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Nursing Travel August 6, 2019

By Staff Writer

Brushing Up On Your ER Nursing Skills

Working in an emergency room is demanding, to say the least. It requires patience, attention to detail, and a constant re-upping of your skillset. Each day on the job is different and exciting, which means nurses are continually flexing their creative care muscles and honing their skills as an ER nurse. Although, not all skills are practiced every day. This makes brushing up on nursing practices a constant necessity to be ready for whatever situation arises.

This is especially true for seasoned nurses who are reentering the workforce. With how fast medical technology and techniques advance, it can be tough to stay up to date with every new change. For nurses who’ve been absent over five years, you’ll find that many protocols have altered or become more comprehensive. A lot is different in today’s medical field, so read on to freshen up your skillset and better prepare yourself for the emergency room.

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What’s Changed Over the Last Thirty Years?

In order to be caught up in the ER nursing field, it might help to understand what’s changed over the last thirty years. Why thirty years, you ask? Many returning emergency nurses haven’t worked since their twenties. That could be ten, twenty, and yes, even thirty years ago. A lot has changed over that time. There’s been medical breakthroughs, technological innovations, and social change for patients.


Certain pharmaceutical drugs have stuck around, but most have been replaced. Knowing the different names and their protocol for safe administering is one area where nurses need to break out their flashcards.

Procedures and Testing

Over the last thirty years, ER nurse certifications on certain procedures have changed. This includes everything from understanding how to work the newer machines to cleaning up bodily fluids and prepping patients in a manner that satisfies all the latest safety regulations.

Patient’s Time Spent in Hospitals

As medications have strengthened and many surgeries have become non-invasive, patients are spending less time on average in hospital beds. A procedure like cataract surgery is now done with minimal risk, and patients are able to leave the hospital the same day. This wasn’t the case twenty or thirty years ago.


Perhaps the biggest factor that has changed in emergency care is the technology used in hospitals. There’s patient-controlled analgesia, automated dispensaries, and smart intravenous lines. Even the charts to jot down patient information are now electronic.

Patient Attitude

Nowadays, patients are aware of what rights they have in a hospital. Diving into what a nurse can and can’t do, say or can’t say is necessary to avoid any malpractice suits. 

What’s Worth Brushing Up On?

Being an ER nurse means using critical thinking by being ready to tackle any complex problem that arises. Patients will come to you with broken bones, open wounds, and debilitating diseases. Because of this, ER nurses are expected to be in tip-top shape with regards to their medical skills. To know which ones you need to brush up on, here are some ER nurse duties and responsibilities examples.


Triage is the term used by nurses to sort patients into categories based on how urgent their condition is. For severe cases where immediate action is necessary, these patients need to skip the line and see a doctor as soon as possible. For broken bones and non-fatal illnesses, these will be lower down on the urgency list.

Each emergency room has its own structure of triage, but the basic levels are structured as follows:

  • Level 1 – The patient’s condition is fatal unless immediate action is taken.
  • Level 2 – This patient is at high-risk. They should be taken in as soon as a bed is available.
  • Level 3 – Depending on their age and vital signs, these patients can hold off for some time.
  • Level 4 – Patient has stable vital signs but will need attention eventually.
  • Level 5 – The patient has no immediate sign of threat. They will be the last to be taken care of.

Although it can be tough to watch a kid in pain with a broken arm waiting for hours in an emergency room, this is often a reality. Broken bones, minor injuries, and non-fatal diseases cannot take precedence over life-threatening situations, regardless of the age of the patient.

Initial Report

Each hospital will have its own form to fill out for each patient admission. But it doesn’t hurt to have the basic idea down. For this, the acronym is SBAR. Situation. Background. Assessment. Recommendation.

First, you need to monitor the in-patient’s vitals. Ask yourself, what is the immediate state of the patient? The next step is to figure out their background. This could involve what their mental status is, how long their condition has been occurring, and anything else that provides a causal link to their situation. Third, assessment. After gathering the initial information, what do you think the underlying concern is? Having the correct assessment would explain any pain, nausea, or any other symptom the patient is experiencing. Finally, the recommendation is what your initial treatment would be.

If the report sheet is largely blank, try to include your own methodology and use SBAR for guidance. Don’t be afraid to ask poignant questions to get the information you need.

Transporting Patients Within the Hospital or Upon Admission

There are specific guidelines for transporting patients with different conditions. If the patient is in pain or experiencing high levels of nausea, you’ll need to administer the appropriate drugs before transferring. Similarly, patients on a cardiac monitor or those with unstable conditions must be transported with an emergency medication box.

Be sure to read up on your hospital’s specific requirements to transport patients properly.

Patient Discharge Protocol

Discharging patients has become a particularly sensitive area where nurses are required to remain extra vigilant. As a nurse, you need to determine whether or not the patient is fully conscious leaving the hospital, has stable vitals, and that their primary concern upon entrance has been addressed.

By inputting all this information into a patient’s chart, you relieve the hospital from any unnecessary legal trouble.

Plus, the patient needs to know what to do moving forward. Discharging allows a nurse to answer any questions a patient might have. Any prescriptions or medical equipment the patient will need to use should be explained. If the patient has received any sedation, they should not be discharged without confirmation of safe transport. 

Common Legal Issues

The stereotype of patients by medical practitioners is that they’re just walking, talking malpractice suits. Of course, this idea is ludicrous. But there is something here worth noticing. According to a Medscape Malpractice Report done in 2017, 89% of physicians felt that a malpractice lawsuit was unwarranted when it came. Which means medical professionals can’t reasonably guess when a patient is going to report legal issues about their case.

Another interesting point from that report showed that 22% of those physicians said if they could do something differently, they would have had better chart documentation. This shows how small habits like proper dictation can become huge liabilities.

This information holds for nurses as well. Nurses are most commonly sued for malpractice over improper standards of care, lack of communication skills, infrequent patient assessment, and a failure to input the correct documentation.

Recognizing Red Flags

As ER nurses, your brain is tuned to seek out warning signs. Based on a short debriefing, you can usually determine what level of critical condition a patient is in and sort them categorically. But the hectic environment in emergency medicine can also be what blocks you from spotting a bright red flag. 

Gut Feelings

Elderly patients complaining of abdominal pain and constipation have a higher chance of mortality than any other age groups. 5% of the elderly admitted to the emergency room with these two symptoms die within two weeks. For other age groups, this is a simple diagnosis. The red flag is the patient’s age.

Return Visits

With how many patients ER nurses tend to each shift, it’s hard to keep track of every name and face. If you recognize a patient is returning complaining of the same problem and presents the same symptoms, chances are the diagnosis was not correct. In cases where a new diagnosis cannot be determined, it’s safer to send them to another department than to discharge them with the same medication.


Medical professionals struggle to know when patients are suffering abuse. If physical violence is suspected, create a reason for the patient to remove articles of clothing. Typically, under the shirt and near the waste line are two places where marks of abuse can be seen. Parents of children with bruises should be able to explain how and where they got the injury. If there is no reasonable explanation, a full child abuse workup might be required.

Personal Coping Mechanism

With how much trauma is experienced in an emergency room, nurses will often feel overwhelmed by their work. This can be especially true when patients in critical condition are admitted toward the end of a long shift. 

Emergency department nurses must have their lives outside the hospital set up to recover and relax from work. Even if no visible signs of stress are occurring, it’s a safe practice to remember different ways of coping.

The basics of self-care include: exercising regularly, maintaining a hobby, hiking or enjoying nature, proper sleeping habits, and using vacation time when needed.

Handling a Full Patient Load

Of all the ER nursing skills, handling a full patient load can be the one that’s most intimidating for returning nurses. It’s the nonstop action of ER nursing that comes as the biggest shock.

When considering a full patient load, remember to take each patient one at a time. Start from scratch and reassess all the relevant symptoms. Trying to think of the best way to treat your next four patients, while in the room with one, will only cause the stress to build up, and it could lead you to miss a red flag in the present moment.

Basics of Bedside Etiquette

Emergency care nurses all succumb to the stress of a long shift. Maybe it’s your last patient of the day and it’s been a particularly exhausting workday. Or maybe events outside of your control in your personal life are affecting your mood. Whatever the case may be, it’s best for you and your patient to not allow these negative emotions into the room. 

Greeting patients with a smile and introducing yourself is a simple way to show people compassion. Remember, these patients could be scared, in pain, and distressed. The last thing they want is a nurse who appears indifferent. Plus, patients who are comfortable will have a much easier time sharing their symptoms, making your job easier.

Some basic bedside etiquette includes: looking at the patient when they’re speaking, using open body language, asking follow-up questions, and adding in a personal question to get to know them better. 

Organization Outside the Hospital

Many nurses will forget how time-consuming the ER job can be. Not only are the shifts long and tiring, but the recovery time is also a factor. To perform at your best, remember to keep your life outside the hospital organized. Have your scrubs, comfortable shoes, and possibly a lunch packed and ready to go the night before your shift.

This will prevent you from coming into the hospital after a hectic morning and make your rest time more valuable.

Nurse Refresher Courses

If you’re considering returning to nursing and don’t feel comfortable jumping right back into the swing of things, a nurse refresher course might be helpful. Nurse refresher courses are typically two to three months long and provide you with a refresher on everything from anatomy to basic nursing skills to the newest technology.

Getting Back into the Rhythm

Whether you’re looking for a quick update of your skillset or you’re making the brave leap back into nursing after some time away, brushing up on your ER skills is necessary to build a strong foundation. The emergency room is one of the most high-stress environments you can work in as a nurse, and sometimes the only way to shake the nerves off is to jump back into the rhythm of things. For all you nurses heading back into the ER, good luck and stay tough!

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