Top 3 things new grad should know about ED

mommatrauma, RN · Oct 6, 2005

Hi all,
I start a new job in the ED next week and I was hoping for some advice.
While I know there are a million things one should know, and also that many folks think one should always do med/surg or something else first, can you name three areas or specific things (skills, subjects, drug clases, etc) that irk you when new grads don't seem to come to the table with confidence/competence in them?
Any thoughts would be appreciated!
Thanks,
Mab

Being a preceptor I can tell you my thoughts....

1. Ask questions...even if they sound dumb...ask..because you'll look more dumb if you didn't ask and mess something up...if you don't know something or why you are doing something...speak up...better to figure it out now while you have someone with you that can teach than waiting til you are by yourself and trying to figure it out...

2. You don't know everything..so don't be too cocky and act like you do...Noone expects a new grad to walk in and just "get it"...you'll have questions, you'll be unsure, you'll be apprehensive...its okay...just don't act like you learned all you need to know and that there is nothing more to learn...nursing is 5% school experience and 95% working experience...after 10 years...I still learn something new every single day....that's the best part of the job...you are always learning...

3. Have a little fear, it keeps you on your toes...because comfort brings complacency...I have worked in the ER for 6 years and I am knowledgable, but if you get too comfortable..you will eventually get lazy, take shortcuts, and give sub-optimal care...we've all been there at one time or another...the trick is to realize it and get yourself back on the ball...

That all being said...remember the ABCs it all will come back to that time and time again...if they aren't breathing...it won't matter what their heart is doing....if they are breathing but their heart isn't beating well, it won't matter that there finger is broken....when you prioritize, always use the ABCs...if you don't have them, you have nothing...don't have tunnel vision...a trauma comes in and the patients leg is half off from the motorcycle accident he just had...and its nasty...but he's not bleeding from the site except a little oozing...everyone is so fixated on that because oh my God...its ugly...and heck, its hanging off...that they forget to realize that he has no breath sounds on the right and he has blood in his airway...look at the whole picture...then think to yourself..what will kill the patient...his leg hanging off?? Maybe if it was bleeding profusely, but its not....so the leg is not his immediate danger....could it potentially kill him later...sure...but if he dies in the meantime from his airway obstruction and dropped lung...the leg doesn't really play into it anymore and you did this man no service...catch my drift??

Also remember...drunks, druggies, diabetics and frequent fliers will burn you...this is where comfortable and complacency come into play...mary jones has been in 7 times in the last month for slurred speech...and the first 6 times it was because she was drunk...so on the 7th occasion mary comes in and she smells like ETOH and her speech is slurred and so everyone thinks Mary is just drunk again and so into a room she goes to "sleep it off" when you check on her in a few hours...she's dead...had someone checked her sugar and realized that it was only 35 when she came in, mary may still be alive....but she smelled like alcohol and speech was slurred and could have been explained away by that....but try telling that to Mary's family and their lawyer when it goes to court for negligence and malpractice....

Also...children...quiet children especially in the toddler age...be afraid...be very afraid....children will look good for a long time and when they start to look bad, they look really bad, really quickly...and then its all down hill from there....

Otherwise...good luck...keep your head up...and take a hot bath and a glass of wine when you get home at night....you'll need it!

Aneroo, LPN · Oct 6, 2005

What they said :)

Ask questions! I think that's one of the reasons I feel so comfortable in my job as a new grad. I feel willing to say, "Hey, I haven't seen this, can I see?" or "Hey, I have never done this- can you help me out?".

One thing I learned in nursing school that has helped me with learned what "See one, do one, teach one"- best way to learn.

Don't be totally afraid (but have some fear).

carachel2 · Oct 6, 2005

What they said :)
Ask questions! I think that's one of the reasons I feel so comfortable in my job as a new grad. I feel willing to say, "Hey, I haven't seen this, can I see?" or "Hey, I have never done this- can you help me out?".
One thing I learned in nursing school that has helped me with learned what "See one, do one, teach one"- best way to learn.
Don't be totally afraid (but have some fear).

1.)When you are taking an abdominal pain patient back to the treatment area, grab a specimen cup and have them stop to pee BEFORE you get them all settled in.

2.)Get in and get your labs and saline well done BEFORE all the other people start showing up....sono techs, x-ray techs,etc.

luvnsg · Oct 9, 2005

I have to say that was priceless advice...thanks...I am also a new grad starting in the Ed.I use to be an ED TECH on the same unit...I am definetely keeping your words on the back of my mind...just wanted to say thanks...

Being a preceptor I can tell you my thoughts....
1. Ask questions...even if they sound dumb...ask..because you'll look more dumb if you didn't ask and mess something up...if you don't know something or why you are doing something...speak up...better to figure it out now while you have someone with you that can teach than waiting til you are by yourself and trying to figure it out...
2. You don't know everything..so don't be too cocky and act like you do...Noone expects a new grad to walk in and just "get it"...you'll have questions, you'll be unsure, you'll be apprehensive...its okay...just don't act like you learned all you need to know and that there is nothing more to learn...nursing is 5% school experience and 95% working experience...after 10 years...I still learn something new every single day....that's the best part of the job...you are always learning...
3. Have a little fear, it keeps you on your toes...because comfort brings complacency...I have worked in the ER for 6 years and I am knowledgable, but if you get too comfortable..you will eventually get lazy, take shortcuts, and give sub-optimal care...we've all been there at one time or another...the trick is to realize it and get yourself back on the ball...
That all being said...remember the ABCs it all will come back to that time and time again...if they aren't breathing...it won't matter what their heart is doing....if they are breathing but their heart isn't beating well, it won't matter that there finger is broken....when you prioritize, always use the ABCs...if you don't have them, you have nothing...don't have tunnel vision...a trauma comes in and the patients leg is half off from the motorcycle accident he just had...and its nasty...but he's not bleeding from the site except a little oozing...everyone is so fixated on that because oh my God...its ugly...and heck, its hanging off...that they forget to realize that he has no breath sounds on the right and he has blood in his airway...look at the whole picture...then think to yourself..what will kill the patient...his leg hanging off?? Maybe if it was bleeding profusely, but its not....so the leg is not his immediate danger....could it potentially kill him later...sure...but if he dies in the meantime from his airway obstruction and dropped lung...the leg doesn't really play into it anymore and you did this man no service...catch my drift??
Also remember...drunks, druggies, diabetics and frequent fliers will burn you...this is where comfortable and complacency come into play...mary jones has been in 7 times in the last month for slurred speech...and the first 6 times it was because she was drunk...so on the 7th occasion mary comes in and she smells like ETOH and her speech is slurred and so everyone thinks Mary is just drunk again and so into a room she goes to "sleep it off" when you check on her in a few hours...she's dead...had someone checked her sugar and realized that it was only 35 when she came in, mary may still be alive....but she smelled like alcohol and speech was slurred and could have been explained away by that....but try telling that to Mary's family and their lawyer when it goes to court for negligence and malpractice....
Also...children...quiet children especially in the toddler age...be afraid...be very afraid....children will look good for a long time and when they start to look bad, they look really bad, really quickly...and then its all down hill from there....
Otherwise...good luck...keep your head up...and take a hot bath and a glass of wine when you get home at night....you'll need it!

KatieBell · Oct 9, 2005

Maintain a high degree of suspicion on everyone. Meaning be thinking- what is the worst thing that this complaint could possibly be and address the needs accordingly (A heart monitor never killed a patient, but not being on one may have).

Be polite and professional to ALL your patients, even the ones who are drunk/have psychiatric issues. These patients are really annoying, but there is no reason to treat them as less than human (I've seen too much of this). How you treat the patient is often how the aides will treat the patient, the physician, and anyone else who comes in contact with the patient (Security, Social work etc). Set an example there, do not follow the crowd.

Don't get overly confident. Actually, perhaps its, be confident, but prudent, and do not act overly confident, because if you do so, suddely all your help/support from the other staff tends to disappear.

Be nice and chat with the aides. They are ten times more likely to help you if they think a. you are their friend (which of course you want to be), b. You trust them to carry out the task, and c. the task is sufficiently important that they are really helping them. Thank them for good work. They have difficult jobs, are not paid well, and rarely get the recognition that a nurse does. (And nurses sometimes get precious little recognition)...