The Top 25 Things You Need to Do Before Your First Day

1. Schedule an orientation with the medical director. The director will most likely cover many of the items listed below; however, if this does not happen, we conveniently list the information you need.
2. Credentialing
   • Check on your credentials to ensure completion
   • If credentials are temporary, what else must you do to complete the process?
   • What are the requirements for renewing existing credentials (number of CME hours, ACLS/ATLS/APLS or PALS, attendance at medical staff meetings, etc.)?
3. Find and introduce yourself to the following people and places:
   • Nurse manager
   • Medical records
   • Medical staff lounge
   • Medical staff office
   • ED assistant/secretary
4. Introduce yourself to ED staff, RNs, techs, clerks, general medical staff, and the nursing supervisors (a fantastic night shift resource) as you run across them.
5. Locate the best hospital dining areas and their business hours.
6. Sign up for computer codes to access hospital systems. Locate established Internet access points.
7. Locate the ED and medical library. Know the available references and the library's business hours.
8. Secure whatever stickers or passes you need for parking access.
9. Get name badge and any other necessary identifying information.
10. Familiarize yourself with the available medications in the ED. What RSI and ACLS medications are immediately available? What are the pharmacy drug dispensing procedures in the ED (including pharmacy dispensing equipment)? What is the retrieval system for medications not located in the ED?
11. Locate the following ED equipment and know how to use it--open the trays and use the equipment if necessary:
    • General room set up and equipment (otoscopes, tongue blades, 4x4s, throat cultures, etc.)
    • Code cart content including pediatric equipment. Do they have the Broslow system?
    • Defibrillator; make sure that you know how to use it yourself to defibrillate and pace
    • Intubation equipment, central line kits, thoracostomy trays
    • Basic ventilator operation; adult and pediatric. Consider a short in-service from the respiratory therapist if necessary.
    • The rarely used trays: ED thoracotomy, cric trays, difficult airway box, transvenous pacers, etc
    • IV pumps
    • Suture supplies
    • Vascular/obstetric dopplers
    • Slit lamp and tonometer
    • ENT equipment including nasal packings
    • Ewald tubes and decontamination equipment
    • If applicable, turn on and use the bedside ultrasound machine. Consider bringing someone along to use as a guinea pig.
12. Get to know your radiology department.
    • Do you have a helical CT?
    • What are the times of operation for CT, ultrasound, VQ scan, MRI, etc.? What are the protocols for calling in technicians? What is their designated arrival time after the phone call?
    • Locate the radiology department and consider its distance from the ED
13. Find out your EMS duties, and learn your required protocols.
14. Get a charting system overview: triage notes, ED physician notes, nursing notes, order sheets.
15. Know how labs and X-rays return results, and understand the preliminary reading process. What are the rate limiting steps in this process? What can you do to expedite the process?
16. Get a copy of standing ED protocols: AMI thrombolyitic protocol, CVA, pneumonia, asthma, sickle cell, etc. Get a copy of ED triage protocols and other standing nurse/tech protocols: wound care/suture set up, chest pain, general pain, etc.
17. Review and obtain a copy of the general admission orders and any standing order sets for common diagnoses (e.g.; chest pain, CHF, pneumonia). Know the extent to which your group agrees to write orders.
18. For consults, do the primary physicians request you call them first? Do you use the on call list? For admissions, should you call the consultants yourself? Do you write an order and let the nursing staff call in the consult?
19. For discharge, what are the clinics/standing referral options for common dispositions? Are there special clinics for indigent patients? Review discharge instructions and responsibilities.
20. Learn about common transfers, and get a copy of the common transfer forms (to Level 1 center, PICU, cardiac centers as applicable, etc.).
21. Know your QI responsibilities including culture and X-ray discrepancy follow-up.
22. Find your ED mailbox and common area so you may receive timely memos that administrators post for the physicians. Learn to fill out your timesheet correctly, so you receive your check.
23. Learn your in-house responsibilities (e.g.; in house code response) and ED protocols for backup on busy days.
24. Know when and where ED staff meetings and general medical staff take place.
25. Review with your director your group goals and relevant hospital goals. For example, your group and hospital may closely follow customer satisfaction percentages, number of admissions, times from patient arrival to final disposition, blood culture draws in pneumonia patients, etc.