Advice for Starting a New ER Job

[thulegreen1101]

Regardless of where you are at in your career and experience:

1) Advice for starting a new ER position with a new ER team? How to set yourself up for success?

2) Questions/clarifications to ask HR or ER management before starting? 

Thanks!

[Apollo1]

1. EMRA reference books are your friend.

2. Develop rapport with a few attendings you're working more frequently with; show willingness to staff sicker patients with them and learn. Your attending(s) would rather have you ask questions if you're unsure of something than wing it, and when they go to sign your chart have to call the pt back or start grumbling about your decision-making.

3. Be polite to the nursing staff, but maintain a large mental grain of salt whenever they present patient issues to you.

4. If you're going to resuscitate the patient, do it all at once. Don't string out your IVF/meds over a period of time b/c it just delays the dispo and your colleagues will be annoyed when you inevitably give them a sign-out.

5. Don't let pts try to corner you into giving Rx for a non-diagnostic visit (i.e. antibiotics). 

6. Don't be the PA in the group who doesn't like to see "X" patients (ex. MVA, Peds) and purposefully avoids them. You work in EM, not a subspecialty that can turn people away.

7. Learn how to do peripheral access lines (including US-guided) and your own splints. Don't volunteer to do them frequently, but have the skill in your pocket for the inevitable time the nursing staff mess up the splint or can't get an IV started.

[DiggySRNA]

#4 (for the love of god...don't nickel and dime your orders) and #7! 

As an ED nurse, I appreciated when the providers talk to me and included me in the management of the patient instead of sitting in their pod while throwing orders in. 

[SedRate]

57 minutes ago, DiggySRNA said:

As an ED nurse, I appreciated when the providers talk to me and included me in the management of the patient instead of sitting in their pod while throwing orders in. 

Could you kindly explain what you mean by included you in the management? 

[DiggySRNA]

18 minutes ago, SedRate said:

Could you kindly explain what you mean by included you in the management? 

Educating me on why certain things are done or why certain things aren't done. Making it a conversation instead of putting in orders and then just wait for the results. It created an open space for me to want to learn and understand more when it comes to patho-pharmacology.

For example, one of my favorite physician to work with would assess the patient and then somehow go out of their way to find me, saying their doing abc to r/o xyz or during resuscitation for a critical patient would say things like "what do you think about? should we do this or what do you think if we did this?"

 

 

 

Edited March 9 by DiggySRNA

[EMEDPA]

31 minutes ago, DiggySRNA said:

Educating me on why certain things are done or why certain things aren't done. Making it a conversation instead of putting in orders and then just wait for the results. It created an open space for me to want to learn and understand more when it comes to patho-pharmacology.

For example, one of my favorite physician to work with would assess the patient and then somehow go out of their way to find me, saying their doing abc to r/o xyz or during resuscitation for a critical patient would say things like "what do you think about? should we do this or what do you think if we did this?"

 

 

 

I try to do this with the nurses and RTs I work with. Sometimes they recommend something I had not considered and it helps with pt care. We are all students and teachers. Don't be too stuck up to listen to someone with a different or "lower" credential than you have. I have learned far more about vents and bipap from resp therapists than any intensivist. 

[ohiovolffemtp]

As you come to know and trust your nursing staff:

• Tell them all questions are fair game.  People respond very well to being trusted
• Tell EVERYONE, from registration, to techs, to lab, to imaging, to nursing, to always feel free to come get you if the patient "doesn't seem right".  Tell them that they are always right - that the patient definitely needs to be looked at if they are concerned.  It may or may not turn out that something bad is happening, but no one knows for sure until the patient is evaluated.  You don't want to miss a chance to intervene.
• Encourage RN's you trust to put orders in under your name if there's going to be a long interval between when they see the patient and you seeing them:
  • IV access and fluids
  • Symptomatic management:
    • antiemetics
    • most pain meds
    • nebs and/or steroids for breathing issues
    • EKG's
    • Imaging: CXR for CP and dyspnea, musculo-skeletal.
  • Again, it builds trust and can really improve throughput.

 

[SedRate]

10 hours ago, DiggySRNA said:

Educating me on why certain things are done or why certain things aren't done. Making it a conversation instead of putting in orders and then just wait for the results. It created an open space for me to want to learn and understand more when it comes to patho-pharmacology.

For example, one of my favorite physician to work with would assess the patient and then somehow go out of their way to find me, saying their doing abc to r/o xyz or during resuscitation for a critical patient would say things like "what do you think about? should we do this or what do you think if we did this?"

 

 

 

Thanks for your explanation. I am glad to hear some nurses appreciate it when we discuss things with them and include them.