I am now 6 months into my RN career as an emergency nurse, and completely on my own! It still feels like a dream. I had plenty of achievements and struggles throughout my journey, and here are some things I learned along the way.
1 – How to do focused assessments
If a patient comes in with chest pain and shortness of breath, naturally you need to assess the cardiovascular and respiratory systems. Listen to the heart and lungs. You do not need to do a full head-to-toe assessment unless the patient comes in unconscious and there is no chief complaint. Here is one of my favorite YouTube channels that has a playlist of focused physical assessments:
2 – How to ask open-ended questions
Instead of asking, ” Do you have questions?” ask “What kind of questions do you have for me?”. This forces the patient to answer in a different way instead of the standard yes/no questions. Instead of “Do you drink alcohol?”, ask “When is the last time you drank alcohol?”. I was surprised when I asked my possible alcohol withdrawal patient if they drank alcohol, and the person stated no, but when I asked when the last time was, they replied with 3 hours ago. I am a huge fan of open-ended questions now. Essentially, try not to ask questions that prompt a yes or no response.
3 – How to bundle care
In the emergency department, nurses need to multitask to get things done in a timely manner. Instead of walking back and forth from the room and the medication/IV/supply cart, grab everything you anticipate you need. If the patient does not look well, grab IV start kits, blood tubes, an IV pump, etc. If you’re out of pumps (which happens quite frequently in my case), call central supply ASAP. While you’re doing the IV, assess the patient. My preceptor gives me 10 minutes to get a patient settled the moment they get into the room with an IV, gown on, hooked onto the monitor, and labwork sent, but this comes with experience.
4 – Anticipate care for the patient
If the patient is having chest pain, a cardiac workup including an EKG/cardiac monitoring may be ordered. If a patient is coming in with abdominal pain and actively vomiting, assume that they might need an IV for nausea medications, bloodwork, fluids, etc. I learned that this comes with experience as well. Over time, I noticed a pattern with patients with similar complaints and in due time I was able to anticipate some orders and get ahead of schedule.
5 – Ask the physician questions
I am still terrified of asking the ED physicians questions, but I learned that it is okay to ask them questions about their orders especially if it is an important medication or intervention. I would much rather ask and get yelled at than potentially harm a patient. I had tropicamide eye drops ordered for a chest pain patient one time, and I kept on wondering why the physician would order this. I double-checked with him, and he meant to place an order for a troponin lab draw, so always ask first!
Here is another fantastic video from an ER nurse with more tips/tricks for new grad ER nurses:
Thank you again for reading my post! If you made it this far, I truly appreciate your time and welcome you to the introverted nurse community :-)) Reach out to me here for any comments or questions you have!