Reality Check: Being a New Grad in the ED

Hellloooooo! It’s been a hot minute. Since I last wrote, I graduated from nursing school, started my residency, and passed my NCLEX! Woohoo! I wish I could say that the NCLEX was the last stop on the nursing struggle bus, but really starting to feel like it’s stop number 5 out of 100.

I accepted my dream job. I had a picture of how it was going to be. I spent over 300 hours in the ED during nursing school, so I thought that I would have *somewhat* of a smoother transition into practice. I WAS SO WRONG. Being a new grad in the ED has proven very difficult for me.


Canboc Stethoscope Carrying Case for 3M Littmann Classic III/Cardiology IV Stethoscope – Extra Storage Taylor Percussion Reflex Hammer, Reusable Medical LED Penlight

One, the ED I’m working in now is a little bit over twice the size that I had experience in, plus, it’s a Level 1 Trauma Center. New grads don’t really touch the trauma bay, and I didn’t expect to for a couple of years anyway. However, my coworkers are super great and are very supportive of learning opportunities! So I have spectated in the trauma bay a few times for some interesting cases.

Secondly, I don’t know where the heck anything is. I’m still getting lost, it takes me twice as long to find supplies, and ALL OF THE EQUIPMENT IS DIFFERENT — The pumps are a different brand and can only handle one primary line and a piggy back – no adding channels…gotta get another pump…????, the tubing is different (as well as the way to prime), the IV angiocaths are different (I do need way more practice with sticks, though), the blood culture bottles are a different shape and color, the medication dispensing system is different, the labeling process for specimens is way more complicated (the hospital recently transitioned to EPIC, so I’m not sure they’ve caught up with what other hospitals are doing), labs are drawn from different colored tubes and therefore the order of draw is different, mixing antibiotics is more complicated, requires an extra step, AND an extra piece of equipment that I’m not used to either. I could go on…but all of these little things are slowing me down immensely.

Thirdly, I am getting different instructions and directions from each nurse I interact with, so if I do something that isn’t quite what that person does, I am also slowed down because they want to explain what they are doing and why. Most of the time, I learn something new and am very excited to have a more efficient way of doing a task! But sometimes I just want to tell them that my preceptor instructed me a certain way and I would like to keep that habit. For example, I am already familiar with EPIC, but this hospital just transitioned. There are a dozen different ways to find information in the EHR. I have my favorites saved and my hands literally have two years of muscle memory to find certain pieces of information very quickly. I’m having trouble finding the balance here. I love and appreciate each piece of advice, but in the end I am responsible for my license and charting, and as long as it accurately reflects the patient’s condition and care within facility policy and the board, it’s six of one and half a dozen of the other. If you’re reading this and have advice–let me know!!

Let me get to the fun parts!!

Yes, the transition has been tough, the patient load is insane, and I feel like I got hit by a train. But I have learned SO MUCH in the three weeks I’ve been in patient care. I’ve seen a lot of new cases such as Cushing’s triad, clamshell emergency thoracotomy, ROSC, subarachnoid bleeds, and open fractures. I’ve also been able to reenforce and improve my knowledge and skills when it comes to the common cases I saw in my internship such as RSI’s, STEMI’s, strokes, and sepsis.

Being a registered nurse is really, really fun. I love seeing immediate improvement in a patient from an intervention or medication that I gave. Everyone is so supportive, and although I am a new grad, I feel like a part of the healthcare team. No one has treated me poorly or looked down on me (at least not to my face or that I know of). I’m really struggling with time management and clustering care, but my preceptors are supportive and patient.

The skill that I feel most confident in right now is my “customer service” skills. I can talk to anyone. I can stay calm in front of patients and do my best to explain what is going on. I can grab that extra blanket or take 15 seconds to take deep breaths with my patient. But I can’t wait to get better at it!

The only advice I feel qualified to give right now as a 3-week-in new grad in the ED is:

  • Don’t be afraid to ask questions! I feel like I ask a question every 5 minutes…
  • Be confident in what you know, but have the attitude that you can always, always improve and learn something new.
  • You can advocate for your patient right away! If something doesn’t seem right, grab someone for a second look.
  • You are going to feel like you are drowning, but my supervisors and preceptors have been telling me that it is a normal feeling.
  • Write things down (checklists, SBAR, questions, etc.).
  • Write out goals for each shift and take 2 minutes to share those goals with your preceptor.
  • Be appreciative of every learning opportunity and be respectful!
  • Learn some positive phrases such as, “Could you clarify this for me?” or “Could you remind me how to _____?” instead of “I don’t know.”
  • If you need to cry, do it in the bathroom or in your car!
  • Get to know your techs because they know more than you and can help you. I can’t tell you how many times a tech has saved my butt already.
  • ASK QUESTIONS. I already said that, but I feel that it is the most important for me right now.

I wrote this post about the transition before I graduated nursing school. It talks about some of the barriers new grads have with adapting to their new role. I re-read it today from a new perspective and thought it was really interesting. I am most definitely in that “first 3-4 months” where the grad nurse feels anxiety and self-doubt in the new role of a registered nurse.

I also grabbed this pocket guide called Emergency & Critical Care Pocket Guide. It’s a cute little flipbook that fits in any of my scrub pockets. It has basic information about common emergencies, ACLS charts, medication compatibilities, and more! I love being able to just grab it and learn something new.

Check out my previous post about essential emergency room supplies. Not much has changed about what I brought during nursing school versus what I bring to work now!

I also highly, highly recommend Hoka One One shoes. Listen, y’all. I had constant foot and back pain during and after my clinicals in nursing school. These shoes were recommended to me while I was in school, but I couldn’t afford them. After I got my first big girl paycheck, I ordered these shoes, and I feel like I am walking on a cloud. My pain has decreased and I can last much longer without feeling pins and needles.

Save up some money, buy some good nursing shoes and compression socks, and save your back and feet. You’ll thank me later!

Long story short, ER nursing has been a wild ride so far. I could go on and on. The bottom line is, if you are going straight from nursing school to the ED, get ready! It’s a lot. I’m only three weeks in, so please take anything I say here with a grain of salt. Not everyone will have the same experiences and I am not trying to portray that I am an expert.

Happy nursing!

Skyanne, BSN, RN


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Nursing Student Summer Tips!

Off for the summer? Here are some productive things you can do! ⛱🌻

1. Do practice NCLEX questions. Yawn. Who wants to do work over the summer? Start by setting a small goal such as 10 questions/day. You’ll find that it won’t take up too much of your time! By the time summer is over, you’ll have done hundreds of questions. I use Saunder’s NCLEX-RN Comprehensive Review for every class and it works wonders! Get a copy of it here!

You can also use Brilliant Nurse NCLEX-RN® Test Prep!, which is an online interactive experience to prep you for the NCLEX!

2. Update your resume. This can be difficult during the busy school year! Take some time to really go through your resume and send it to a few trusty people for advice.

3. Look for internships and jobs. Set aside some time to gather up information about internships and jobs. Apply for what you can and get your name out there! What is your ideal unit? What is your ideal salary? 

4. Review tough topics. Did you have a hard time with the endocrine system? Cardiac? Psych? You’re not alone. Look over some of these topics in a stress-free environment. No pressure, no due dates, no exams! You may remember more material this way. Go with 20 minutes a few times a week.

5. Relaxxxxxx. You’ve been working so hard. Plan time to treat yo self! 

Happy Summer!⭐️⛱



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The Ultimate Guide to Surviving Nursing School!

Congratulations for getting into nursing school! I put together a list of supplies you may need. There are also a few tips for surviving that no one else will really tell you until you’ve been through it. Keep in mind that every one’s experience is different. What applies to me may not apply to you.

MUST HAVES:

Lecture Supplies!

  • Binders
  • Looseleaf notebook paper
  • Black pens (or colored if you are the type to color-code notes)
  • Highlighters
  • Drug guide (App available if lecturer allows electronic devices)
  • Textbook (IF you need it)

Tips for Surviving LECTURE:

  • Read the assigned text BEFORE class. I don’t mean skim. Understand it. Make this mandatory in your homework routine.
  • Come to class with questions. Mark down the answers as the lecture goes on. If there are unanswered ones, get them answered before class ends. If you don’t understand something, don’t be afraid to raise your hand and ask. Chances are that there is someone else with the same question.
  • Star, highlight, underline, circle, etc. any topic that the professor repeats. I usually put a star down for each time it is said. I can’t tell you how many times they put this information on exams.
  • Avoid using electronic devices. I always use pen and paper. I have e-textbooks, but I only pull my tablet out when I absolutely need to. Silence your cellphone and only use it during breaks or emergencies.
  • Keep your energy up. Eat a high-protein breakfast and drink plenty of water. Snack on nuts or other nutrient dense food. I usually eat almonds and/or apples with peanut butter.
  • Be courteous to your neighbors. Avoid opening loud snack packaging, using your phone, talking, or doing another classes’ work during lecture. Anything abnormal that you do during lecture is a distraction to others around you. Don’t be afraid to move seats during break if you can’t concentrate.
  • Wear comfortable clothes. Nursing school is not a fashion show. I wear sweats most days because I am sitting for 6+ hours at a time. I usually have a jacket because I get cold very easily.
  • If you are given a break, USE IT! Go walk around, go outside, walk up and down some stairs, etc. Just get your blood flowing.


Tips for Surviving LAB:

  • Lab is for PRACTICING skills, not learning. Usually you will be assigned a video or reading assignment that explains how to perform the skill. The professor will demonstrate the skill, but you are more than likely expected to already know the steps. Don’t make a fool out of yourself by not preparing. We were given step by step instructions for most skills. If your school doesn’t provide these, then make your own.
  • Come to lab in uniform and with all of your supplies. Make sure you wash your hands before beginning.
  • Try performing the skill on your own before asking too many questions. You will learn more by making mistakes than by avoiding them.
  • Don’t overthink anything. You are practicing skills to perform them on a human being. Put yourself in their shoes. Practice compassion. Talk to your mannequin as if it were a real person. It will feel silly at first, but it will help you in clinical.
  • Explain every step out loud in lab. This will not only help you, but it will help your lab partner and others around you. It is also easier to catch mistakes this way.
  • Take advantage of open lab hours if your school provides it. Get together with a study buddy and spend an extra hour or so each week practicing.

Tips for Surviving CLINICAL:

  • Congrats, you’ve made it to clinical! You will probably be nervous, but that’s okay. I was nervous AND excited. That is normal. Take some deep breaths and go with it!
  • Eat a high-protein breakfast. You will probably have to wake up at an hour you’ve never been awake for. If you’re like me, I can barely eat in the mornings to begin with. Force yourself to eat. Don’t go for a high-carb breakfast. You will crash before 9am. Bring snacks for the commute. I usually eat egg/bacon/potato breakfast burritos and I bring an apple to eat on the way.
  • Be prepared. Your school will have different requirements for pre-clinical. If you are assigned a patient the day before, make sure you know which drugs they are getting and WHY.
  • Stay busy. If there is a lull in the day, ask your nurse if there is anything you can do. If he/she says no, then that’s the perfect time to go talk to your patients.
  • Ask to perform skills you have already learned. Already learned how to put in a Foley? Ask your nurse if you can do the next one. Injections? IV starts? ASK!!! You will never learn if you don’t ask. The worst they can say is no.
  • Talk to your patients. You will learn more about them through conversation than by reading a chart.
  • Don’t think of yourself as a shadow. You are a student nurse who is there to help, not follow. Although you will be “shadowing” a nurse, your confidence will give your nurse more confidence in letting you take the reign!
  • When it’s time for lunch, eat something healthy. You already know how high-carb/high-fat meals make you feel. Plan accordingly. Take the full break. If you get 30 minutes, try to sit and rest for that full amount of time. Make sure you wash your hands before and after, and use the restroom before going back.
  • Enjoy yourself! This is what you’ve been working hard towards, right??
  • We always had a debrief with our instructor after clinical. It was an open “round-table” discussion about our day. Be honest about how your day went. Not every clinical day is unicorns and rainbows. Other students will appreciate your honesty.

Tips for READING your textbooks (BEFORE lecture):

  • Turn off your phone, TV, etc. I have a classical music station that I listen to when I study.
  • Skim the chapter and pay attention to titles/subtitles. Count how many pages you have to read and allow yourself enough time accordingly.
  • Start reading from the beginning. Look up any words that you don’t know. Read slowly and carefully.
  • Take breaks every 30-50 minutes.
  • Write down any questions or unclear topics.

Tips for STUDYING material (after lecture):

  • Review the lecture notes from each class when you get home that day. Make sure everything is organized to make studying easier.
  • Go through the assigned reading again and highlight or underline the main topic/sentence of each section. This will make it easier to find information.
  • If you have a homework assignment for this chapter, do it now.
  • The next day, review your notes and skim through the book again. Look for different sources of information for main topics. I like to find YouTube videos that explain topics.
  • Rewrite important information on notecards or in a notebook.
  • If you can, on a different day, get together with a study buddy or group to discuss the information. Don’t do the homework together unless there’s a question that you couldn’t answer on your own. Study groups are not for learning, they are for discussing and solidifying concepts.
  • Notice that now you have reviewed/heard the material 5 times.

Tips for studying for an EXAM:

  • Although I study every day, I usually start my “exam” studying a week before the test.
  • Practice NCLEX-style questions
  • Answer the questions at the back of the chapter.
  • Get any unclear topic resolved at least 48 hours before an exam.

I hope that this information is useful! Feel free to reblog and add anything I may have missed. Also feel free to message me with any questions!


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