[cardiacRN2006]

Hey there folks! I'm a new ICU nurse x8 months, and have been given the opportunity to cross train into the ER. I'm very excited, and truth be told, I know I will eventually be an ER nurse anyway. I was an EMT before, and also worked in the ER as a PCT.

Of course, it's a whole different story as a nurse.

So, what do I need to do to be prepared?

The meds should be the same, right? Procedures such as line placements, and codes should be similiar?

I could use some advice!

[Altra]

Some of the changes will include:

1. the variety of patients - you'll have a vented stroke patient next to a vag discharge

2. the sheer number of patients

3. increased family presence

4. the lack of detailed info on patients - we typically give report on 3-5 patients in no more than 10 minutes tops

Come on down -- hope you love the ER!

[TazziRN]

Also, be prepared to focus on the problem.......you do not need to do a head to toe assessment on the person who comes in with an infected hangnail. Codes are run the same but the lines will be different in that there will be more things like Abx and not so much in the way of cardiac maintenance. You will have to move way faster than you're used to.....get 'em in 'n out as quick as you can, because there are 15 other pts waiting for a bed.

[CritterLover]

I did the same thing -- had worked in ICU for years, then cross-trained to the ER.

Well, I no longer work in ICU, and really don't want to go back.

The weirdest thing for me? Discharging patients. In the begining, I double and tripple checked to make sure I could really let the patient go! Sounds so weird now, even as I am typing this. But I remember thinking "It can't be this easy. You just have them sign a paper and off they go?" I had never discharged a patient before I went to ER.

The sheer turn-over takes some getting used to. When I had a busy night in ICU, I would save my charting for the end of my shift, sometimes not even opening my chart until I had reported off in the morning. Can't do that in the ER. At 7am, you might not even remember what that patient you had at 8pm looked like, let alone what their breath sounds were like.

The "routine" codes on the DOAs were different. It isn't like in ICU where you see the code coming (hopefully). People will be brought in by ems, and chances are, if they were asystole when the paramedics got there and stayed that way after treatment in the field, they don't have much of a shot. A few rounds of drugs, and the docs will usually call it.

And of course, as you've surely read here a thousand times, after working with critically ill patients for most of your career, the piddly crap that some people will come in for will truely amaze you in the begining. And it takes a while to learn to not show your surprise on your face.

Then there are insurance issues when the patient has to be admitted and isn't critical. Insurances, esp HMOs, want the patient going to an in-network facility. Unfortunalty, many patients don't get that concept, and come to the closest one. Once insurance info is finally collected and the doc decides to admit, it becomes a game of "lets find a bed at the appropriate facility" if the patient is out-of-network. If things are the same in your area as when I lived there, you have the added "joy" of medicare HMOs. At least around here, anyone with medicare was in-network at any facility. But people who have medicare HMOs have facility restrictions, just like other commercial insurances. Same for AHCCCS. You might think that this shouldn't be the nurses' problem. Well, it shouldn't be, but it often is.

Good luck!

[bill4745]

After 10 years of ICU, I made the switch and love it. I still get some critical care here. But I love the variety and the need to think for yourself, instead of having an order for everything. It can be a very fast-paced, crazy environment; you may find that you form much stronger bonds with your co-workers in the ER-I guess it's the shared stress. One difficult adjustment is that you rarely can do a complete head-to-toe on your patients-you often look no further than their complaint.

[cardiacRN2006]

Cool! I'm wondering what I'm allowed or even encouraged to do on my own.

Say a chest pain pt comes in. Am I expected to do the 12 lead, iv, and nitro, O2 prior to the dr getting there? Do you have standing orders per se?

[NicoleRN07]

ER is very different, but it's different in a good way. You'll probably have more patients that you are responsible for, and it is a much faster pace. You have to be prepared for just about anything that rolls through the door. It's exciting and lots of fun. As far as what you can do on your on, it depends on your standing orders, and what you feel comfortable with. Once you have developed a trusting relationship with the doctors, they will pretty much trust your judgement, at least the doctors do where I work. You will learn their limits. For example, the doc who usually works nights with us pretty much allows us to order whatever labs and meds we want before she sees the pt, but we always let her know before we do it.....sometimes she'll say, let me just see them real quick, or that's fine. There are other docs that I wouldn't even order labs for, much less meds. So, what you can do, depends on your standing orders, and your docs. Most of our docs hate the standing orders and prefer that we not use them unless it's just Tylenol/Motrin for fever. ER is a wonderful, different world!! HAVE FUN!!

[nursebrandie28]

Originally Posted by cardiacRN2006

Cool! I'm wondering what I'm allowed or even encouraged to do on my own.

Say a chest pain pt comes in. Am I expected to do the 12 lead, iv, and nitro, O2 prior to the dr getting there? Do you have standing orders per se?

Yes and No, you will be expected see that all of that is done, however, techs, EMTs, and tech (support staff) might do the EKG and O2 while you get the IV and get the NTG out of pyxis. This is all depending of course, if you have support staff.

And yes, most hospitals have chest pain protocols like

EKG in 5 min
O2, IV, NTG, MOS04 and ASA

and an easy pneumonic is MONA

M = Morphine
O= Oxygen
N= NTG (if BP is over 100 systolic)
A= ASA


does this help?