Floor nurse moving to ER? Lots of questions?

[tsm007]

I know you get these questions all the time, but sorry here I go. I did browse the threads, but looking for some calming of nerves type of responses.

I just applied for an ER position. I've had a couple nurses that work with me suggest that I'd be a good fit for the ER that have come from the ER and asked if I ever considered it. That kind of started the thinking. My strengths are I am good at critical thinking and decision making, I am good at multitasking and prioritizing. Weaknesses I suck at real time charting sometimes. I usually play catch up to get the important things done when they need to be done. I'll just jot stuff down on paper and catch up as I have time. Not always, some stuff I do in real time. I'd imagine real time charting is more important in the ER.

Okay, second problem I am not a new nurse. I've been a nurse going on 3 years, but I work on a really stable floor with a very low census. There is just a lot of stuff I have not seen. I have never participated or even watched a code. People just don't code on our floor. The closest I've had is a rapid response on a low blood sugar (which if it had been my patient would have never got that low in the first place.) So this makes me nervous. I don't want to quite go as far as scares me because I know how I am. I won't freeze. I will do something, maybe not the right something, but I don't usually panic in a crisis.

So I'm not sure what my questions are. I don't know how to prepare for any of this. I know that I'm ready for a change and I think I can do this, but how do you prepare for things like this. As a new ER nurse how much help do you get with codes. I would be super nervous about a code by myself as my first event. Also, I'm trying to wrap my brain around how to transition to ER thinking.

[amzyRN]

Be prepared to increase your workload a lot and also don't expect to get the interesting sick patients right away. Depending on where you work you might start with lower acuity patients, the kind you'd get on a med surg or tele floor except the workload greater and turn over will be much much faster. Once you have your nursing skills up to par and know the "routine" of the department then you might start to do more interesting things. Of course be prepared to help and jump in with codes and what not but don't expect it to be all trauma and codes because a lot of what you see in the ED is pretty mundane. You will see some interesting things however and the diversity of cases and the random craziness and unpredictability is what keeps me coming back.

[Not Your Nurse]

watch Ny Med and Real ER 911; The Bronx to get a glimpse....been an emergency nurse for years

[tsm007]

Be prepared to increase your workload a lot and also don't expect to get the interesting sick patients right away. Depending on where you work you might start with lower acuity patients, the kind you'd get on a med surg or tele floor except the workload greater and turn over will be much much faster. Once you have your nursing skills up to par and know the "routine" of the department then you might start to do more interesting things. Of course be prepared to help and jump in with codes and what not but don't expect it to be all trauma and codes because a lot of what you see in the ED is pretty mundane. You will see some interesting things however and the diversity of cases and the random craziness and unpredictability is what keeps me coming back.

Actually that would be my preference.

[tsm007]

Other than keeping current on your charting, the other issue I find with floor nurses that come to work in the ED is that they aren't used to a team approach to patient care. Not saying floor nurses aren't helpful. In the ED when an EMS crew rounds the corner, a few nurses and a tech get up to help check that pt in and get him on a monitor, etc. When a code or other critical patient (non-trauma) rolls in, everyone gets up to go help.

I also see that more people are willing to help with your other patient(s) if you get a 1:1 patient in your room. I love that I know I can count on my co-workers to help with my other patient and I try to do the same for others. I just don't see that so much on the floor.

Another thing floor nurses aren't used to is having the physician often at the desk with you in the ED. We all become friends outside of work too.

You will also have to learn to be autonomous in the ED. We are afforded some nurse-driven protocols that we can initiate for our patients and the docs love that we do this. It makes the LOS shorter and allows the MD to focus on sicker patients if need be.

good luck!

We actually do a decent amount of team playing in my current job. At least I do. I have never had the it's not my patient attitude. This aspect I am sure I can take on. I'm just trying not to get too far ahead of myself right now. I'll never know if this is a good fit for me if I don't try. Thanks for the tips :)

[bgxyrnf, MSN, RN]

As a new ER nurse how much help do you get with codes. I would be super nervous about a code by myself as my first event. Also, I'm trying to wrap my brain around how to transition to ER thinking.

Even as an experienced nurse, there's never been a shortage of people to help out in codes... in fact, traffic control can become a legitimate issue because every nurse in a 3-county area will suddenly materialize.

While they can be exhilarating, there's often not that much actually involved in running codes. You've got the code team leader, a few people rotating in on compressions, somebody bagging, somebody ensuring access (IV or IO), somebody manning the defibrillator, somebody prepping meds, and somebody giving meds... and the last three can realistically be done by the same person if they're paying attention and familiar with the typical meds and where to find them in the crash cart.

My experience is that it's much more common to have too many people around than too few.

[2bTraumaRN2008]

Charting in the ED is entirely different than on the floor. On the floor there is way more charting that is NOT done in the ED, so "keeping up" or charting in "real" time should not be a problem for you.

[Alexandra1998]

You will have a preceptor, and its very important to absorb all their information. Practice your charting at home. Imagine a scenerio and practice your real time charting as you go. Most of all. ..please relax. Say a little prayer before you start your shift and go. Remember that every single last one of us ER nurses were new at one point. This is your turn and if you love ER nursing you are going to be absolutely fantastic!!!

[ILUVERNSG, MSN, RN]

I say, GO FOR IT! I've been working ER for 28 yrs and I STILL LOVE IT! It's fun, fast-paced and challenging. It never gets old for me.

There will always be something you've never seen before no matter how long you work there. It's great!

[tsm007]

I say, GO FOR IT! I've been working ER for 28 yrs and I STILL LOVE IT! It's fun, fast-paced and challenging. It never gets old for me.

There will always be something you've never seen before no matter how long you work there. It's great!

Thanks for the positive energy. I'm really getting my hopes up now and hoping I nail the interview.

[Esme12, ASN, BSN, RN]

Thanks for the positive energy. I'm really getting my hopes up now and hoping I nail the interview.

BREATHE! Your work load will be bigger. You turn patients over as quickly as possible so it is entirely possible to have several different patients in your rooms but you are never alone. Everyone jumps in to settle patients in or in a crisis then they go about their business. Real time charting kind of comes naturally. What you do in the ED is very task oriented and focused on complaint. The patient "I'm short of breath" you take vitals, tell the MD, orders are given, start an IV draw labs, you give lasix, chart.

Don't freak out and if you have questions come here and we will help. Minus all the books I would look at ACLS and some monitor strips.

You won't be alone...take all orientation they have to give. GOOD LUCK!