Med/Surg to ER?

Specialties Emergency

Published

I've been a med/surg RN for 7 years and lately have been thinking about working in the ER.

I've gotten to where I can assess a patient just by walking by their room. For instance I was walking by a room and noticed a pts breathing. (Not my pt). I was watching him breathe when his doctor walked in the room. He asked me if I was his nurse. I told him no I was just watching him breathe. The doctor listened to him with his stethoscope and said "he's fine". So I went about my business. But came back to the room. I counted his rate for a full min. then got the tech to count it also. RR where 8. The pts nurse was on break by this time and I was covering. I called the doctor and got an order for narcan.

Or when a new admission is being wheeled down the hall. I'll pay attention to them and look for signs of "distress". Do they look uncomfortable, stressed, or in pain? If so I'll walk in the room and say hi. And do a visual assessment. Even if it's not my patient. I'll try to get them stable. SOB-O2, Pancreatitis-Fluids/pain med, ETOH - Ativan/Librium.

I pay attention to what the patient tells me. For example a pt in broken English/Spanish tells me that she is having trouble seeing. I tell the doctor and he goes in and does a FULL assessment. Turns out she had a stroke. This was after a full day of calling the doctors because I thought something was off about her. But I thought she was going septic.

My whole thing is I don't do codes! I want to address the problem before it gets to that point.

Examples I've seen other nurses do...pt says they can't breath after an egd. Was on RA now on 5LNC O2. Nurse says ok and turns up O2 to 6L.

Im screaming in my head(NO!!! WTH!! Call the doctor, this is not ok!!)

I nicely tell her she may need to do something.

Or when I had a pt that I was worried was getting septic. She was becoming more and more lethargic. I asked the charge if I should call a rapid. The charge tells me "she's ok. She wakes up with stimulus. She's not unresponsive"

Im beginning to think I'd do better in the ER. I'm a veteran and I think that's why I'm always on alert for problems. In my mind the littlest thing can quickly become a big problem. (Ex. Pt c/o leg pain and feeling "off" after two wks admission. No labs in 4 days. Got orders for labs. K was 2.2. EKG showed pt was now in a fib)

I picture the ER being more like this. Where the nurses are more problem solvers.

Gary Mendoza

84 Posts

Specializes in Emergency Department.

Nicole, those things that you describe doing are what every nurse should do imo. However, from what you're saying I think you have good potential for being a good ER nurse, but ER is much more than those things. It's completely different and I've seen many nurses, from many different areas (especially ICU), think they wanted to be ER nurses, but once they got down there they hated it. I would say about 80% of nurses that come to the ER dislike it because it's radically different than any other kind of nursing. I've heard it best described as organized chaos. If you need structured, organized and neat ER is your worst nightmare.

I would suggest you shadow in the ER for a few shifts, in a busy ER, and see what you think before making the dive because once you get transferred it might take some time to get out; you might be miserable for a while if you don't like it.

JKL33

6,768 Posts

My whole thing is I don't do codes! I want to address the problem before it gets to that point.

I also think you should shadow in the ED. You have some skills and a mindset that would be very useful down there. This ^ being something you'll have to come to terms with of course - not necessarily the codes as much as the fact that patients both roll and walk in with "rapid response" types of complaints all day long ;)

On the other hand, people also come in all shift with potentially concerning complaints and then those are ruled out. That's the real trick. All of these people who feel "off" or have leg pain/stomach pain/chest pain/headaches...those things you are used to having "become a big problem?" - - it turns out they AREN'T a big problem a lot of the time. You'll have to get used to that.

Nurses can and should be (and are) problem solvers in many different areas. But it sounds like you may be ready for a change.

If/when you come to the ED, you probably won't feel much like a veteran any longer. But that's okay.

allnurses Guide

JBudd, MSN

3,836 Posts

Specializes in Trauma, Teaching.

Did you mean veteran as in military? I can see where that would lead you to being on "high alert" all the time. On the other hand, those kind of observation skills should be routine for all nurses, it is what what we do (ADPIE!).

If ABC is compromised, call a rapid. Since you had time to consult your charge, you had time to intervene in other ways than a full rapid response. Don't use a sledge hammer where a flyswatter will do :)

The biggest change in coming to the ED is the mindset: no longer can you map out a day of getting things done throughout the shift, everything tends to be a now thing. Setting priorities shifts a lot. We tend to respond to most things ASAP or STAT, just to get people in and out faster. Picking up on the little things can sometimes get lost in the rush, but with experience those red flags do go up. We also tend to discount a good bit of the drama we are presented with, how much is histrionic and how much is real? Assessment helps a lot there too. Uncomfortable vs.distressed? doesn't usually get narcs and ativan.

I agree with the PPs: go shadow a bit in your ER.

Specializes in ER/trauma, IV, CEN.

My whole thing is I don't do codes! I want to address the problem before it gets to that point.

OP, if you want to be an ER nurse, you will do codes. Some patients are brought in coding, or will shortly after being brought in before we have the chance to act. You don't always have the chance to address the problem before hand with true emergencies. I agree with the other posters, many come to the ER and are not ready for the organized chaos. If you need control and being able to prevent problems, the ER may not be right for you. We specialize in damage control.

Specializes in ED.

I agree 100% about shadowing in the ER. I've seen a lot of floor nurses and OR nurses come down to the ER and thing he/she can hang but end up hating it. It is not only a different mindset but also a different skill set. A few ICU nurses have come down and we find they do pretty well but it is an adjustment. ER nurses work autonomously most of the time but also know when to ask for help and team environment. I pick up shifts on the floor every now and then and it is vastly different. The pace, the teamwork, the charting, the skills... it is all very different. On the floor, we start our day kind of busy with assessments, morning med pass and some charting which can be time stamped hours after it actually happened. Not true for the ER. There's also hall beds. You don't get these on the floor. And not knowing what's coming through those ambulance doors sometimes is overwhelming. By the time that patient gets to the floor, often the hard stuff is done and we know what's wrong with the patient. One thing I've found that floor nurses have a hard time with is prioritizing patients and what to do for the patient. For example, in our ED, a priority 1 or 2 pt has to travel with a nurse so going to Xray or CT takes that nurse off the floor for a while. A MRI of the head could take about 45 minutes. What about your other patients? It can be very overwhelming for new ED nurses. What about when that full arrest rolls in or your all appearing stable patient crumps while you are giving some IV meds? It happens. What about the GSW or overdose patient that is dropped off in the parking garage / front lobby of the ER? Can't tell you how many times I've dragged a lifeless, incontinent, aspirated body out of a car with my co-workers.

I don't want any of this to discourage you at all but rather to prepare you for what lies ahead.

With all of the bad, my co-workers are my family and I've seen my family do some f@cking amazing things!!!! I wouldn't trade it for the world.

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