Floor nurse moving to ER? Lots of questions?

  1. I know you get these questions all the time, but sorry here I go. I did browse the threads, but looking for some calming of nerves type of responses.

    I just applied for an ER position. I've had a couple nurses that work with me suggest that I'd be a good fit for the ER that have come from the ER and asked if I ever considered it. That kind of started the thinking. My strengths are I am good at critical thinking and decision making, I am good at multitasking and prioritizing. Weaknesses I suck at real time charting sometimes. I usually play catch up to get the important things done when they need to be done. I'll just jot stuff down on paper and catch up as I have time. Not always, some stuff I do in real time. I'd imagine real time charting is more important in the ER.

    Okay, second problem I am not a new nurse. I've been a nurse going on 3 years, but I work on a really stable floor with a very low census. There is just a lot of stuff I have not seen. I have never participated or even watched a code. People just don't code on our floor. The closest I've had is a rapid response on a low blood sugar (which if it had been my patient would have never got that low in the first place.) So this makes me nervous. I don't want to quite go as far as scares me because I know how I am. I won't freeze. I will do something, maybe not the right something, but I don't usually panic in a crisis.

    So I'm not sure what my questions are. I don't know how to prepare for any of this. I know that I'm ready for a change and I think I can do this, but how do you prepare for things like this. As a new ER nurse how much help do you get with codes. I would be super nervous about a code by myself as my first event. Also, I'm trying to wrap my brain around how to transition to ER thinking.
    •  
  2. 21 Comments

  3. by   nurse2033
    Buy and read Sheehey's Sheehy's Manual of Emergency Care, 7e (Newberry, Sheehy's Manual of Emergency Care): 97832378276: Medicine & Health Science Books @ Amazon.com.
    That will help with knowledge. As for work flow, you will (or should be) oriented by a preceptor. Good luck.
  4. by   Kuriin
    Real time charting is imperative in the ER. You should be making this a habit, even on a medsurg floor. What do you think will happen if a patient comes in, stable at first, then starts having stroke like symptoms? Your charting won't be up to date and no one will know what is going on.

    Buy Emergency Nursing Bible and Sheehy's Manual of Emergency Care.
  5. by   tsm007
    Quote from nurse2033
    Buy and read Sheehey's Sheehy's Manual of Emergency Care, 7e (Newberry, Sheehy's Manual of Emergency Care): 97832378276: Medicine & Health Science Books @ Amazon.com.
    That will help with knowledge. As for work flow, you will (or should be) oriented by a preceptor. Good luck.
    Thank you! I will look into that. Not making any purchases until I know if I have the job or not, but going to put that on my list.
  6. by   tsm007
    Quote from Kuriin
    Real time charting is imperative in the ER. You should be making this a habit, even on a medsurg floor. What do you think will happen if a patient comes in, stable at first, then starts having stroke like symptoms? Your charting won't be up to date and no one will know what is going on.

    Buy Emergency Nursing Bible and Sheehy's Manual of Emergency Care.
    I know. It's just a bad habit because literally nobody I work with charts in real time. We don't have docs on staff at night so nobody looks at the chart unless you call them and it's just easy to slip into that habit. It's a really small hospital where are docs are on call at home versus on site. I'm going to start working on that ASAP and see if I can get that skill set down. It's just not been something I have made a priority to work on.
  7. by   tsm007
    Quote from Kuriin

    Buy Emergency Nursing Bible and Sheehy's Manual of Emergency Care.
    Emergency Nursing Bible was on Kindle Unlimited so I got that one.
  8. by   JKL33
    It sounds like you feel like you're sort of stagnating. If you're interested in the ED, go for it! Don't make the mistake of accepting a severely abbreviated orientation based on the fact that you're not a new grad, though. The range of what you will see down here is...well, you will see everything. So you need a proper orientation. That's my #1 recommendation as far as preparing. Purchase the text already mentioned.

    You aren't going to be Coding anyone by yourself. Although ED codes are handled from within, they still require the same medical/nursing/ancillary services as up on the floor, and similar numbers/types of people are involved.

    You need to kind of see it in action - don't worry about how to transition to ED thinking until you get there. Generally speaking, we are not trying to optimize every single problem we come across. We are sorting and prioritizing (Sickest, sick, not sick), appropriately treating and stabilizing, and trying to make a rapid decision about disposition - where is the patient going next (home, admit, surgery/cath lab, etc).

    Anyway...sounds like you should check it out!
  9. by   Ruby Vee
    Quote from tsm007
    I know. It's just a bad habit because literally nobody I work with charts in real time. We don't have docs on staff at night so nobody looks at the chart unless you call them and it's just easy to slip into that habit. It's a really small hospital where are docs are on call at home versus on site. I'm going to start working on that ASAP and see if I can get that skill set down. It's just not been something I have made a priority to work on.
    It IS a bad habit, and it's a habit that won't work well in a variety of environments. Since you know you'll need to use real time charting in your prospective environment, work hard on changing that now. If your floor tends to be slow, it should be easy to break the habit.

    I hope you're reading the ED forums on Allnurses. There is valuable information in there, and they have the funniest posts!
  10. by   nurse2033
    Quote from Kuriin
    Real time charting is imperative in the ER. You should be making this a habit, even on a medsurg floor. What do you think will happen if a patient comes in, stable at first, then starts having stroke like symptoms? Your charting won't be up to date and no one will know what is going on.

    Buy Emergency Nursing Bible and Sheehy's Manual of Emergency Care.

    Yes! There is no such thing as "later" in the ED. Keep up or you will never catch up.
  11. by   KeeperMom
    Other than keeping current on your charting, the other issue I find with floor nurses that come to work in the ED is that they aren't used to a team approach to patient care. Not saying floor nurses aren't helpful. In the ED when an EMS crew rounds the corner, a few nurses and a tech get up to help check that pt in and get him on a monitor, etc. When a code or other critical patient (non-trauma) rolls in, everyone gets up to go help.
    I also see that more people are willing to help with your other patient(s) if you get a 1:1 patient in your room. I love that I know I can count on my co-workers to help with my other patient and I try to do the same for others. I just don't see that so much on the floor.

    Another thing floor nurses aren't used to is having the physician often at the desk with you in the ED. We all become friends outside of work too.
    You will also have to learn to be autonomous in the ED. We are afforded some nurse-driven protocols that we can initiate for our patients and the docs love that we do this. It makes the LOS shorter and allows the MD to focus on sicker patients if need be.

    good luck!
  12. by   akulahawkRN
    In some ways I still feel like a reasonably new ER nurse myself. The ED was my first nursing job and the learning curve was STEEP!!! You'll also have a steep learning curve but yours shouldn't be horribly steep. You should have a pretty solid assessment at this point so your major issue will be that you will mostly do focused assessments instead of a more thorough assessment as you're used to doing now. The team approach is also something you'll also need to get used to. I'm from a Paramedic background so in some ways I'm used to the team approach and in some ways I just do things better on my own. If you get the job, get used to the idea that while you have your own assignment, pretty much everyone in the ED is your patient too, in an odd way. When a new patient comes in, I'll jump in and get stuff done, even if it's not *my* patient. Many hands make for light work and when a lot needs to be done, the extra hands make it all happen really quickly. The patient's primary nurse calls the shots, so to speak, but we jump in and get stuff done. That's how a patient goes from landing on the bed to being changed into a gown, placed on monitor and initial vitals done, IV start completed, labs drawn, and 12-lead EKG done, all in less than 10 minutes. What's the primary nursing doing during that time? Assessing the patient...

    Another thing you'll have to get used to is the pace of working in an ER. In your current role, you might get an admit or two and a discharge or two during your shift. Busy floors will see more than that, but those aren't likely your typical M/S floors. On an average day, I'll assess and discharge around a dozen or so patients and if I'm working in a "fast track" environment, double that. Doing real-time charting is an absolute MUST and only allow yourself to get behind if you have no other option. Once you have a moment, you MUST get to the charting because LOTS of other services depend upon your charting to do their work too.
  13. by   spotangel
    Go for it! It's like labor! Can't prepare for it---! Loved the experience! Will help you in every area of your life. ER nurses are a close knit group and you will make some real friends. Do not be afraid! The nervousness is good---will get the adrenaline flowing. You will get through codes. Just remember your CABs!
  14. by   amzyRN
    Be prepared to increase your workload a lot and also don't expect to get the interesting sick patients right away. Depending on where you work you might start with lower acuity patients, the kind you'd get on a med surg or tele floor except the workload greater and turn over will be much much faster. Once you have your nursing skills up to par and know the "routine" of the department then you might start to do more interesting things. Of course be prepared to help and jump in with codes and what not but don't expect it to be all trauma and codes because a lot of what you see in the ED is pretty mundane. You will see some interesting things however and the diversity of cases and the random craziness and unpredictability is what keeps me coming back.
    Last edit by amzyRN on Jul 31

close