Cardiac to ED

So you guys are required to perform and document a complete head to toe assessment on every patient? That's a new one to me, because all I ever get from the ED when I admit a patient is a handwritten flow sheet that has no head to toe assessment anywhere on it. I would imagine that there would be situations where a rapid head to toe would be warranted, but my impression is that in general your assessments are rapid and focused, and you do not have the same documentation requirements that exist on the floor.

As far as feeding people, I was referring to meal trays being served. Obviously a diabetic who is on insulin or oral hypoglycemics would need to eat something if they are in the ED for any length of time. Our ED will even get someone a sandwich or something if they've been there all day and there is no reason for them to be NPO, even if they're not diabetic. Am I incorrect? Are meal trays commonly served in the ED?

Wow, well they don't do meal trays in our ED, and the head to toe assessments are not required for every patient, every shift, like on the floor. Their assessments are focused on the primary complaint and whatever else comes up during the visit. I suppose head to toes would be warranted for traumas and certain other conditions, but if someone comes in with SOB or CP, they're not turning them over to do a skin assessment and check for decubs. That gets done by the admitting nurse on the floor. The ED does not do med recs either. If the patient is to be admitted, they have a medication worksheet they fill out, which usually just consists of the names of the meds the patient takes, and rarely if ever has the dosage or frequency on it. I recall a while back there were some ED nurses doing the med recs, but I haven't had a patient come up from the ED with a med rec done in months.

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. In the ED, they use a flowsheet and document IV starts, medications, focused assessments, and narrative on that flowsheet. It's quite different.

I don't start for a few weeks yet, and I did not have an opportunity to job shadow. It's against our rules to float an RN down there (they're not part of our "pod" or something), so I haven't been floated there either. It's an internal transfer, so it's handled a bit differently than a regular job interview/hire situation. I have spoken with some other floor nurses who transferred down there and love it. Our unit has had many nurses transfer there, and they never come back. Fortunately we do have a union contract that has conditions for transfers, so if it's not a good fit, either for me or for the established ED staff, I can have my old job back.

It's a Level II trauma center, BTW.

Already have ACLS, required to work in cardiac.

What do you love about the ED?