How different is ER nursing from floor nursing?

Specialties Emergency

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I am on an observation unit/tele and I was curious how much different ER nursing is from being on a floor. What does an ER nurse do that a m/s nurse does or doesn't do? ER is something that I am interested in but wondering how much of a challenge it is. Thanks in advance!

Specializes in Pediatric/Adolescent, Med-Surg.

The best way for you to understand what is different about the ER from the floors would be to spend a day shadowing in one.

On the floor you can organize your day, plan out your meds, etc. In the ER pts are constantly coming and going, with new orders constantly being added and no real schedule. While floors have a set amount of beds, the ER can't turn away a sick pt so it is possible that you may have a busy ER with all your beds full and people waiting in the waiting room when EMT shows up with a CPR in progress that you now have to quickly figure out where they are going to go because they are the priority.

One of the differences I love the most is the teamwork. In most ER's everyone jumps in and helps out when a coworker is falling behind or has a very sick pt. I know some floors can be like that but I never saw it to the degree it is in ER

ER is not for everyone. I did floor nursing prior to transferring to the ER, and while it is a very different beast I think it is an easier transition once you have some basic nursing skills down.

Specializes in Emergency.

Laugh a lot more?

I transferred to ER from the floor last December and here's what I've found:

There is no set pattern in the ER. You have no clue how many patients you will see ,total, in a day... You may turn over your entire assignment multiple times or just once or twice... You never know! And how can you predict how many MVC's you'll have??? No way! The ER... you never know whatcha gonna get!

You don't know the patients! On the floor, you've gotten report, you've had the pt for a couple of shifts, you get to know them (how they react to meds, preferences, medical history, med allergies, etc). In the ER, sometimes they arrive unconscious... Well, are they allergic to the levophed you're about to start????

You don't develop that lasting relationship with the pt (I have found that I like this part of the ER, you might find it the other way around). For the most part, you get the pt, you stabilize them, they move out! What was their name again?

I think I'll take my lunch at 1230 today.... Wrong!!! Bus rollover! It's 1500 and the cafeteria closed!

You don't get that 0900 Medication 100k Dash... You give meds as pts come in... Usually they stagger in... Isn't that nice? ~also you usually don't have to worry about their 27 home meds in the ER ;)

Medicine Mondays!!!!!! Trust me, it's a thing.

Also, depending on your hospital... You might get to know your homeless population very well! They come and sign in, chit chat, get some food and what not.... I know most of them by name now!

"Hi, nurse Becky? This is you public health nurse. You know that pt with a mild cough you had last week for 8 hours in that teenie-tiny little room???? Ding ding ding!!!! TB!!! Come on down and get your free PPD!"

And the biggest difference to me is that, on the floor, you know what's wrong with them. You have a diagnoses to battle with. CHF Exacerbation, pneumonia, asthma, COPD, Bronchitis, Atelectasis, pleural effusions, they all look pretty similar without their fancy title!! Which one does this stranger walking in with SOB have?

Spend a day or two down there... If you think you have what it takes, I'm sure you friendly ER will be happy to have the extra set of hands!

Good luck!

Thanks for all of your explanations. I have found I do not like the day shift as I hate having to give the patients their 15 different medicines by 9:00. I like the night shift a lot because of the less medications. I hate to say this but I like the treat them and get them out kind of thing. I think that's why I am interested in the ER or L&D. I hate having a patient watch the clock so they get their pain meds in the time frame. Or you get in the room after fighting with the drawers in the Pixis for ten minutes getting their 15 different medications and they have to go to the bathroom and can't wait and you have other patients to medicate with their 15 different medications. Don't get me wrong I do like my job. My patients have all been sweet and patient with me as new nurse and I have learned a lot and look forward to learning more. I have a great manager and the staff have been great with teaching me and putting up with my questions. But it's something in my gut that I do not want to do. So any more insight or stories are greatly appreciated.

Specializes in Emergency/Cath Lab.
Laugh a lot more?

I was going to say we walk faster.

Its a whole different ballgame. Come down for a night and see what it is like. Most floor nurses have no idea what goes on and it is good for you to come down, if for nothing else to understand the organized chaos that is ensuing. Gets the blood pumping!

It's m/s on speed. The patients you transfer to ICU as soon as possible are the people who come to you via ambulance or triage. Think a code on your unit is scary? Wait until your patients roll in the door with the LUCAS pumping. Perhaps a ruptured AAA to get your day started? Arterial bleeds, MVCs, traumas, ODs, active strokes, etc. There are a lot of stressful situations and you are truly dealing with multiple life and death decisions within a few minutes span.

Then there's other stuff...boatloads of drug seekers. Lots of street drug use/ETOH combined with psych issues. Increased potential for violence. Rapid assessments (and sometimes judgements), frequent chest pains, and mystery belly pains. Frequent fliers that torment you with each visit. Extensive workups, narcs and more narcs, starting IVs, managing family members constantly. Did I mention lice and bed bugs?

It's a different beast and not for the faint of heart. You get to work closely with the PAs/NPs/Docs, and your input really matters; they often ask, "what do you think?" You actually feel good when you are able to walk a scared patient and their family through what is happening during their ER visit. Sometimes simply telling them, "I am here with you, we will do this together" can make them feel at ease. I enjoy the increased autonomy as a nurse...I can actually put in orders for things that are necessary without calling and asking permission. I love it and would never go back to floor nursing again!

Specializes in Med-Surg, Emergency, CEN.

I absolutely agree with ChristineN about the inability to schedule the day. Also, every order is stat or now. VS q hour or q2 hours. Pts are not allowed to eat. Everyone, and I mean everyone, thinks they are coming in for a 15 minute Dr. visit and is angry that they are there for hours. Everyone is allergic to ibuprofen, tylenol, toradol, sulfa, NSAIDS, or anything else that isn't dilaudid.

You dread what pts might have on them that you don't know about: lice, scabies, bed bugs, MRSA/VRE, TB, knives/guns.

On the other hand, there are the good things. Bringing back a pt after coding them for 40 minutes, finding that your coworkers automatically help you when you had a hemorrhagic stroke, STEMI, and pneumothorax at the same time, hugging a kid and telling them that they did great with their stitches, hugging their mom and telling them that they did great for their kids' stitches...

My favorite up side is when a bunch of the team goes out for a meal right after shift and vents their day before going home.

I have found I do not like the day shift as I hate having to give the patients their 15 different medicines by 9:00.
Ugh... that's what I most hated about working the floor... and those rare occasions that I'm around in the morning with an assignment of m/s boarders...

My patients have all been sweet and patient with me
Pretty sure no ED nurse can say this after a shift or two...
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

They go 3 places...home, heaven, or admission. Sure you have boarders but it is not the same. Odds are after a bad day or a nasty patient they WILL NOT be there tomorrow.

Specializes in Emergency.
. Perhaps a ruptured AAA to get your day started?

!

And they were sent to fast track because the complaint was back pain...

I was kind of on the same boat with you; transferred to level 1 ED after sometime in MS and actually transferred from observation (not the "real" obs, but the floor obs where people stay about 2-3 days).

In short, I LOVE it. I probably have to write pages about how much I love love love ED compared to floor, but well let's see... you don't feel like a pill pusher, narc pusher. There's no such thing as PRN, everything is one-time, and that helps when all they want is morphine and dilaudid. I was surprised that you don't even start IVs on everyone but the ones the nurse thinks will need IV (autonomy... ain't that amazing?). Furthermore, whatever I do know feels much more important. You know how it is on floor; mostly charting consists of clicking on boxes on 6 patients and you are thinking "why the hell am I doing this?" At ED, I feel like things I do actually matters whereas on floor, I was just checking boxes just to make TJC happy; plus it's focused assessment, so no, you don't need to do stupid things like integumentary or GI assessments if pt has no complaints of those at all; you chart assessments based on specifically what they came for. Someone mentioned teamwork, absolutely! I was in 2 traumas and code, lots of people there, amazing teamwork, lots of pressure and fast pace; I love it. There's no such things as "me and my patients" but more like "me and my zone/pod". I am temporarily done with tasks on my peeps, see some meds or interventions popped up for my friend, you ask and go do it, and that's how it works; you NEVER EVER see the same kind of teamwork in ED anywhere else. Availability of physicians is also def plus since you don't have to ring docs at 3am for zofran or benedryl iv. ED docs also tend to be nicer it seems because they have to work with same team day in and day out, so everyone is familiar with each other.

The challenge in ED is definitely something that surpasses floor by miles and miles. As many mentioned, lots of critical pts can fly in any time. Hell, I saw almost same amt of critical pts in 2 wks at ED than my entire 1yr half nursing career on floor. Plus all the drips, protocols, code stroke, what to dos, what doc needs during this procedure, that procedure, setting up for those procedures, etc etc... it's tremendous amount of things to learn. It's amazing and a blessing that I got into this, and I have no regrets! I also feel like the patients seem to have more respect for ED nurses compared to when I worked on floors it seems; that could be just a perception. And yes, adrenaline, having to work under enormous pressure and pretend like you are not affected at all, ED is awesome and I found my place for all I can right now. I hated MS with all my heart because I had to constantly face the non-compliants, had to see them for so many days, etc, and at ED, they are quickly good bye. And most importantly, I feel like I am doing something that matters compared to my floor nursing (some will say floor matters too, but that's for another discussion) and making a change. Get on aboard with it when you can. You will love it!

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