Any advice for a floor nurse making the transition to the ED?

Specialties Emergency


After paying my dues on a med-surg floor for a year, I will be moving to the ED in about 6 weeks. I observed there and absolutely loved it. But I know that it's completely different from floor nursing. (I'm used to carrying around my clipboard with all my notes on it, but no one down there had one - yet they all seemed to know what was going on). Any advice would be greatly appreciated.



Dixielee, BSN, RN

1,222 Posts

Specializes in ER.

You don't need to completely throw away the clipboard. Everyone doesn't, but I write down what is said to me in report about the patient. Little things, not huge info, but if the patient has gone to CT, if the blood is drawn yet, if they responded to pain meds, etc. It only takes a minute and when I get report on 6 people I don't know and maybe will only know another hour or so, it is nice to have some info available. Maybe some just have memories like a steel trap, but after 31 years of doing this, the trap is a little rusty sometimes. It also depends on your specific hospital, but I like to keep my nursing notes on my clipboard and not on the main chart, because the doctors get the charts and dissapear wiht them leaving me no way to chart vital signs, updates etc. This is especially true when residents or attendings get it...I think they go to a black hole somewhere, write 100 Stat orders, hide the chart, then ask why they were not done 10 minutes ago!

One thing you will do over time, and it will take a little time is to learn to think in the here and now, not necessarily in the far future. You generally are there to address one or two emergent problems. You will have patients with multiple long term problems, but you can not get bogged down in all of them. Take care and address the one that brought them to the ER in the first place and leave the rest to the PCP at a later date. Same for psych problems. Address the main problem, you can not cure in a day what has taken a lifetime to develop.

My favorite patients are ones that you can actually "fix" in a day...i.e., lacerations, kidney stones (usually), asthma attacks, MI's (maybe not fix, but at least keep from dying and get them to the cath lab, surgery, ICU, etc. in one piece!).

You will find your own ways of coping, but focus on what you can do and not what you cannot. If you look at the big picture on everyone, you will make yourself crazy. Don't be as concerned about I/O as you are just that the patient is voiding. Don't worry about just one high blood pressure reading, look at the the patient in pain, anxious, etc? Probably, they are in the ER you know. Be aware that there are people who will take advantage of your kind heart and willingness to serve. You will harden yourself a bit over time, but don't let it color your life too much. Most folks appreciate you, they are just in a bad situation when they come to you.

Treat EMS with the respect they deserve. You don't know what they have had to deal with just to get the patient to the hospital. Don't get too bent if the IV is not where YOU would have put it or the patient report is not "complete". You will have more time to gather info later. If not, that is what they do on the floors, right???????????

Don't be intimidated by the doctors. You will gain their trust and they yours after a while. You will work with the same group generally and a real bond will be forged.

Most of all, remember, we all have bad days, and don't take it personally. If someone is short with you, let it roll off, and get on with your own business. Life is too short to worry about it. Enjoy your new adventure, you will never be bored.


272 Posts

Specializes in ER.

Take any order that you expect to have at work, and forget it. There is no order, no way to tell EMS to "circle the runway" or "North Adams is a mere 21 miles away", and the waiting room fills faster than the patients leave.

But, you know what? I wouldn't work anywhere else (except maybe an ambulance again)!



237 Posts

Specializes in emergency nursing-ENPC, CATN, CEN.

Chip and Dixielee have excellent advice. I'll add and repeat asI havebefore. - ED nursing is a GREAT place-every day is different-some will be HORRIBLE. It is YOUR responsibility to make yourself an ED nurse-not your preceptor's or mentor's- they're going to show you the ED routine, make sure you're providing safe care. Join ENA- go to the meetings, read the journals- get ACLS, PALS, Trauma education ( trauma can be very ambulatory and just walk in- trauma pts sometimes don't check at the door if you're a trauma center) and more pediatrics!!! Show initiative- go to the codes-even if only to observe- expose yourself to as many situations as you can--LEARN!! ED nurses are typically jack of all trades and masters of many- you will be doing ICU level pts next to pediatrics next to gynecology, next to ortho--- you have to be able to think on your feet, switch hats frequently and function in organized chaos.

Good luck

ED nursing is exciting



40 Posts

Thanks for the advice everyone!


Specializes in ER, ICU, L&D, OR.

Pray a lot

Golf a lot

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