10 ER Nursing Hacks You Need to Know
ER nursing hacks can take your shift from terrible to not-as-terrible. As nurses, we aren't afraid to get our hands dirty — we take charge, do what needs doing, and find a way to laugh about it after.
Working the Emergency Department is draining physically, mentally, and emotionally. Just because nursing is hard doesn't mean we can't use tips and tricks to make a 12-hour shift more bearable. Use these ten hacks to save time, save your senses, and save your sanity.
Use Your Judgment
These hacks are anecdotal. Use them within your own clinical judgment and your facility's protocols.
1. Double-Glove for Foleys
For high-infection-risk procedures, sterile gloves are required — and Foley catheter insertion is one of them, since catheter-associated infections are common. One catch: the cheap sterile gloves in the kit are typically a size 5.0, so grab an appropriately sized (latex-free) pair, maybe a half-size up.
After positioning and washing your hands, put on a pair of clean gloves first, then open the kit, apply your sterile gloves over them, and insert as normal. Once the foley is in and the balloon is up, peel off the sterile gloves (now dripping with betadine and fluid) — and you still have a clean pair underneath to secure the catheter, position the bag, and clean up the trash.
2. Burp That Bolus
In the ER we hang a lot of boluses, and pumps are harder to find than a rectal thermometer — so we use gravity. The problem: a bag runs out and half the tubing fills with air, forcing you to re-prime or waste a whole tubing set.
Clamp the tubing and spike your bag — but do not squeeze fluid into the drip chamber yet.
Turn the bag upside down, unclamp, and "burp" the excess air out of the top of the inverted bag.
Once the air is gone and fluid fills the drip chamber, turn the bag right-side up and prime as normal. You've created a vacuum, so flow stops before it empties the chamber — ready for your next bolus.
3. Juice Cup? Change It Up
Unless you're at an adult-only ER, you'll see pediatric patients — and kids hate taking their meds. Dexamethasone oral solution is a particular offender: it's high in alcohol content and smells and tastes terrible, so kids often vomit it back up.
One hack to avoid an IM shot: swap the oral dexamethasone for the IV solution given orally, mixed with cherry syrup or juice or followed by a popsicle — children take it much more easily. IV meds can't always be given PO, so run this by the provider first; the literature on efficacy is somewhat mixed.
4. Septic Sock (Foot Odor)
You've smelled some smells in the ER, and sometimes the worst comes from the feet. Quick science: sweat itself doesn't smell — it creates a medium for bacteria (Brevibacteria and S. epidermidis for the cheesy smell, propionibacteria for the vinegary one), all of which are highly acidic.
Related: Six Steps for Sepsis Management
5. Thinking Outside the Vial (Lidocaine Uses)
Lidocaine is well known as a topical anesthetic for suturing, regional blocks, and injections — but it has several other uses worth knowing so you can suggest them to the attending when appropriate.
Related: Opioid Alternative Analgesics in the ER
6. Alcohol Swab Tricks
Alcohol pads are one of the most versatile things in your pockets. A few uses beyond cleaning a site:
7. IV Stick Trick (Less Pain)
Patients hate needle sticks because needles hurt. Here's a way to decrease pain with no medication or extra equipment: after cleaning the site, rest the needle flush against the skin, bevel up, and press for 3–5 seconds before puncturing. The brief pressure desensitizes the pain receptors, so the actual stick hurts less — and it removes the "shock" factor, making the patient less likely to jump. It won't help every patient (especially if you dig), but many will say "is that it?!"
Related: 10 IV Insertion Tips for Nurses · How to Start an IV
8. BP Not Enough? Use the Bedside Cuff
ER blood pressures tend to run very high or very low. When low, we push fluids fast — but pressure bags aren't always available. Instead, wrap a bedside manual blood pressure cuff around the middle-to-top of the bolus bag and pump it up until it flows nicely, topping off the air as the bag empties. It's an effective stand-in for a pressure bag.
Related: 5 Vital Sign Errors to Avoid
9. Neb-Wick Air Freshener
After a smelly patient leaves, the aroma lingers and Lysol doesn't always cut it. Take a used nebulizer adapter, squirt some water or saline into the medication chamber, add a few drops of essential oil (or strong lotion), and turn the oxygen on high. The room is freshened in minutes.
10. The Dependable Bedpan
Many ED patients can't or shouldn't ambulate, and bedpans tend to make messes. Whether using a fracture pan or regular bedpan, line it with an adult diaper or absorbable pad and secure it with tape or rubber bands (a large pull-up turned inside-out works too). Any urine or liquid stool is absorbed instead of splashing, and cleanup is easy.
Not for Samples
If you need to collect a urine or liquid-stool sample, don't use this lined-pan method — the absorbable material will soak it up.
Related: Comprehensive Urinalysis Interpretation
Clinical Pearls
Related Guides
References
- Lidocaine for NG tube insertion (pain reduction). PubMed.
- Nebulized lidocaine for cough. PubMed.
- IV lidocaine for renal colic vs. morphine. NCBI (PMC).
- Inhaled isopropyl alcohol for nausea. NCBI (PMC).
- Oral vs. IV dexamethasone in children (efficacy). NCBI (PMC).
Do you have any stability data to support running Zosyn under hot water? Thanks
Ashley,
That is a great question – honestly, I hadn’t even considered it. I researched this and there’s not much data on it. What I did find, however, seems to indicate that a hot-water bath of 30 minutes definitely decreases the effectiveness of Zosyn on fighting bacteria. While 1-2 minutes under hot water likely wouldn’t have as much negative effects, I definitely don’t want to continue recommending an ER Hack which could potentially negatively impact a patient! For this reason, I have updated the article and replaced the Zosyn hack! Thanks again!
When I reconstitute Zosyn,I put that vial/bag in the inner pocket closest to my “hot” body. By the time I’ve entered the pt’s room, verified correct pt, Rx, route, dose & scanned everything the Zosyn has usually fully reconstituted.
So smart! I did initially have a tip about running it under hot water to speed up the chemical reaction, but there was some evidence that it may make the medication less effective by heating it up. I doubt its significant enough to matter much, especially just using your body heat!
thank you for giving me wonderful information
Nebulized mouthwash works wonders as well. Mmm minty fresh in moments
That’s a great idea!
Coffee does wonders as well. Plus it makes people happy. ?
You must be born to be a ED nurse. Your tips are amazing!!!
Haha wow thank you, I’m glad you found them useful!
When giving my ICU patients an enema in bed, I will place suction tubing in the bed near (but not on or in) the patient’s rear. That way, excess fluid gets auctioned out of the bed and you no longer have a lake to deal with when changing the sheets after an enema.
Everyone thinks I’m crazy until they try it and then they never give a bed bound patient an enema without it!
Omg this is such an amazing idea!!
Great information.
I love you! Your tips are amazing and you are an amazing human!
Use a trach suction Cather or yaunker and suction while draining abcess, no smell, no mess!!
Love that idea!
May i know what specialist can all of nurse (who don’t want to follow their retirement at 65 age ) continue their path as a nurse ? Is there any nurse continue to work between 65 to 75 ? is it possible? can you show me some cases ?
I am familiar with UroJets being used for males during foley insertion. My question is, is this specifically suggested only for males? In the facility I have worked in, it was only ever ordered to use for males. I know the male urethra is longer than the female urethra, but how about size related to diameter? I have never noticed any big size difference as far as diameter and women can experience pain during catheter insertion, as well. I was just wondering if this is a typical practice only for males for a specific reason.
Absolutely, UroJet can be used for both males and females. It’s often more common in males due to issues like enlarged prostates or past surgeries that can make insertion trickier. But if a female patient finds catheterization painful, there’s no reason it can’t be considered for her too!
If you ever have a large male patient that is too big to secure adult diapers around (or in the event of skin breakdown on the bottom), try this: Get a disposable pad or chux, fold in half and then in half again so it’s in 4 sections. Cut a smallish hole in the center. You can always pull the hole larger with your fingers if you have to. (If you make the hole too big, it will defeat the purpose and you’ll just have urine in the bed and on your patient). What you want to do is gently… Read more »
Thanks for sharing these ER nursing hacks! The tip about using a plastic medicine cup to protect stethoscope earpieces is so clever.