Advice ER nurses...please

texaschic888 · May 14, 2008

thanks for all your advice!!! i think i just might jump into the er and see for myself!!! i think i will do the shadowing bit too!!! thanks again!!!

s1716698 · May 29, 2008

hi, i had 4 years in a medical ward and am now working in ed, but we are all different . i dont think ther are any hard and fast rules, follow your passion and be teachable

:yeah:regards s1716698:yeah:

helloworld · May 29, 2008

Like the rest, I say go for it. I started in the ED right out of nursing school three months ago and i am about to come off orientation. I can't even describe the magnitude of what I have learned in just three months. Like someone else said, it IS a crash course in time management and prioritization and delegation, we do occasionally hold a lot of medsurg and ICU pts because of lack of beds, and so we do a lot of floor nursing too. You see all patient populations, from peds to geriatrics, and all pt problems, GYN, Psych, trauma, minor injuries, codes, etc.

It's not for everyone but you won't know till you try, so by all means, go for it!!

Good luck to you.

mwboswell · May 30, 2008

Another thought on "pre-ER" experience....

I still to this day do not understand why critical care experience is "preferred" for an ED nurse?

I mean when you look at the total ED volume and the c/o they check in with...what's THE MOST COMMON complaint for an ED visit: Abdominal Pain!

How many abdominal pain patients required ICU level skills?

Sure there may be a few AAAs out there but for the most part it boiled down to general medical/surgical caliber patients.

I do not have absolute numbers, but the overall number of "critical" patients that come in is a much smaller percentage of the total ED population and thus, I argue, critical care skills not necessary.

I believe (such as we do in my ED) that a new grad or even a xfer from med-surg, starts in our Intermediate ED; you know, the run-of-the mill stuff; the bread and butter: the abd pains, the pelvic pains, the minor trauma, the asthma pt's, the "walkie talkie" MVC's, the headaches and the N/V/D patients. This is a GREAT place to start - it is really more of a generalist role than anything.

I didn't even say start them out in "fast track". Fast track (FT) is a unique population set. FT is where your management skills are MOST in demand. Knowledge of splinting/crutches, different antibiotic injections, basic wound care and LOTS, LOTS, LOTS of patient education. the sheer numbers of pt's you'll see going through FT is staggering compared with the number of rooms you'll turn over in the intermediate ED unit or even the critical care unit or chest pain unit.

helloworld · May 30, 2008

My experience in my ED during my orientation has been that we see a tremendous number of critical care patients. As you say, there are a lot of routine med surg cases but I would definitely say the number of critical care cases is not small by any measure. My ED hires new grads, but all of us have to go through ACLS, PALS, and critical care and trauma classes before the end of our first year. Even while on orientation I have had critical care patients, and I have seen nurses who are six months out of nursing school having the critical care rooms assignment with intubated patients, pts with a-lines, and lots of drips. We also get a lot of ped traumas and codes. The experienced nurses will usually back you up wonderfully if you have that assignment but I can see why critical care skills are needed and desired.

Another thought on "pre-ER" experience....
I still to this day do not understand why critical care experience is "preferred" for an ED nurse?
I mean when you look at the total ED volume and the c/o they check in with...what's THE MOST COMMON complaint for an ED visit: Abdominal Pain!
How many abdominal pain patients required ICU level skills?
Sure there may be a few AAAs out there but for the most part it boiled down to general medical/surgical caliber patients.
I do not have absolute numbers, but the overall number of "critical" patients that come in is a much smaller percentage of the total ED population and thus, I argue, critical care skills not necessary.
I believe (such as we do in my ED) that a new grad or even a xfer from med-surg, starts in our Intermediate ED; you know, the run-of-the mill stuff; the bread and butter: the abd pains, the pelvic pains, the minor trauma, the asthma pt's, the "walkie talkie" MVC's, the headaches and the N/V/D patients. This is a GREAT place to start - it is really more of a generalist role than anything.
I didn't even say start them out in "fast track". Fast track (FT) is a unique population set. FT is where your management skills are MOST in demand. Knowledge of splinting/crutches, different antibiotic injections, basic wound care and LOTS, LOTS, LOTS of patient education. the sheer numbers of pt's you'll see going through FT is staggering compared with the number of rooms you'll turn over in the intermediate ED unit or even the critical care unit or chest pain unit.

mwboswell · May 30, 2008

My experience in my ED during my orientation has been that we see a tremendous number of critical care patients. As you say, there are a lot of routine med surg cases but I would definitely say the number of critical care cases is not small by any measure. My ED hires new grads, but all of us have to go through ACLS, PALS, and critical care and trauma classes before the end of our first year. Even while on orientation I have had critical care patients, and I have seen nurses who are six months out of nursing school having the critical care rooms assignment with intubated patients, pts with a-lines, and lots of drips. We also get a lot of ped traumas and codes. The experienced nurses will usually back you up wonderfully if you have that assignment but I can see why critical care skills are needed and desired.

There's an easy answer, pull up your ED census for a particular month and run the numbers:

a) Total patients into the ED

b) Total pt's admitted to "critical care"

c) Total pt's admitted to "non critical care"

d) Total patients d/c'd to "home"

B, C and D should be about approx 10%, 20% and 70% respectively.

See how your numbers compare.

al7139, ASN, RN · May 30, 2008

Hi,

Im my opinion, I think it boils down to two things for a new nurse:

1. Does the ER have a really good orientation program for new nurses?

2. How do you personally handle stress, organization, and new situations? Specifically...are you in your element when you are confronted with a major situation, or do you learn/perform better in an environment where there is not so much pressure to make immediate decisions, and have time to think things through?

I have been a nurse for 1 year. I originally thought that I would like to go right to the ER/Trauma after school. I have the personality for it (assertive (some would say aggressive) and confident), plus the added experience of a medical background in Veterinary Emergent Care (it really does apply to humans too!) for 16 years prior to my career change.

I realized in my last year of nursing school, that while I have the knowlege, the application can be very different. I do handle stress well, and am at my best in chaotic situations, but I realized that to really be a great nurse, I should start out slowly, and gain confidence in dealing with patients, doing procedures, etc, where there is less pressure to act immediately.

I am glad that I chose to work on a telemetry unit where I see a wide variety of pts, am constantly challenged, and have situations where I can learn what to do without (usually) the chaos of an ER.

I have floated to the ER several times, and enjoy it, but it really reinforces my decision to wait awhile, and gain experience before taking an ER position. This way I already have the real world nursing experience to bring to the ER when I do get there. This is working for me, but other people may be able to do it as brand new nurses. There is no right or wrong, just what you can handle.

Good luck!

I hope you find that you love it and do well, but don't be afraid to change your mind if you realize it's not for you.

Amy

helloworld · May 30, 2008

There's an easy answer, pull up your ED census for a particular month and run the numbers:
a) Total patients into the ED
b) Total pt's admitted to "critical care"
c) Total pt's admitted to "non critical care"
d) Total patients d/c'd to "home"
B, C and D should be about approx 10%, 20% and 70% respectively.
See how your numbers compare.

Regardless of the ratios or numbers, the fact that we do have an appreciable number of critical care cases EVERY single shift that I have worked means that critical care knowledge and experience is desirable. Bear in mind that I am a new grad here, and I am feeling I need to take some critical care classes ASAP so I am better prepared. I didn't come to the ED with any critical care experience except what I learned in school, but even from my position as a brand new nurse I can see why the job description read "critical care experience desired/preferred". They still hire new grads, and nurses with no critical care experience, but they train us and make sure there are critical care experienced nurses on each shift.