transitioning from floor nurse to ER

JessiekRN · Aug 3, 2012

Hi! I moved to the ER in February after three and a half years on med- surg. I am so glad I put my time in on a ms floor before moving to the ER- I feel I came prepared with a basic skill set, knowledge of medications, time management, communication skills- I give the nurses who come into the ER as new grads props because I can't imagine having entered the ER as a newbie. Honestly I don't know if I would have made it. Also because I switched into my own hospital's ER, I had the advantage of already knowing many of the hospital's physicians, pharmacy system, etc. That said, however, I do think in some ways I have had to train myself out of many "floor nurse" habits. Like a lot of the hygiene care, pampering, etc- sometimes that just doesn't happen in the ED. Also it's a VERY different sort of prioritozation skill set that you need and although I thought that would come instinctively- it didn't. I'm a people pleaser by nature- I had to get used to the idea that I wouldn't be able to please everyone all the time, and the lady screaming that she needs a sandwich is not anywhere near important as the PE patient that needs their heparin- u need to think critically and prioritize accordingly, something you are not always required to do on a floor full of relatively stable patients. Anyway I hope this helps and made sense. Good luck- !!

CrashED · Aug 3, 2012

I moved to the ER almost 3 years ago with a background in General Surgery, Vascular Surgery, Urology. (And before that had worked Neuro and Rehab nursing). I found the transition was overwhelming at times, but it was the best thing I ever did. The first thing that shocked me was the sense of autonomy that you do not get from floor nursing. (especially floor nursing where all your MD's are surgeons!) Emergency nursing is a different kid of nursing from any other speciality, you do not have a care plan to refer to or order set, you do not have the ability to open a chart and find a history. You have to do your own dirty work, and figure out the problem. You need to learn to trust your own assessments, grow a thick skin because unfortunately working with the community can be a challange as some people are not as nice as others and learn to prioritize. And with your background you still remain somewhat specialized bc your collegues may turn to you for the wierd and wonderful tricks of gensurg!! Unfortunately it may make you the post-op-comp, woundcare, ostomy,catheter, ng and Chest tube queen... but for nurses that went to the ED as a newbie they don't have near the experience in those skills as we do seeing just that on the floor! They are great skills to have and I do not know how people go to the ED As a newbie! Good luck in your adventures to the ED! I hope you love it!!! It is an amazing place to work, there is always something new to learn and new to see!

danggirl · Aug 4, 2012

Ditto regarding the other posters. I worked for 13 years in various med/surg/tele units before moving to the ED. Because I had my ACLS I was asked to float down to our ED one day and I was hooked. The pace is definitely more rigorous. Prioritization, time management, strong assessment skills, and strong critical thinking skills are a must. Starting in a familiar ED would be helpful because you wouldn't have to worry about learning the basic logistics/physicians/general hospital policies in addition to ED stuff. My biggest obstacle was confidence in myself to handle the "real" emergencies since on the floor it had always been the ED nurses to the rescue! The other biggie is, as crashED wrote, practicing in a more autonomous role. Generally there are protocols for particular presentations such as chest pain or shortness of breath and standards that must be met (think JCAHO, CMS, etc.). Some things that are really cool: having a doctor there all the time at whom you can toss queries, a team of nurses with different strengths and backgrounds, rapid patient turn-over (mostly) so if you clash with the pt/family in room 12, 9 times out of 10 you aren't stuck with them for days on end, the ability to make a suggestion regarding your patient's treatment and (mostly) having it listened to by the physician, exposure to a never ending variety of problems (and a never ending source of humor).

It is not easy and it is not routine. Some nights go on forever and some nights you will feel like crying or cursing. "lunch break" and "bathroom" become exotic terminology. Some of the floor nurse will treat you like a hostile, mortal enemy.

On the other hand, it can be one of the most amazing jobs on the planet! You can save lives or greatly impact them every single shift. You will learn skills (such as IV starts) to an incredible degree of proficiency. You can learn what it really means to work with a team and trust your co-workers on an entirely different level. You may not have the opportunity to give every patient warm fuzzies but you will see sides of humanity (and your community) in a very different light.

Your background in med/surg is a great foundation and the transition for you should not be "difficult" per se. You'll find that you know a heck of a lot more than you think you do! Good luck to you! I too hope you find it exciting and rewarding and that you enjoy it as much as I do!

brainkandy87 · Aug 5, 2012

If you're motivated enough to do it, you can do it. You have experience in a wide variety of areas, so that will definitely help. However, ER nursing is unlike any other type of nursing. You have to prioritize far more than in any other field of nursing. You can have four critical patients all at once. You must prioritize their assessments and interventions, as well as getting those things done in a timely manner. The name of the game in ER is treat em and street em. We aren't here to hold patients. Never plan on that happening. Does it happen? Yes. But your plan of care for that pt should be stabilizing and moving, whether it's to the floor or out the door.

It can be a rough place to work.

You'll have days where you feel completely out of your element and that you're in a hole you can't crawl out of. In one shift, you'll see the entire spectrum of the patient population, from peds to geriatric. You have to be prepared for everything that can happen and take care of everything that has happened. Sometimes you'll just look at your orders and struggle to find the willpower to complete the daunting task in front of you. You'll have patients that cuss at you, question your competency, and even try to swing at your head. You'll have doctors that treat you like you're inferior, you'll have nurses that treat you like an outsider, and you'll have patients complain about you.

But then, you'll have those days where you're on your A-game. Those days where you can do no wrong. You hit every vein the first time, catch something before the doc does, and have your intuition lead you to saving someone's life. You'll have patients and their families give you a heartfelt thank you and give you compliments you thought you'd never hear. You'll have doctors trust your abilities and know that when you're taking care of their patient, they don't have to stay on you to get that patient taken care of. You'll have other nurses help you out and develop a camaraderie with you that you can always count on.

No matter what day you're having in the ER, you must do this: always move forward. At the end of the day, no matter what day I've had, I alway love my job. This is an area where you love it or hate it. And to be successful, you must love it.

Ryan RN · Aug 14, 2012

My best advice is to use your current knowledge from medsurge as stepping stones into the ER... Nothing worse than having a new ER nurse act like they know everything in a completely new environment. Im not saying act like a dummy, but show your new coworkers you are willing to take in what they teach you without "correcting" them. Certain things are done differently in the ER as you will soon find out.

Also, getting your CEN will help show your new dept that you know what the heck you are talking about. Even if you dont have the "years of experience", getting that cert alone will help you gain knowledge that would otherwise take you years to figure out.

sukh :), BSN, RN · Nov 18, 2015

I have been reading your thread. just wanted to ask something, i have been a mother baby nurse for 5 + years. Now I want to change to ER or ICU floor nursing. What can I do so that i can achieve my dream of working in ICU/ER? I will be very thankful for any advice.

danggirl · Nov 22, 2015

Is this a newer question? Sorry, I haven't been on here in quite a while and was just wondering if that is November of 2015! The great thing about nursing is that you CAN go from specialty to specialty with some training and orientation. For the ER particularly, you will have skills obtained in your current specialty that will be immediately applicable. Getting into the ER/ICU can be a matter of who you know in some places or a matter of the willingness of HR and the unit to make an investment with all the required training and orientation. Anyway, if it is something you are seriously considering you may want to see if you can do a tag along for a shift to see if it's what you think it is! Make it happen: talk to the HR department and/or the director of the unit you are interested in. Good luck to you!