Goodbye, PACU! Hello, ER! Any tips?

DudeNurseRN · Oct 12, 2007

Sure. You should plan on it being hellishly busy or very slow.

It's Cowboy/Cowgirl Medicine:

You and the MD's quickly assess the patients to figure out what the biggest problem is, give them treatment to get the patient stable, and either send'em home or send'em upstairs. Lots of folks with chest pain, a fair amount of folks that have trouble breathing, a few that have broken bones, quite a few that have minor things like cuts, some drug seekers, some psych patients, and the majority of your people are going to be your average joe(or josephina) using the ER as the Dr.'s office (I have a cold, I have the flu). And depending on your Trauma (I,II,III) status, you'll get the occasional gunshot wound and so on. But that's pretty much it in a nutshell.

You get to see a lot, but typically you don't get to talk a lot with the patients. You gotta get'em in, get'em stable, and move'em incase you have somebody critical coming in (which you will).

Gotta be on your toes. But it's goodtimes if you are all about fast-paced nursing.

brissie · Oct 12, 2007

Just remember.....stay lookin good.

allnurses Guide · Oct 12, 2007

I just started in a bigger city ER after working for 6 years part-time in a rural ER (9 total years as a nurse doing med/surg, OB, etc.).

I have to say there is too much paperwork. I don't like the flow of how things work so far . . .maybe I'm too new to make that judgment. The nurses have to copy the ER chart if the pt is admitted (in our rural ER the EMT's did that) so if you have a patient needing to be admitted and another patient is crashing and the ER really needs the bed cleared . . you are IT. ER is total patient care - vital signs, EKG, up to the bathroom, etc. If I have time, I take the patients to the floor they are admitted to because transport is so busy.

I think the folks I'm working with assume that because I worked ER in a rural area, I am ahead of the game. But I disagree. It really is new to me.

I miss the time spent with patients . . . other posters are right, you don't have a lot of one on one time with them. Had a man bring his wife in the other night - early Alzheimers - he has no respite care - I didn't have time to link him up with agencies .. .I felt awful.

I really want to get good at this . . . . It is only week 3 . . .

I wish you luck.

steph

flychick08 · Dec 20, 2007

Well today is my last day as a PACU nurse. Monday I start in the Emergency Room. Just wondering if anyone has any insight on what I'm getting myself into.:uhoh21:
Thanks!

Just saw this thread...sorry it's 2 months out. I've been in ER nursing for 3 years and have some friendly advice:

1. Trust your gut. As a paramedic friend once told me "if it doesn't smell right,look right,feel right, it probably isn't right"

2.Don't let the docs bully you. Your first few months they might try to do this, until you pull their butt out of the fire on something big they missed on a pt. and then they're good to you. When they give you crap,toss it right back. They'll respect you more.

3.Listen to your patient. Often times they will blurb out something seemingly small that turns out to be the key to their diagnosis.

4.If someone comes in with a migraine, back pain or tooth pain and refuse toradol,compazine,reglan,benadryl,ultram then they are probably a seeker. The clencher is if you ask them what usually works best for them and you get "It begins with a D. Hmmm...demerol,dilaudid?" Yep, you just nailed yourself a seeker.

5.Find a few mentors.Nurses who have been there awhile and still have some jump in their step;paramedics are good resources too. They have great assessment skills and are on top of their game when something ugly rolls in. When the rest of us are spinning like tops, our paramedics jump in and get a handle on the big picture.

6.Remember that no matter how bad a day it is, it's only for 8,10,12 hrs. or whatever you're there for. Go home and think about something good you did on that shift that made a difference and what you've learned today.