ED-did you always know?

GOMER42 · Oct 23, 2008

I always knew ED was for me.

Based on your post, I'm not feeling it is for you.

You are scared of watching critical patients awaiting ICU? ER is the junction where all of the unstable medical and trauma patients meet before being admitted to the hospital. You rarely see direct admits that bypass the ED. You will have your share of stable patients using the department as a clinic, but you will also have traumas and very ill patients to care for concurrently. If you can't stand the heat... you know the drill.

Good luck in finding your niche.

alyx · Oct 23, 2008

OK...so you weren't talking about erectile dysfunction. I'm sorry but my mind went right there and finding the post odd I just had to read it. Thanks for making me smile at my own stupidity...sometimes you can dress me up but you just can't take me anywhere.

~'JesusRocks'~ · Oct 23, 2008

Just to clarify-I get the whole "critical pt" thing, there are citical pt in the ED. Take it fr. my standpoint as a floor RN; critical pt. comes in-ED stabilizes enough to go to ICU at some point. Critical pt. needs various drips, needing various Q2hr monitoring and so forth-meaning 2 pt RN care MAX. I guess what I want to know is at what point is that ICU bound pt getting ICU type care (frequent monitoring, frequent interventions)-is it in the ED w/ the RN having 2-3 other critical pt. If so how do you do that. If ICU RN only have 2 pt. and ED does not-help fill in the blanks here.

MN BigJ · Oct 23, 2008

CNA in surgical, then float pool where I first went to ED. Then got LPN, took some EMT classes, worked in ED as LPN and tech and that's when I knew I could never go back to a floor.

MN BigJ · Oct 23, 2008

I find it challenging and rewarding with the critical pt's and busy times. Usually have enough help with other nurses and staff. Every day is an adventure, no 2 days the same.

BrnEyedGirl, BSN, MSN, RN, APRN · Oct 23, 2008

As a former floor RN, let me see if I can help. First off let me start by saying I am very fortunate to work in a trauma center that has great staffing! I honestly find my current position in ER much less stressful on a day to day basis than the cardiac unit I left.

I start my night at 1815. All the staff coming on duty meets in the break room for a "shift huddle". We talk for 20 to 30 min about what's going on in the dept, new rules, PG results etc. We are then given our room assignments. I am assigned 3 rooms and will pick up hallbeds as needed. Many times we will have float nurses that take all the hallbeds.

I get out into the dept and find the RN who has my three beds,.he/she will give me a quick report "Rm 12 is a 56yr old male, c/o chest pain,.he has a hx of HTN, high chol, and had a stent placed to his LAD 1yr ago. He was hypertensive when he got here and rated his pain 8/10, I've given the nitro X3, Asa, EKG is done and showed no acute changes from previous EKG's, labs are drawn, he has an 18g in the L ac and is currently pain free, last BP was 128/68" (I also understand that he is on a monitor and O2,.because that's what we do),

"Rm 13 is a 7yr old little girl c/o sore throat, HA and fever, vitals ok, normally healthy kid, temp was 102.4 at triage and they gave motrin, strep screen and labs are done, no IV access",........."Rm 14 is a 86yr old female from a local nursing home, c/o change in mental status, hx of MI, CVA, DM, and multiple ortho surgeries, her temp was 103.7 when she arrived and I gave tylenol suppository, she has an 18g R ac and labs, EKG, CXR are done, I placed a Foley and sent a urine, her accu check was 238, she has NS TKO and btw she's allergic to PCN". Day shift leaves and I'm on.

I start with my CP pt and introduce myself, peek at his monitor (remember that the ER is set up like a ICU unit and I can physically see all my pts during report and I can see the monitors in the room as well as at the nursing station),.I ask about pain, he's pain free, VS all look good, tell him to call if he needs anything or if his pain comes back, and that as soon as his lab gets back, this usually takes 1 1/2 hrs, I will update him on the plan. I then go to the 86yr old, appears to be resting comfortably, will answer questions when asked, VS good,.explain we're waiting for labs etc, re check her temp,.100.6, great we're moving in the right direction.

Next is the 7yr old,..I see labs back (we have colored tabs on the charts to alert us of new orders, labs to be drawn, labs back etc) her strep screen is positive,.update doc and receive orders for IM abx,.I pull the meds from the accu dose and go to the room,.introduce myself, explain to pt and Mom about the strep and the plan,..give the meds, and remind pt she has a 30 min wait after abx and I'll get her discharge ready. As I go back to the nsg station I glance at my other two pt, then look at the monitors when I get to the nsg station,..all looks good,.I write out the dc instructions for my little girl and place a sticky note that she can leave at 1940,..

The tech comes to tell me that my pt in 12 is c/o CP 5/10,..I go to room,.pt says pain is 5/10 "more of a pressure",.quick VS reveal no changes and monitor appears unchanged,.ask the tech to get a repeat EKG,.update the DR and repeat nitro X3,.pain is now 2/10,.update Dr and get orders for MS 4mg IV,.get the meds, give the meds,.chart at bedside while I'm doing all this,...pain is gone,..labs are back,.trop is 3.4,..new orders from Dr,....

Mother of pt in 13 is asking what is taking so long,.a co worker asks what she can do to help,.she dc's the little girl for me and I cont. orders for CP,......

CXR and labs are back on LOL in 14 and she has pneumonia and a UTI, new abx orders,....meds are finished for CP pt and he is pain free and waiting for a room assignment,...I start grabbing meds for LOL in 14 while EMS brings a 34yr old male, intoxicated, fell and hit head to 13,...my coworkers get quick report from EMS, EMS has placed an 18g R ac and drawn labs,..I hang abx on LOL in 14 and wait for bed assignment,...

Drunk in 13 is yelling and swearing, has urinated all over himself,.security is called,....it's now 2050 and I have a room for CP in 12,..I copy the chart and call report to floor,..13 is still yelling and trying to get out of bed,..orders for haldol from doc,..give the meds,...take CP in 12 to floor,...when I get back 12 has new pt from triage,.looks like a young adult female,...

Room assignment is back for LOL in 14 and drunk in 13 is snoring,...glance at the chart of new pt in 12,.27 yr old with migraine, VS WNL,.multiple allergies and pain of 10/10,...doc hasn't seen her yet so I'll go copy chart and call report for LOL in 14,...ask tech to take 14 to floor,...new orders for HA in 12,..pull meds,...EMS calls,.52 yr old male, resp distress, sats 70's on 15L NRB,.hx of CHF and lung CA,.4 min out,.

Tell tech to get LOL in 14 upstairs ASAP,.we need the room,.ask sec to page Resp to meet us in room 14,..run to HA in 12, argue with her about only giving toradol and phenergan,."that's candy,.it won't help",..don't have time to argue with her,.yell at doc to chat with her and meet EMS in 14,..pt is very SOB,.sats 72% on 15L NRB,..EMS already has a line in and labs drawn,.yell for a doc and an airway cart,..where is family?,...is this pt a full code?,..get RSI meds ready,.intubation kit is at bedside along with doc and three of my coworkers,..monitor in place, EKG done, CXR at bedside,..family here "please save my Dad",...push meds for intubation,..doc places ET and resp is in control of vent,...start charting,...

Lady in 12 needs 4mg MS IV,.co worker does that for me,...drunk in 13 needs his wound cleaned and a suture tray set up,.I ask a tech to do that for me,......it's now 2130....

As you can see,..things move VERY fast in the ER,..we don't have as much "busy work" as the floor and we only treat what must be done now,..I frequently hang pressors do conscious sedations,.and get people ready for OR or cath lab,..I'm never alone and I often have to make decisions on what must be done now and what can wait (notice I didn't treat the blood sugar in LOL in 14). The ER is designed to work this way and we have the staff, meds, equipment etc for this to work most of the time. There are times when things get real chaotic and we just pull together and do the best we can. I love it btw!

Hope you were able to stick with me through this,.wasn't sure how else to get my point across,..hope it answered some of your questions.

101st_LVN · Apr 22, 2009

Reminded me of my last shift :-) I almost can't wait to go back to work this weekend!

emtb2rn, BSN, RN, EMT-B · Apr 23, 2009

:yeahthat:

'nother day at the office.....

Anyway,

#1

Did you always know that you wanted to do ED or did you stumble into it and find that you liked it.

- It's where I knew I would end up.

#2

Where did you start out, ED or other (state where)?

- Started in the ER

Editorial Team / Moderator · Apr 23, 2009

I was a graphic designer/desktop publisher/web designer/corporate wage slave/middle management for almost a decade before I became an EMT, then paramedic -- I just did it because I'd always been interested in it, and I thought volunteering would be enough for me. Turns out it wasn't ... the more time I spent as a paramedic, the more I came to despise my cushy corporate job. I finally quit my desk job and took a 50% pay cut to work as a tech in an ER in 2005. Been hooked ever since! Got my RN in 2008, and I'm still working in the same ER -- they decided they wanted to keep me.

I did continue to do some small-scale desktop publishing work each month until I was "downsized" out of that gig this past January, but that's fine with me ... I'm really enjoying having only one job for the first time in years! :)

cookienay · Apr 24, 2009

Dear JR- I always knew I wanted to be an ED nurse. I knew it fit my personality. When I graduated nursing school, I worked telemetry/step down for about 6 yrs or so. Opportunities for ED not avail. after graduation, and when one was avail. I chose to stay in current job because, well- I liked it. Took a temp. assignment as nursing super. during that time and also loved that. Then took a mgmt position and lasted 11 mos.- hated it (but that is another thread for another day). Felt the time was right to move to ED and have been there 9 1/2 years. Very glad I waited to go to ED after I had several years of experience under my belt. Made for a smaller learning curve and I was already accustomed to the culture of the facility. I recommend it. The new grads who easily acclimates to the ED are few and far between.Best wishes to you in your endeavors.

mellowkat · Apr 25, 2009

About halfway through the first year of my nursing course I had the idea that I wanted to be an emergency nurse. Even in my student rotation of the emergency department I was absolutely loving it.

I did my graduate year last year and did several rotations in different areas. My first rotation was Theatre and I finished up in Ed. Ed was by far my favourite. Even after 2 months I really felt comfortable within my role as an ED nurse but I never hesitated to ask any questions about things I didnt know (which was plenty). It was daunting at first but you will find that eventually you will just click and will be able to roll off the top of your head what you should be doing for particular patients and why. You will soon be able to prioritise and do things in a timely manner when things start to click. Having a great support team helps alot as well. Without them I wouldnt have felt so comfortable and would have struggled significantly.

At the moment I am working agency work where I do many many different types of shifts in all different hospitals. I always hang out to do the ED shifts and have even applied to work in some of them.

RN cardiac you summed it up pretty much to a T. Very crazy and busy but you will be hard pressed to find many of us who would have it any other way! :up: