ED nurses more educated than other specialties?

[trauma_lama, BSN]

Hi friends,

I'm just beginning in a level one trauma ED. I transferred to it from a tele unit in my hospital system. It seems like the classes and certs I'm required to get surpass any of the requirements of heard of nurses in other departments needing to fulfill. Luckily, I got a few of the classses out of the way when I oriented for my old unit, like IV infusion, 12-lead, and EKG interpretation. But now I'm also having to do TNCC, PALS, ACLS (which I already had from when I worked in the OR but let it lapse bc it's not required for floor nurses other than ICU at my hospital), mass casualty class, nonviolent conflict resolution, lethality (domestic abuse class), decontamination (we aren't too far from a nuclear power plant)... I think there was one called ENSI too, but I can't remember if that for sure is it. There's another ped very we have to get as well but I can't remember the name of it. Anyway, based on my experiences, this is a lot more information than most of our floor nurses are required to take in. Don't get me wrong- I'm not complaining- I love learning, and I want to be hella prepared for any possible contingency. I just get the impression that ED peeps are more formally clinically educated than most other types of floor nurses, am I totally off the mark? I mean they were "strongly encouraging" nurses to pursue stroke certification and cardiac certification on my last floor, but it wasn't mandatory so a lot of people took it as a "meh." I was working part time so I wasn't eligible to take the classes and exams under hospital pay, so I couldn't afford it but I generally approach things with an all or nothing attitude and would have if they'd offered to pay for the exam. Anyway, just wanted to know yalls thoughts on this? I was at a community hospital with 380 beds, and now at the main one within my same hospital system with 890 beds, if that is at all necessary to inform your opinion.

[Lunah, MSN, RN]

Are you familiar with the expression "jack of all trades, master of none"? That is kind of the mindset. Broad base! Although over time, I have seen it become "jack of all trades, master of all trades too," haha. You see patients of all ages in all conditions.

[amzyRN]

I think the ED requires a broader knowledge base, hence more requirements. ICU also requires a lot of in-depth knowledge. I wonder what the ICU nurses think or nurses who have worked both specialties. Of course ED nurses have more requirements than a floor nurse because of what goes on in the ED, but how does this compare to ICU?

[Guest374845]

CEN, CCRN here. In the ED you definitely carry more certs than most other areas, but that's because you will be initiating care for every specialty that walks through the door. I always say ED can't be beat in the flexibility department.

But there's a big difference between certification classes and formally educated”. Where you're woefully unprepared - I say this working in a massively staffed level 1 ED where I can count the ICU expats on one hand - is caring for critically ill patients for hours and days.

When I say critical, I mean ARDS, cardiogenic shock, severe TBI, etc. We care for these pts every day but often only insofar as drawing labs, hanging meds and minimally titrating the same carousel of sedation, analgesia and pressors.

Understating hemodynamic monitoring, ICP, IAP, and how the pt interacts with the vent are all as important (if not more in some cases) but these aren't skills taught in a fail-free certification class.

With that being said, there's no ICU nurse looking down their nose at you who can seamlessly triage, code or just generally care for a 4 day old and 100 year old in the same shift. That's where you make your mark.

[canoehead, BSN, RN]

We have to maintain a LOT of certifications. I have no problem with continuing education, but once you hit twenty years of BLS, and ten of ER nursing, either you got it or you don't. I'm starting to feel the same way about PALS and ACLS, mostly because they spend half the time reviewing BLS, and dangit, I'm there to learn, not review! When they pass everyone, whether they know the material or not, there just seems to be no point in attending.

[akulahawkRN, ADN, RN, EMT-P]

While ED nurses do get many certifications, they rarely get to really become a master of none but resuscitation. They get a very wide base of education but they don't need (usually) to delve too deeply into any of them because what the ED does is get the ball rolling. The patient comes in, gets seen and evaluated, and then dispo'd to the appropriate department for further care. Seriously, in the ED, I have only about 3 or 4 possible patient dispositions: Admit, Transfer, Home, Celestial Exit. Doesn't matter how they arrived, they're going to leave basically on one of those ways. "Home" is wherever they're going to reside... and that can be the streets, residential care, usual residence, jail, long-term care, etc., and that's also usually where they came from initially.

[PeakRN]

I agree with the previous posts.

The ED is also very intervention driven so ED nurses tend to need a lot of procedural training. We have to go to a class or have an annual check off for Sedation, EJs, USGPIVs, IOs, Ports, Restraints, hemodynamic monitors, the BiPap, the Vent, the transport vent, the other transport vent (I have yet to understand why we need two different brands), etcetera. Add in ACLS, PALS, NRP, NIHSS, TNCC, ENPC and the never ending continuing education and we quickly rack up the education hours. The only nurses in our system who have more are the critical care float pool nurses because in addition to our stuff they also have CRRT.

That being said all of my ED education based on initial treatment and good for the first couple of hours of care. Put me in a med/surg environment and the education looses its value very quickly.

[LM NY]

I enjoyed reading all the comments. As for me, I'm a few days shy of hitting my two year anniversary on a medical-surgical unit. I had the opportunity to transfer to the ED a few months ago, but I wanted a little more time on the unit. I want to get everything I possibly can out of med-surg before making that huge leap. In my unit, I also have the chance to train to administer chemotherapy and get certified as a stroke nurse since there is a 10 bed designated stroke area in my unit. I know once I get to the ED, those opportunities won't be readily available to me. So, maybe during the summer or even in one year I can make that move to the ED. I love knowing that I will learn so much and will be trained to basically respond to any given situation. It seems overwhelming, but extremely exciting at the same time.