biggest challenge in ED transition

Specialties Emergency

Published

as my internship is nearing to an end in the ED, as once a floor nurse I can say that I'm enjoying all the learning I get to do and the ED experiences I get for future career. I thought that the biggest challenges in ED would be something like learning how to handle and chart on critical patients like intubation, code stroke, blues, and such, but nope. The biggest challenges is that I simply cannot do things at the pace I used to do at the floor.

On floor, things can pretty much plan itself out. Meds passes at 2000, finish for all 6 pts at latest 2130, occasional pain meds or prn bp meds here and there, then sit around the desk for awhile, get new admission from ED and work on it for about 30 minutes, and sit around for a while. At the floor, if things hit the fan, it's on one pt, so while the other 5 is stable and has had their meds and sleeping, I can work on the one that's going down.

ED has been a whole different animal; there is no such thing as pace or plan. if they keep coming, they keep coming and don't stop. It irks me that I am doing work up on one pt, then walk out and see my other 2 rooms already filled up in last 10 minutes, and it's worse if one of them are EMS pt. Pts are literally shoved down the throat and orders are on all of them, but I am only one body, I can do only one thing at a time!!! This is where the floor nurse dilemma breaks in. We are so used to doing things on the time and on the pace that when I get behind, it bothers the hell out of me that I can't get things done.

This has been causing me a hell lot of stress lately, but I need to work on it and say screw it! I'm only one person and there's no help. I can only do one thing at a time, and the other less important things, they can wait their turn.

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Specializes in Med-Surg, Emergency, CEN.

Hopefully you have supportive colleagues who can help you out. Ask the charge nurse "I'm drowning over here, can you please send someone to help for a few minutes?"

Most likely, charge didnt even know you were struggling because no one told them. Also, there is no shame in asking your coworkers directly for help. Did you ever think badly of someone asking you to just get an EKG or something? Of course not!

Good luck! Let us know how it's going and if it gets better.

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Specializes in Emergency Department.

Ah the joys of ED. I agree with NurseOnAMotorcycle, ask for help.

There is so much that is new and as you have found out - it doesn't stop. Occasionally it slows a little.

One of the attractions of ED is that there is no set routine, you work what comes through the doors and the patients set the day.

It becomes slightly easier with experience.

Good luck.

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Say it with me, all emergencies are not emergencies!!

Yes it's busy. If they are breathing, have good vitals and are not in distress, don't distress yourself over it.

If you have stable peeps and an arrest rolls in and then a stroke, chances are, the stable people you have to ignore for 1-2 hours are still going to be stable. :)

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Nearly always you can find 5 minutes to lay eyes on the new patient, get 'em on the monitor, and discern if they're stable.

If you've got multiple unstable patients, you need help... no ifs, ands, or buts.

Prioritzation and reprioritization are keys.

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thanks everyone for the input. one of couple things that bother me also is that people don't seem to understand the nature of emergency room very well when they come in. guaranteed, the daughter would like to have her 85yr old dad get a bath and cleaned on ER stretcher (won't move a finger at home, but wants everything done at ER.. you know that routine) but then I laugh because I don't even have time for doing that most of times. I have to say I have 3 other patients whom I need to work on and that being dirty is an inconvenience but not an emergency so I will come back later when I can, but cannot do the cleaning at the moment. it's astounding how many people come in just for no big deals so many times. the idea of patient satisfaction is so engrained in this "business" now and it's probably the saddest thing that came along as hospitals became hotels and health professionals just minions. well of course, I work hard but take no bull since I don't mind getting fired and do totally different thing. thankfully many people have same philosophy as I do at the ED, and guess that's because we are department most exposed to social injustice

seems like my post went to another direction. back to the point, i am finding it hard to re-learn what to and how to communicate with charge or the doctors, what to call for etc. like many said, i hope all will come with time

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One foot in front of the other. There's only one you and you can only be one place at a time. Speed comes with experience, as does the ability to quickly assess someone and decide if they need you right now or can wait. Work a patient up start to end, don't count on having time "later" - there's never later in the ED. If they're breathing, not bleeding & talking to you you covered your ABCD's. Put a quick note in the chart to prove that you eyeballed the pt and that they're alive and well and go back to your most urgent case. Explain to you other 2-3 pts that as soon as you're done working on this other person you'll be with them - and do that! Give them a time frame, if you could, and try to stick to it.

It'll get better!

Good luck!

D.

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Oh, I saw what you added at the end of your reply to everyone - what to call on: your floor experience is valuable! Trust your gut. If a person "just doesn't look right" to you, go get the doc. If it's been 30 minutes with this pt and you still can't leave the room to go deal with your other pts, ask your charge for help.

It's better to over-communicate at first, and you can tweak it with time...

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