Choosing the best prep for ER

Dixielee, BSN, RN · Mar 31, 2005

In my experience, most of what you will see in the ER is more medical than surgical. Yes, you see lots of fractures, lacerations, etc., but unless you work in a pure trauma center, you are going to be faced with a lot of medical emergencies. An acute MI is a wonderous thing to behold, and can be every bit as emergent as a trauma. Quick recognition of changes and treatment are a must. Subtle things can mean the difference in life or death. If you are in triage a while, you will see what I mean.

Diabetic emergencies must be dealt with quickly. If someone is unresponsive, you don't know if their sugar is 15, or they are a head injury, CVA, or whatever could be the problem, so you need to be able to do quick assessments.

Allergic reactions, anaphylaxis, is a life threatening situation that must be recognized quickly.

Asthma, COPD, CHF, all can lead to acute respiratory distress/arrest, so things must be recognized and treated quickly. Remember your ABC'S? Well this one is the big A.

Being able to recognize "unhealthy" sounds is important, i.e. stridor. Also, you must be able to recognize unhealthy color. A chronic renal patient is generally somewhat "gray", but nothing like a big MI pending arrest.

Based on what I have reviewed above, I think a medical background is more beneficial. In the ER, if you have a trauma coming in, you generally have some notice (EMS) and they have begun the stabilization process, IV, C collar, etc. I know there are those times a GSW is dropped off at the door, but that is not the rule in most hospitals. You also have more support in a trauma center, surgeons, OR available 24/7, etc. which you don't always have in a non trauma or non teaching hospital.

But when you are the triage nurse, and someone walks in not looking too well, and all the beds are full, YOU must be the one to decide if they can wait, or if they need to come back and kick someone else out of a bed. It can be a daunting task sometimes, juggling the sickest of the sick.

Good luck, hope my rambling makes some sense.

needsmore$ · Mar 31, 2005

i agree with dixielee--excellent advice as usual. i started as a gn- medsurg- helped me enormously when i went to the ed-

medsurg helped me to develop a solid clinical background and also critical thinking skills in a not so urgent (but hectic at times) environment. medsurg reinforced nursing school education- honed my skills with foleys, ngs, assessments, time management.

(23 yr ed veteran nurse and still going...)

anne

mommatrauma, RN · Mar 31, 2005

As a nurse for 10 years, I have worked in all of those settings you mention. Although every one of those types of patients will lend something to your learning experience for your ER future, I feel the medical side of things will definitely be more of a prep for what you will see in the ER...My oncology experience helps me better with dealing with dying patients and their families, plus I end up being the one that accesses all the port-a-caths in the ER...my surgical floor experience made me proficient in NGT placement and foley placement...but medical is where I learned my time management. I learned how to pick sick and not sick out of a crowd...I learned all about the meds I was giving cause everyone is on at least 50...It gave me a broad gamet of illnesses so I got to see alot. So I agree with Dixie in that the medical is better as far as prep goes...The things I learned on the other floors were mostly procedure oriented things, which I think are alot easier to learn. Its the time management and knowing sick vs not sick that can be more of a challenge...The biggest thing is no matter where you work..stay hungry...and learn all that you can...ask lots of questions...this field is ever changing and you have the opportunity to learn something new everyday...I know I do, and i've been doing this for 10 years now...you'll find people in this field love to teach, and the ones that don't, will teach you how not to be...don't be afraid to get your hands dirty...and good luck with it!!

Spacklehead, MSN, NP · Apr 2, 2005

Congrats on passing the boards! I definately agree with the previous posters regarding going the medical route. What may also be beneficial is if you can take a telemetry course (rhythm recognition) and ACLS in the future. When you are ready to move onto the ER, it may make your resume appear more attractive having already taken those courses. Just a thought to consider....good luck!:)