What do I need to bring?

LobotRN, BSN, RN · Dec 10, 2011

I had the opportunity to shadow an ER nurse friend, and I remember that she used paper towels in the room constantly to jot things down. Then she made a point of immediately entering the info into the computer, or at a minimum that she was "assessing documenting on the half (hour)." That way when the pt disposition changed, she wasnt' caught trying to chart and remember someone that had been gone for hours. Things moved too fast to keep a paper list of what was going on, the goal was to treat and street, or admit asap.

DixieRedHead, ASN, RN · Dec 10, 2011

You will do yourself (and your feet) a favor if you always have these things ON YOUR PERSON:

1. Bandage Scissors

2. Small pair of hemostats, put a roll of tape on them and clamp them on the bottom of your scrub top. Works great for picking up Mcnasties, and pulling off grody stuff. Be sure to clean well with alcohol.

3. Alcohol wipes

4. 15 pens (hahaha, that's just me)

5. Stethoscope

Robublind · Dec 10, 2011

Notepad until I leave it somewhere, then I steal one from another nurse who left it on the counter until one of my pt pukes on it, then postit notes from the unit sec when she isnt looking, then for the next 10 hr of my shift I go to the paper towel. ER you work differently then on the floor. On the floor you can make a schedule, in the ER your "schedule" is flexible.

I have only worked in the ER for a couple of months now but here is the workload:

You get a new pt:

1) Work up the pt: ABC first (Assessment, IV with bloodwork, UA, send them to CT, Xray US etc)

2) Tx the pt (fluid, pain med, zofran, abx, etc)

3) Holding pattern: Monitor pt depending on acuity (holding pattern is were you can get caught up on charting, waiting for the lab work etc to come back)

4) Last phase: get rid of your pt (street or floor)

The goal is get your pt into the holding pattern so you can quickly street or admit them.

You are working you ass of in the work up and tx phases, but the holding pattern phase is more relaxed.

Now do this with 4 pts, each "you hope' are in different phases. The worst is when you get all 4 in the workup and tx phases (this is the time your running your ass off).

What you need is some way to quickly write down: VS, assessment, were and what you stuck the pt with (IV, foley, NG tube etc), what you gave the pt (I usually chart my meds as I give them), once I charted the info I throw (paper towel, note paper, postit) out, time to move on.

I get made fun of for having my scrub top filled with pens but I go through them during my shift. I don't leave home without my cheap digital watch set to 24hr, iphone with a drug guide, scissors, and stethoscope

brillohead, ADN, RN · Dec 11, 2011

2. Small pair of hemostats, put a roll of tape on them and clamp them on the bottom of your scrub top. Works great for picking up Mcnasties, and pulling off grody stuff. Be sure to clean well with alcohol.

Mcnasties..... I have a new favorite word! :lol2:

Dixielee, BSN, RN · Dec 13, 2011

You really don't need to have binders, clipboards etc to hold a lot of individual patient info like you do on the floor. You will turn over your rooms several times in a shift so you don't have a lot of things to tell the oncoming nurse. I always take report on a plain sheet of paper but as that info becomes useless (patients discharged or admitted) it is discarded.

You will know everything you need to know about most of your patients because you will see them from the onset. You may be the one to triage them, so you know their history, meds, complaint etc. As you get more use to the ER, you will see patterns. Almost all kidney stone patients will follow the same path, i.e meds, labs, tests, outcomes etc. You will see the same with chest pain, lacerations, orthopedic injuries etc. A lot of it is cookbook medicine and you will soon memorize the recipes :)

You can count on the minor injuries to be quickly treated and discharged. You can count on your sick ones getting an IV, basic labs (CBC, chemistries), cardiac patients will all get EKG's, CXR, CBC, Chem, Troponin, PT/INR and more depending on outcome of above.

You can even count on your cardiac arrest patients being very similar. Sadly, most full arrests that come into the ED do not survive and if they do, they don't have good outcomes. There are exceptions of course.

So you know all of your patients will get a quick eval, labs or xrays (sometimes just a strep screen or urine is all they need), pain meds if indicated, Rx if not and then a disposition of some sort.

Obviously I have simplified it, and all patients do not act the same, but you will most definitely catch on to the rhythm (no pun intended) of the ED rather quickly.

All that said, chart as you go to the very best of your ability! If you hold onto things, you will never get them charted. Most places now have computers quickly available. We use computer charting for everything but major trauma and codes.

If you have the ability to have vital signs come straight from the monitor to the chart, do that. If you can't do that, then at least set your monitor to take vitals at predictable intervals so they are saved and can be reviewed later.

You will quickly learn which lab tubes to grab when you start your lines. You will be multi tasking by having the vitals being taken on monitor while you are asking the patient questions while starting the IV and drawing labs. If you know from EMS or triage that the patient is a chest pain, you take the EKG machine with you or page whoever does them.

Almost everyone needs to be in a gown, so just do it up front and you don't have to try to undress them over a running IV.

Get rectal temps on all babies and unresponsive patients. Axillary temps are a waste of time.

Buy yourself a cheap calculator, make a cheat sheet with important phone extentions and tape it to the back and never let it leave your side! I have passwords (altho you will memorize this quickly), phone # for security, CT, MRI, lab, pharmacy, poison control, animal control, etc. You will not want to waste time searching for a directory for most of these calls.

PDA or smart phone with Epocrates and some drug calculation programs are also helpful and are not cumbersome.

In the beginning you might find laminated cards with ACLS drugs and protocols, types of splints (we do all our own OCL splints), RSI drugs and hospital phone numbers very useful. You can type them up on your computer and have them laminated at Kinkos. Use a hole punch and a key ring and you have a wealth of information at your fingertips.

OK, that was ED 101! Good luck :coollook:

mybrowneyedgirl, BSN, RN · Dec 13, 2011

I have dollar store calculator for drips, ped liquid med dosing

bandage scissor

stethoscope

two pens (one will break or get stolen)

when I get there I pick up alcohol wipes, IV tape and a flush

I pull a piece of paper out of the copier for my report/notes

JessiekRN · Dec 14, 2011

Hi All. thanks so much for the really useful advice.. I know its going to be a completely new and different experience from floor nursing.. so I'm trying to go in as prepared and open-minded as possible. I want the med-surg experience to give me an upper hand but not get in the way of learning new routines and new patterns. I'm really looking forward to learning as much as I can and just soaking it all up..thank you cause I feel like you have given me a great start, in addition to everything else I've picked up on this forum. Thanks again and keep it coming..

hiddencatRN, BSN, RN · Dec 14, 2011

When I started in the ED I carried a clipboard. Then learned the paper towel trick of jotting down vital, everything else gets charted as it's done. I've had patient's joke about the hospital needing to spring for notepads, but honestly, that's just one more thing to have to keep track of and was more a hindrance for me than anything else.

With critical patients, sometimes I see nurses jotting things down on the bedsheets like times meds are administered.

hiddencatRN, BSN, RN · Dec 14, 2011

Oh, as to what I DO carry:

trauma shears

sharpie

pen

stethoscope

on my badge holder I have a copy of Wong Baker's FACES pain scale. have used it once. used to have phone numbers but it fell off so should probably get another...

If I'm in an assignment that has stocked carts (LOVE that assignment simply for that convenience!), nothing else. If my assigned rooms are bare I carry alcohol, chlorprep wipes, flushes and sometimes pulse ox probes. When the joint commission was visiting we were made to empty out all the rooms of useful supplies that made our life easier and I was tempted to get a fanny pack to carry around a mini-supply room of things.

I USED to carry around my ipod that had drug and medical software on it, but that got unweildy and my books were not the same formulary the hospital uses, and we have computers pretty accessible with our drug book on it.

((Also, I'm wistful at those that talk about putting patients on monitors to auto check vitals. Most of our rooms have missing wires so god help you if you have a patient in the room without heart monitor leads and you have a patient who needs to be on CR monitoring. You either have to track down one of the portable monitors or steal wires from another room. Plus I work in peds and parents and patients are not always compliant about staying on monitoring. Ohhhhh and don't get me started about the doctors who take the patient off all monitoring because they don't need it anymore because they are going home but then decide they want one more set of vitals so I have to rehook the kid up to everything and then wait for them to stop screaming so I can get a good heart rate and BP.))