A question I often get asked is, what advice do you have for new nursing grads or nurses switching to the ER?  While there are about a hundred plus things I could think of, I figured I would try to limit it to the most pertinent things I learned when I went into the ER straight out of nursing school.
  1. Be open to learning new things and taking in new experiences.  If you’re in a trauma hospital ask to observe or play in the traumas so you better understand the nurses role (plus see some pretty cool stuff), ask to help with stroke alerts or STEMI’s, or assist with a patient diagnosis you have never seen before.  These first hand experiences will go far in expanding your understanding of emergency nursing.
  2. Don’t go into nursing or the ER with an I know it all attitude, because you will quickly learn school taught you nothing in comparison to real life experiences!  Listen to what other nurses/doctors/techs/medics/radiology etc. have to tell you, even if it is something you feel like you already know, they may be able to expand your knowledge on the subject or teach you new tricks.
  3. Know that it is okay to not know it all or have all the answers.  In a field that is constantly expanding and changing it is impossible, so don’t be hard on yourself!
  4. Don’t be afraid to throw out an SOS if you are drowning. Everyone sinks from time to time, especially in a busy ER.  This week I had to do just that!  I had one patient that was anemic and needed blood, a septic patient with no IV access in need of antibiotics and fluid resuscitation, a stroke patient, and a chest pain.  Needless to say I was overwhelmed.  Luckily, that is what your team is there for, to give those medications for you, answer that call light, or help that patient to the bathroom, so you can focus on providing patient care.
  5. Know your hospital and state policies.  Do not work outside of your scope of practice!  Doing so puts the patient at increased risk and can lead to lawsuits or the Board of Nursing revoking your license.
  6. Never accept that violence is part of the job as a nurse.  If you ever find yourself in a quickly escalating situation, the patient is intoxicated, or you have that “this just isn’t right feeling” call security!  Don’t be afraid to call them early and often.  Their job is to help ensure your safety as well as the patients.
  7. Know your medications prior to administration!  I always look up a medication if I have never heard of it before, because let’s be honest most medication names look made up anyways!  But this provides me with knowledge of the indications, administration, and adverse effects.  It is also important to look up IV compatibility when giving medications such as antibiotics, heparin, or lactated ringers, or anytime you will have two medication ran through the same line.
  8. Follow the doctor or other nurses into the patient rooms whenever possible!  Observing their assessment, what questions they ask, how they interact with the patient, what tests they order, and plan for treatment helped to shape my own nursing practice and helps you to know what to expect for future patients with similar presentations .  You can’t imagine how much you can learn from every individual.
  9. Know that this work will be some of the hardest, saddest, and most rewarding.  You will watch patients take their last breath, console families as they mourn, and bring back patients that have coded.  You will have moments that make you laugh, and those that make you cry, and that is okay.
  10. Lastly, never say the “Q” word.
There is a learning curve when beginning out in nursing, especially in the ER.  Remember you were hired for a reason and you made it through nursing school, even with those questions that had multiple right answers but one was more right!

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