working that shift. Before long, you've got your patient stabilized and waiting for transport and you're in the next room helping someone else with their patient. That team-work is probably the most important thing in the ER and probably the most taken-for-granted.

Since I've been a nurse-leader with my department, I've seen more than one new grad not figure out how to be a 'team player' even with coaching, and see them treading water for their first several months before they realize that the expectation is not that you're able to handle each crisis on your own, but that you're part of the team that can resolve the crisis and move on to the next. The ones who don't make that realization or cannot make the connection are the ones we gently persuade to find a different department where they can be more successful. Some of them have been excellent nurses, but in order to be a "good" ER nurse, you have to understand that your team is one of the most important tools in your orificenal. (especially to help with those other skills.. until you've become a master at most of them yourself - the things mentioned by my colleagues in previous posts.. IV starts, NGT placement, etc.)

Good luck to you in the future! I hope you do well and find a great team for yourself!

[emtb2rn, BSN, RN, EMT-B]

Autry,

You bring up a excellent point about teamwork. The "dogpile on the rabbit" approach to unstable pts in the first few minutes is (to me) one of the coolest things about the ER.

[That Guy, BSN, RN, EMT-B]

The ability to turn it to 11 at the drop of a hat and then back to 1 just as fast.

[JC0476]

#5 is great advice!!! thanks for posting!!!

[floridaRN38]

Always asses the pt as they come to ur stretcher. Either triaged or rescue. U never know what the real deal is until u walk in the room

[Meredith5802]

Start getting certifications:

Advance Life Support

Trauma Nurse Corriculm course

Pediatric advance life support

or focus on a specialty and get those certification such as sexual assault nurse examiner, the more you add makes you that more valuable for hire

[JB-RN]

The ability to communicate clearly about care with families. This is especially important with critically ill and resus patients. I do my best to explain my actions to the family and facilitate their presence in the room.

[1fastRN]

You gave a lot of great advice but this part shocked me. Did the doctor actually say the words "I don't want to treat hypertension"? If so I would put quotes around it. If not then how can you speak to what the doctors wants? Maybe they WANT to but other treatments take priority, or maybe treatment or hypertension is contraindicated at the moment, or maybe the anti hypertensive med is contra indicated for this patient at this moment. If any of those are true then you have just misrepresented the situation in the medical record.

Give depositions, or testify in court a few times and you will learn to stick to the facts as you know them. In the given example you only know that the physicians did not give orders to treat hypertension, not the reason why not (unless she said that, then you should put quotes around her words). A more appropriate way to document that interaction would be to say "Patient found to be hypertensive at 220/110, Dr. Smith updated by author at ____ (time), no new interventions ordered at this time".

I also like to avoid using "MD" as shorthand for physician since many physicians are not MDs.

You're right, I didn't really think out my reply and just wrote it on the fly. And I'm pretty much referring to only slightly elevated BPs. We usually treat 180 sys and above. But sometimes if it's 150-160 sys range, the doctor doesn't bother doing anything. I agree with your last example, that's more congruent with something I would actually chart. I guess my main point was just to chart that the doctor was aware so that your butt is covered.

Thanks for pointing that out, though! :) And i usually like to write the physicians full name so there's no room for interpretation.

[1fastRN]

The ability to communicate clearly about care with families. This is especially important with critically ill and resus patients. I do my best to explain my actions to the family and facilitate their presence in the room.

I cant stress the importance of this enough! I've seen so many nurses ignore the family when they're obviously concerned. Sometimes it's simply because they're busy! So if it's another nurses patient, I sometimes step in to talk to the family and explain what is going on in a code/critical situation.