ED RN Duties

Yingtsay, BSN, RN · Sep 4, 2018

I work in a rural emergency department so this may not apply very well to all other cases. As ER RN my duties includes:

*patient registration (if the unit clerk is unavailable), triage, collecting patient information

*the ADPIE of nursing

*provide a summary report to the ER physician, anticipate and prepare relevant diagnostic equipment

*Identify the patient's level of knowledge,obtain and prepare useful information for patient teaching (handouts), and prepare relevant discharge paperwork for the patient.

From my own personal experience, the level of anticipatory preparation is depends on your individual relationship with the physician. There are some physicians that will ask what orders you would like when you give summary report while others want to hold it off until they personally see the patient.

Another thing about ER from my experience is knowing your standing orders. For example, if there's any abnormal ECG via 5 leads telemetry, 12 lead ECG is automatically ordered or obtained by myself. If there's ST elevation in II,III,V1 with 12 lead, I will automatically get V4R, if there's any ST depression in V1-V3, I will automatically ask for 15 lead.

LadyFree28, BSN, LPN, RN · Sep 5, 2018

I work at a Level I Pediatric Trauma Center as well as a Stroke/Heart Center Adult ED (non-trauma)

They both have a "Main ED" which patients that need complex medical interventions are placed as well as a "fast-track"/urgent care, which are simple medical interventions or "doctor's office" type complaints.

Medications: we don't prescribe medications as Registered Nurses; that would be an Advance Practice Nurse or Nurse Practicitioner (NP) role;

as far as having knowledge of medications, Nurse have some idea of potential medications to use;; sometimes there are plans of care that nurses can follow and be allowed to give medications in Triage or during the course of care for a patient.

Diagnostic Testing: same as the explanation for medications; we are able to order plans of care to have us order diagnostic testing when appropriate

First Aid: There are times where we have to dress wounds, splint application and care; these procedure are standards of practice and are standards of care that are taught in nursing school and expounded on with on the job training

At my Pedi ED position we work with NPs; they take patients independently if they are a "fast-track"/urgent care patient; more critical pts can require a physician collaboration, howeve they are the primary caretakers of the patient.

At the adult ED I work in, Physician Assistants (PA) take on the same roles.

Heylove, BSN, RN, EMT-B · Sep 9, 2018

Medications: we don't prescribe medications as Registered Nurses; that would be an Advance Practice Nurse or Nurse Practicitioner (NP) role;
as far as having knowledge of medications, Nurse have some idea of potential medications to use;; sometimes there are plans of care that nurses can follow and be allowed to give medications in Triage or during the course of care for a patient.
Diagnostic Testing: Yes, same standing orders for tests and labs, etc.
First Aid: There are times where we have to dress wounds, splint application and care; these procedure are standards of practice and are standards of care that are taught in nursing school and expounded on with on the job training.

I do believe the OP was referring to standing orders for medications. Correct me if I'm wrong, but nurses in different areas of the ED may have a list of standing orders that they may administer from if needed? I would expect that the patient needs to be assessed and AND accepted by the MD in order to administer these medications? CC and triage medications would have different criteria than pain medications, I would hope? Maybe? I have no idea.

Don't wound dressings, splits, etc., short of a bandaid all require doctors orders? I am not allowed to give an icepack without an order.

From what I understand, NP scope is dictated by the state nursing board. I have absolutely no idea about PAs.

Mary3010 · Sep 15, 2018

Yingtsay, LadyFree28 and Hey Love: Thank you everyone for your comments...I really appreciate it!!! When I mentioned the part about medications, I was referring to basically having knowledge of different medications and applying that knowledge in helping a patient (maybe even independently).

From what I wrote does it sound more like an urgent care/fast track advanced nurse then? Thank you all once again!!!!!

LadyFree28: Am I correct to say that you can work in different areas of emergency? So rather than being confined to just one area, you could have a broader practice through helping in both the adult and paediatric emergency departments or you could work within different areas such as urgent care and elsewhere within emergency. Thank you!

HeyLove: It sounds like you are really restricted in what you can do without orders (not being able to even give an ice pack). Thank you!

Editorial Team / Moderator · Sep 16, 2018

Mary, this is also going to vary by country. The system and scope where you are may be very different.

Mary3010 · Sep 18, 2018

Thank you Pixie. Is there somewhere where I can go which lists these duties like a website for instance?

Editorial Team / Moderator · Sep 18, 2018

Thank you Pixie. Is there somewhere where I can go which lists these duties like a website for instance?

Not really - scope of practice varies by state, and EDs vary in policy. The national professional organization might be the closest thing - the Emergency Nurses Association, ena.org. They do have position statements and clinical practice guidelines available.

Mary3010 · Sep 24, 2018

Thank you, Pixie!! I don't suppose you would know what emergency nursing in Australia would be like? There's this website but I think it's more aimed at giving an overview of what nursing is, rather than a description of emergency nursing: How to become a Nurse - Registered | The Good Universities Guide