Transitioning into the Emergency room, Please help!!!

neneRN, BSN, RN · Mar 19, 2007

Congratulations! There's nothing like the ER- wouldn't work anywhere else.

As far as meds, there's a thread in the Emergency Nursing Forum entitled Most Frequently Used ED Meds-I'm not computer savvy enough to post a connecting link here, but do a search for the title and you should be able to find it (or maybe someone reading knows how to post a direct link to it?)

Dixielee, BSN, RN · Mar 20, 2007

Good luck in your new job! ER is definately the way to go. I don't have any recommendations on books, but I do suggest you get a PDA with some ER related and med related software. I use my Davis Drug Guide (buy online) or Epocrates (free online) every single day.

When you are in triage and assessing patients home meds, you will always hear of a med that you need to check spelling on, or supply some sort of info on. I am always looking up a drug for myself, a co worker or a patient.

ER suite is a good software to purchase. It has lots of good info as well.

You can check with co workers who have some of the programs they can "beam" to you as well. I have Merck manual which is also free, and Tabers that I paid for.

You will still find things you need to look up and the PDA makes it easier and faster than finding a reference book.

Also, if you don't already have ACLS, PALS, ENPC, TNCC...try to get them all as soon as possible. They all offer a little different information that you will find valuable.

One word of advice from an old timer....don't be too quick to judge your co workers when they complain about someone being a drug seeker, frequent flyer, etc. Walk a mile or so in our shoes before you critisize.

Give yourself time to learn this new area and don't be too hard on yourself while you are learning. It is a different pace with different challenges than other areas of nursing. You need to know a little about EVERYTHING, but you don't need to know evverything about everything. You never will become a specialist in the ER, but you will learn so many things it will make your head spin.

The longer I am a nurse, the more I realize I don't know, so take a deep breath, jump in and learn!

Overland1, RN · Mar 20, 2007

Definitely do the ACLS, PALS, etc, and also plan on getting certified within a couple of years or so. That much time and experience are necessary for the CEN, which will help you to keep your knowledge up to par. Keep a sense of humor, because there will be times when you will need it. Keep a sense of emotional stability, because there will be times you will need that as well.

Along with talking with your patients, remember that listening to them is most important; check on them every so often and explain what is going on with their care. With a positive outlook and effort on your part, the ER ("ED" for those so inclined..... I still call it the ER) experience can be rewarding and one of the best choices you can make.

gonzo1, ASN, RN · Mar 20, 2007

try to pick up a book on how to triage people. There is one listed on the ENA website. Although you most likely will not be allowed to work the triage desk for 6 months to a year, you triage each new patient you come in contact with and these books give you a system by system approach to consider. For example if a patient comes in with "belly pain" the book will tell you what questions to ask, what labs are most likely to be ordered by the doc and what vitals signs can be significant and why. I have been in the ER now for 2 years and am finally starting to feel somewhat competent. Good luck and enjoy. I too would never consider working any other department.

kmoonshine, RN · Mar 20, 2007

I am a new nurse in the ED and am also transitioning. But, here are some things that have helped me:

GET A PDA: I have Davis's Drug Guide on my PDA and use it mainly to double-check appropriate dosing for drugs and how fast/slow to push IV meds. Some drugs should be diluted, some shouldn't; this has been my lifesaver!
Get a good general emergency nursing/medicine textbook: I have "An Introduction to Clinical Emergency Medicine: Guide for Practitioners in the Emergency Department". When I come home after work, I pick a patient scenario from the day and look it up in the book.
Find out if you have standing orders in the ED where you work: I was given a little booklet with all our standing orders listed by condition and I write notes in it. For example, under our standing orders for "Symptomatic Diabetics", I put the ADA diagnosis criteria for DKA for my reference, highlighted "put on monitor", etc. I also wrote useful extension phone numbers (pharmacy, respiratory, lab, etc) in my book, along with the order of tubes when drawing blood off an IV start. I also wrote which color is for what (ie. light blue=PT/PTT/Fibrinogen)
Here's a list of some IV meds I use frequently: morphine, zofran, protonix, pepcid, toradol, reglan, levaquin, nitroglycerin (sublingual and IV drip), heparin, cardiene, cardizem, labetalol, metoprolol, dilaudid, ativan, potassium (ie 20 mEq in 100 ml, mixed by pharmacy), phenergan (make sure to look up P/P at your facility; some places it is against policy to use it, others it must be diluted in 10 ml NS, etc). Here's a tip on insulin drips: lets say I have an order for 5 units/hr, and I get a minibag with 100ml in it, with 1 unit=1ml. I will program the pump for a drip rate of 5 ml/hr and program the volume for 10ml (not 100ml). So, the pump will beep after 2 hours; it's a good safeguard (and can you imagine infusing 100ml by mistake?!). It's good to think like this (esp. with some other cardiac drugs); if this whole minibag were to be used, it would take 20 hours to infuse all of the medication!
Know some of the RSI drugs used at your facility
Know which drugs are given for conscious sedation and know P/P. The BON in some states will not allow propofol to be pushed, and know what your facility allows. Some common drugs used are versed, fentanyl, etomidate, ketamine (for peds). Some have reversal agents, some do not. Some can be argued to be deep sedation/general sedation. Regardless, know what your facility approves, know the reversal agents, and know the consequences should the patient become too sedated.
Look up the P/P for those skills which "vary" from person-to-person. For example, I see some nurses access mediports without a mask on and using providone/iodine sticks. Our P/P states to use those chlorhexidine sponge swab-sticks and use a mask. Maybe some people don't think this is a big deal, but I saw a 21 year-old girl with sickle cell anemia who has had several mediports replaced and relocated because of infection; using the chlorhexidine is best practice and research shows it is superior to other cleansing agents.

Good luck to you and welcome to the ED!

teeituptom, BSN, RN · Mar 20, 2007

Pray a lot and learn to golf and play tennis

RNSacht · Mar 20, 2007

Thank you all for such inspiring posts!!!!!!!! :yelclap: I already have ACLS and a palm pilot, I have the nursing drug handbook program, and the Lab and diagnostic tests program, I currently am researching more programs for my palm, I have been checking :uhoh3: :idea: out the ACLS program on skycape, there are two to choose from any suggestions???? :clown: :coollook:

Again thank you so much, I am so excited!!!!!!!!!!

RNSacht · Mar 20, 2007

ER suite is a good software to purchase. It has lots of good info as well.

Anyone know where to buy this er suite?????????? :uhoh3: anyone have it and how do you like it????????????? :idea:

RNtigerEMT · Mar 25, 2007

I am also transitioning into the ED, have been on the floor now for a total of 7 days, after 3yrs on a cardiac med-surg unit(with tele). I had my ACLS prior to starting in the ED, and am starting my TNCC in a couple weeks. I also have my EMT-B, which I have been told will help with TNCC. The thing that scares me the most is pediatrics, I am not used to working with children even though I have 4 of my own. I've never had to start an IV on a child, and am terrified! I am starting out in our medical decision unit, a branch of the ED where we place pts that may/may not be admitted. It frees up ED beds, and hopefully will make my transition a little easier. I love working the ED, buts it is scary starting out. I feel like I'm in the middle of the ocean and forgot how to swim. Luckily, the staff is very supportive and understanding. Good luck in you job. As my daughter tells me every day before I leave for work, its all good as long as you don't kill someone. (She is a twisted child, but gets it honest.)

TwinkieBee · Mar 28, 2007

I need help from this forum... I need advice on how to ace an ER interview. I interviewed for an ER internship and found out I did not get it. I'm very bummed over this, as I want to work in the ER in the worst way.

I've had one year as a med/surg nurse on a very busy floor. During the interview, I faced 6 people who all shot questions at me. I definitely got the impression that they did not think well of floor nurses. I know now that I should have "sold" myself better.

It didn't help that my boss said just enough to the ER supervisor to cast doubts on my ability to function in the ER. My floor cannot keep staff, and my boss handles this by not allowing anyone to transfer off. People have to quit to get off my floor. I'll be leaving in December when my contract is up.

I'm in my 40's, and I worry that I may be perceived as too old for ER work. I'm going to take this opportunity to loose a few pounds, get in better physical shape, and brush up on my Spanish and try again in January.

Any advice would be lovely. I need to know what interviewers look for in an ideal ER candidate. I need help on the proper words to say. I really want to knock 'em dead in the next interview. Thanks to all. This is such a great site.

RNtigerEMT · Mar 29, 2007

I can really feel your pain as far as interviews go. I hate them, and I used to be the one doing the interviews(pre-nursing). The best way I've found to handle interviews is walk in like you already have the job. Don't be cocky, just bowl them over with confidence, make them think the dept cannot function without you. If you have to, fake it (the confidence). My previous job, I attempted 3 times to transfer to the ED and was blocked every single time by my manager. My current job(almost out of orientation! ) I walked out of the interview feeling like I had the job. I did, it just took a week and a half (family emergency)to find out.

During the interview, don't let them fluster you, they will try, just to see how you deal with pressure. Cry afterwards if need be, but never let them see you sweat. Know your info, research the facility you want to work at, talk to current staff. As far as key words....energetic, willing to learn, team player, patient oriented, critical thinker, ability to think on your feet, .....You know yourself better than anyone, so sell yourself. Make the interviewer wish you were family, cause thats what most ED staff ends up feeling like.

Hope I helped