Whenever I have new nurse grads in the Emergency Department, I find myself repeating my maxims over and over.
Finally, I wrote them down as ED’s Rules.
Mine are not as refined as the House of God rules, but I’ll keep working on them. I’ll take suggestions too!
Emergency Department 101 for new grads
Bringing a crash cart into the room can ward off evil spirits.
Don’t panic, if the airway is patent, get a set of vitals. It’s useful information and buys you time to figure out your next move. Moreover, it makes you look like you know what you are doing.
We have to treat all our patients, not just the nice ones.
The patient is not the enemy.
The Emergency Department is an easy place for a nurse to kill people. If you don’t walk into work a little scared of doing so, you probably aren’t paying attention.
Over time, it is always easier if you do the right thing in the first place.
Doctors will yell at you for doing the wrong thing just as they will for doing the right thing. Thus, it’s easier to do the right thing.
You are never the most important person in the patient’s room.
Don’t pre-anger the patients in triage. Don’t argue with patients in triage … just nod your head and get as much information as you can.
The one time you don’t do what you always do, you will wish you did.
Think in worst case scenarios: If a patient says they have esophageal varices and their chief complaint is “vomiting” they need two large bore IVs — even if their vitals are perfect.
Chart like your license depends on it.
EKGs are cheap, undetected MI’s are expensive.
Check blood sugar on anyone with altered LOC.
You patient’s blood pressure will drop about ten minutes after you start the IV antibiotics and just before you admit them.
Don’t DC an IV until the patient is dressed and in the wheelchair ready for discharge.
Don’t argue with drunks or crazy people.
Nurses don’t work for doctors, they work for patients.
When a doctor asks “who has room x?” The correct response is “what can I help you with.”
They are all my patients.
There are many reason for people to be become demanding, agitated, or argumentative. Sometimes it is an underlying disorder of the personality that you have no control over.
Sometimes it is because they are dying. Often they don’t know what to expect and aren’t used to being powerless.
At the very least, it may be because you just met them on the worst day of their life. This is a good possibility given that they are in an emergency room.
Your job is to try and be the best part of the worst day of their life.