From the floor to the ER

[turnforthenurse, MSN, NP]

For nurses who have worked the floor and decided to pursue ER nursing....how did you make the switch? What was the most difficult thing for you?

I actually never though I would be interested in doing ER. I will be honest, the first time I floated to my hospital's ER I didn't like it very much. I was still a baby nurse (like, 4 months in!) and they threw me in fast track with an LPN, PA and FNP. I was very uncomfortable. I didn't understand why they would send a brand spankin' new grad to the ER who was barely off orientation and though I would be able to function on my own. I was still trying to learn how to function on my OWN unit. With that said, I didn't think ER nursing was for me, let alone a place for a new grad to be (not without proper orientation, at least!)

A lot of time went by until I was sent to the ER again. They put me in as a "float" where I would help with discharges, administer medications, start IVs/drew labs, etc. Or I would be assigned to our cardiac/trauma rooms to help out there. I have been floating to the ER quite a bit as of late and now I always have my own section, even when they know I may not be down there the entire night (there's a good chance I will get pulled later in the night to the floor once they get full). I personally love working in the ER. I haven't worked just a couple of shifts and decided I loved it, either - like I said, I have been working there a lot lately! I get along great with the nurses and the rest of the staff, including the providers....and oh, those providers! They are so approachable, I love it. Not like some of our hospitalists and other docs. Is it like that in every hospital?

I also get along with the charge nurses, and everyone is a great resource and are nice even when I ask questions. The charge nurses have introduced me to the ER manager. I'm seriously considering making the switch from progressive care to the ER.

Sorry, that was long. Any tips/advice for transitioning would be great! :)

[AWanderingMinstral]

I'd be curious to hear from other RNs who switched from med/surg to the ER. I have been a RN (med/surg, research, insurance, and travel) for nearly six years and I'm considering switching to the ER in 2014. Thanks!

[JessiekRN]

I will admit- it was a pretty humbling experience! I've been in the ED for over a year now, after almost three and a half years on the floor. It was a tough experience to go from being a preceptor, to being precepted. I had become extremely comfortable on my unit- but quickly went from comfortable, to being bored, and felt like there was more I needed to learn. Still, I knew all the doctors, was looked up to by the newer nurses, was taking charge- so to go to the ED and wake up to the fact that I absolutely knew nothing- it was scary, I admit. I remember feeling awed by how much everyone knew. Not that floor RNs aren't amazing and competent- but I felt we were limited to the knowledge of the same conditions we saw over and over again. In the ED- you have to know a lot about everything- and be prepared for anything. I felt like I left the safety of home, and there were more than a few times that I wondered what on earth I had been thinking. Looking back now- a year later- though, I am so glad I made the move, and I don't think I could ever go back to the floor for very long. I am constantly learning. I love working with the mid levels and the MDs, and of course, my RNs. I love the teamwork and the unexpectedness and the constant fluctuation. Sometimes I miss seeing the same patients more than one shift in a row, and sometimes its so busy you are doing the bare minimum for people. But overall I'm so gald I made the switch. I wasn't sure if I could at first- I'm pretty sensitive and don't always think I'm as thick skinned as others, but you toughen up quick. Make the switch!!

[Music in My Heart]

I spent 11 months on a low acuity m/s floor before going to a small rural ED. From there I went to an ED in a somewhat larger city and finally to a large, academic trauma center.

Each new position has been very challenging but diligence and tenacity always paid off.

In your case, the transition should be pretty easy since you've already been there quite a bit.

I'm not really sure what you're asking.

[turnforthenurse, MSN, NP]

I spent 11 months on a low acuity m/s floor before going to a small rural ED. From there I went to an ED in a somewhat larger city and finally to a large, academic trauma center.

Each new position has been very challenging but diligence and tenacity always paid off.

In your case, the transition should be pretty easy since you've already been there quite a bit.

I'm not really sure what you're asking.

I guess I was just wondering about making the full transition from floor RN to ER RN. Sure, I have been there quite a bit already and am pretty familiar with a lot of things, but I'm not taking my own cardiac/trauma rooms (though I did end up with a patient in the main ER, got transferred to one of the cardiac rooms, still ended up being my patient and they ended up having a dissecting AAA ) or doing triage. Really I'm just in the main ER and have my own patients or I float around and help give meds, draw labs, start IVs, etc. in the main ER and cardiac/trauma rooms.

[emmy27]

For nurses who have worked the floor and decided to pursue ER nursing....how did you make the switch? What was the most difficult thing for you?

I spent several years on med-surg before switching to the ER. The biggest transition by far was breaking the habit of doing full head-to-toe assessments in favor of focused assessments. It felt like "cheating" at first. Other former floor nurses who started at the same time as me have made similar comments. Once I really accepted that it was not just okay but necessary, I loved the streamlined practicality of it.

It was strange to go from being a preceptor to precepted again, but my preceptor was great and the transition wasn't any scarier than any new job in nursing would be, I don't think. If you like the camaraderie and fast pace of what you've seen of the ER already, you'll probably love it full time. The people who seem to dislike the ER are the ones who really enjoy the structure of floor nursing- being expert in one set of conditions, caring for the same patients for an extended period, having a relatively stable work flow each shift. If you won't miss those things, or if you actually dislike them, you'll probably find the transition to the ER as much of a relief as it is a challenge. I did.

I can't imagine going back to the floor, even my old floor with a team of coworkers I loved, now. I breathe a little sigh of relief every time the elevator doors close on my on the way back to the ER from taking a patient up to the floor. Floor nursing taught me some great time management skills (even when I have two patients going bad simultaneously in the ER, at least I don't ALSO have six others waiting for 2200 meds and toileting for their colyte preps!) and I'll always appreciate the time I spent there, but the ER feels more like home.

[That Guy, BSN, RN, EMT-B]

Mine biggest issue was adjusting to the changing pace. On the floor, I was able to plan most of my night. You walk in to the ER and you might as well set fire to any perceived schedule you have.

But in the end, that is what I love the most about the ER.

[turnforthenurse, MSN, NP]

Awesome! Thanks for the suggestions, everyone!

What about any tips with dealing with peds? Especially when it comes to having to draw blood or start an IV? I was in the ER again last night (yay!) and the provider ordered a line to be placed along with some labs on a 4yo. We always try to draw the labs off of the IV line so that the patient will not get stuck twice. One of the ER nurses asked if I was ready to go poke that kid and I said absolutely not, I'm just NOT comfortable with poking kids with sharp objects I think my biggest fear is that this will make them cry and then I become an enemy afterwards. So how do I get past this?

Also, I realize all ERs are different, but is there always a certified mental health nurse (or whatever the official title is called!) who takes the behavioral rooms?

[One1, BSN, RN]

We don't have mental health nurses in our ED. We have a trauma, a med, and a psych section and all staff RNs are able/assigned to take any of these areas. Regarding the kids: always have another nurse help you keep the kid still, go in gentle with the needle and advance in tiny bits if you are not hitting the vein right away so you don't accidentally blow it.

[emtb2rn, BSN, RN, EMT-B]

Same setup as one1, you can work any section in our er. That's part of the fun.

With kids, numb them if it's not an emergent stick. Emla cream or fluoro ethyl spray. Also use distraction, music, a held up smartphone with a colorful picture. And tell them they're doing great.

[Music in My Heart]

We have no special psych nurses - we all do our time with the crazy people.

It's like paying your dues to pull the trauma room ticket.

[VICEDRN, BSN, RN]

There are multiple threads that pose the same question. Try using the search tool at the top right. It may help you get a few more insights. ;-)