Cardiac to ED

Hi Virgo,

I work in a CVICU, and I'm thinking of transferring to the ED as well! I have a friend that works "down there", she has a lot of complaints, but I can tell she really enjoys the fast pace and adrenaline.

I'd love it if you could update us on how your ED adventure is going, you could even email me (under my profile name).

I have to say I love the ER and can't imagine doing anything different but you will find your own complaints. The grass isn't always greener. Some things will be better and some worse. Here are a few ideas.

Pros
-different patients, complaints every day. You never know what you will get from one minute to the next. You can have a cardiac, a pediatric, and a psych all at the same time. You learn a lot and you don't get bored.

-yes we have less paperwork then you do. We are required to do med recs and the way I understand it all ER's are now.

-we don't document head to toes all on patients but we do on traumas and very sick medicals.

-We have to be investigators. Pts don't come with a diagnosis. Sometimes we have no information other then someone found them like this. We may not know names, past history, or even the reason they are there
-If you have a patient you don't like you only have them for a short time
-Huge adreneline rush when you get a nasty trauma and great satisfaction when you save them
_You always have a doctor in the ER if you get into trouble they are a shout away.

Cons
-You are a jack of all trades and know a little about everything but not a lot about anything.
- You can go from busy to busier in a second. You can't turn down a patient because your rooms are full or you have a certain number of patients. They keep coming.
-All the floors in the hospital especially the ICU think you are dumb and incompetent because you haven't done a head to toe, you don't know breath sounds on your broken foot, the patients aren't all cleaned up and in a nice little package when you are done
-You don't get to see what happens to patients. You stabalize them and ship them off. You often don't know if they got better or worse
-You see patients and families at their worst. They are stressed an scared and take it out on you.
-You get tons of non emergencies
-Yes we feed people and they expect it even if we don't have routine meal times. It's actually more of a pain in the ER to feed patiets because of this. We have to call dietary and find a tech to go get the tray. It's not automatic like on the floor.

"On the floor we have computerized charting and have to complete and document a full systems assessment (head to toe), a pain assessment, an IV assessment, a nursing narrative, an overview of their hospital stay, and of course their routine vitals/medications/nursing interventions."


We do all of this in our level 1 trauma center. And EVERYONE gets a FULL head-to-toe assessment. We do the exact same charting that is done by the floor nurses upstairs. We also do med recs, all PMHs, etc. This is consistent for all admitted patients no matter if the are a trauma, GI, OB, peds, etc.. We also do hourly rounding the entire time that they are in our care. Thank goodness for EMRs! In fact ours is only slightly different than what is used on the floor.

Good luck with your new adventure, I bet you will do great! I agree with everyone else-get TNCC asap, also the CEN, it is sooo helpful!

Well I just wanted to put my input in being that I'd worked on the "floor" at a Cardiac Specialty Hospital before I became the ER nurse I am... First off... I am programed to do a full head to toe assessment...I would feel inadequate if I didn't...that's the way I am a nurse... After a period of time being a RN your assessment skills become second nature... Certainly focusing on the pt's C/C..... I LOVE that I was a floor nurse first... I naturally do all the extra things that an ER nurse might forget about as being important... water pitchers, blankets, pillows..etc.... PS ( Cardiac skills are CRITICAL)
The ED is amazing to me... I am ALWAYS learning and at an intense rate no less!!! I feel the repetition of being a floor nurse would have burnt me out... AND I must say... there is no better bond and respect then within an ED.... When the SH@$ hits the fan.... ya better be confident... and you BETTER be confident in ALL of your co-workers...it's true team work... the ED would not function without it.... GO FOR IT!!! You'll be pleasently surprised

I love the fast paced work. My crew has a great team. We all work together to see that the patients receive the care and attention they need. I love the fact that I really do learn everyday! Every day offers something new, and the work day flies by! Mostly, when people come back, recovered, and tell me 'Thank You', my heart swells with pride, joy knowing I truly helped someone, or even better, that I saved someone's life. That is true emotional reward.

Virgo, I'm in the exact same boat as you. I start orientation in the ER tomorrow (yay) after working on a cardiac floor. I'm nervous, scared, but most of all excited to get off the floor and make the move to the ER! I'm ready for a change of scenery so to speak, and I can't wait to start!! Good luck to you!!

I love the ED for the pace and variety. And you do literally have to become a MacGyver of sorts. It's very team oriented. The docs often ask your opinion of what you think is going on with the pt. They depend on your judgement. The floors often don't give you any respect at all, especially the ICU as others have posted. What they don't realize is that I'm a critical care nurse too and I've just kept their patient alive long enough to get to their floor. We do head to toe also on all patients and if we miss a decub we are in for a write up. Med recs are required. As an ED RN you are expected to do everything quickly, just about perfectly, under the most stressful of conditions. You don't have the luxury of declining a patient or saying "Just give me half an hour til the next one so I can get caught up." I love it though. Wouldn't work anyplace else.

D

This is just my opinion:
* I would wait till you have atleast a year in the ED before you sit for your CEN.
* Same for the TNCC (unless it's a requirement for the ED your switching to).
* I strongly recommend taking as many "Critical Care" courses as you can (especially hemodynamic monitoring and intervention - CVP, Arterial lines etc.)

cheers,