Recent transfer to ED from MS

Lev, MSN, RN, NP · Jun 4, 2017

Plan ahead. Make sure you are well rested and hydrated before your shift. Bring along an energizing drink that you can sip throughout the shift. Work on getting the story as quickly as you can and get out of the room quickly. Anticipate the needs of your patients and cluster care. Also, don't be afraid to delegate. Keep your charge nurse updated and don't be afraid to ask for help. Jump in when you can to help your coworkers.

Also, if you don't know something, look it up. That will teach you a lot.

~Mi Vida Loca~RN, ASN, RN · Jun 5, 2017

Utilize every part of your orientation while you have a co-nurse, remember how you are on your orientation will determine what the nurses think about you and working with you and can totally make or break your experience when you get done.

Jump in as much as you can, hone in on all your skills as much as you can because in the ER you have the opportunity to get tons of practice. Like on IV's, in and out cath's, NG tubes, and so on. Work as a team, observe and learn, pay attention. If you need help ASK. If you are unsure ASK. If you have free time be productive. If you have something to do and Molly has a lot going on and has multiple tasks to do offer to do one. Even if you have housekeeping they get swamped, especially with the way patients get bulk discharged and admitted, so when you walk your patient out don't be to good to go strip the bed or help clean the room. As time goes on if you feel you're getting really strong in some areas but not so much in others, communicate and let your preceptor and educator know so you can focus on the stuff you need. If you have others that do EKG's, volunteer to do your own a lot so you can get good at them because you never know when you won't have an EKG tech or ER Tech there to do one and I can't tell you how many times I have seen 3-4 nurses standing around a room where we have a patient in SVT or something and one of them is calling for someone to page the tech to do the EKG and the machine is literally 50 feet from them, It's absurd. Or how many times I have had a nurse tell me they don't know how to do an EKG because it's been so long.

I mean you will be learning the flow to be on your own but while having a team mate it's important to learn all these other skills as well. So don't listen to thinks like (oh it doesn't matter if you know how to do that, the CNA's do it" or whatever.

Wuzzie · Jun 5, 2017

ED nurses do "focused" assessments rather than full "head-to-toes". This is the number one stumbling block I have found with nurses switching from MS to ED. It seems to be difficult for former MS nurses to wrap their heads around. Of course there are situations where a full assessment is done (traumas, etc) but in general it's a very quick assessment based on the chief complaint. This does not mean that ED nurses are providing less care...it's just different. When I worked in the ED, depending on my assignment I could see as many as 12 and up to around 24 patients in a shift. This was a 43 bed ED with an average daily census of around 360-400. No way could I do a full head-to-toe on all of them.

~Mi Vida Loca~RN, ASN, RN · Jun 5, 2017

One thing I forgot to add which was the best advice I got from my preceptor to this day; If you find yourself scared or nervous about what the next patient might be, like EMS bringing in a patient, at the end of the day your roll will always be the same with very little variance. If the patient is coming in with chest pain for example, do not get stuck on "what if it's a MI? what if it's only angina? what if it's a cardiac tamponade? what if it's anxiety? What if I am wrong?"

It doesn't matter because when that patient rolls in, (depending on who does what in your facility) you're gonna do or make sure the patient is hooked up to the monitor, triage is done, EKG is done, X-ray is done, IV is started, blood is sent to lab, focused assessment is done etc etc. Same with Abdominal pain, it doesn't matter what is causing the abdominal pain initially, your roll is still going to be the same. The starting point. As results come in and information is gathered, things will get narrowed down and what you do from there will change based on the doctor. Things you'll want to keep a watchful eye on will change, you'll know the patient better and you'll adapt. Traumas are the same, what the trauma is doesn't matter, the initial things you will do will be the same.

You can have some variances to these of course, but once I realized that it took a lot of anxiety off of me (I was pretty much a new grad) and I could focus on learning. Because initially I was afraid if I messed something up by it being a MI instead of Angina for example when it didn't matter because it didn't change the course of what I would be initially doing.

amzyRN · Jun 5, 2017

Like mentioned above, clustering care (do it all at once), anticipating what will be needed (eg., chest pain, EKG, IV lab draw, possible aspirin, and nitro immediately), prioritization of interventions and patients. The prioritization is very important. Tell your preceptor you want to make sure you are doing things in the correct order. Speed will come with time. Safety is more important.

Kuriin, BSN, RN · Jun 7, 2017

Our facility ED makes us do head-toe assessments as a first assessment after triage and then focused assessments for q1-2hr reassessments.

Wuzzie · Jun 7, 2017

Our facility ED makes us do head-toe assessments as a first assessment after triage and then focused assessments for q1-2hr reassessments.

That is utterly ridiculous. You do full head-to-toes on everyone?!! Lacerations? Sore throats? Utter waste of time.

Editorial Team / Moderator · Jun 7, 2017

That is utterly ridiculous. You do full head-to-toes on everyone?!! Lacerations? Sore throats? Utter waste of time.

I agree. That is a supreme waste of time. At the very least, they should scale it back by ESI level. Sheesh.

amzyRN · Jun 7, 2017

I don't know how anyone could do a full head to toe on every ED patient regardless of acuity. Unless you are glossing over things. For example, I'm not going to listen to breath sounds or heart sounds in a healthy 25 year old patient here for abdominal pain. I only assess if there is a reason to do it. The turn over in my ED is too fast we could not do a full thorough head to toe on every patient and be able to keep up with the flow of patients especially in the fast track area. I never even chart an assessment for an esi 5. I only chart focused assessments on esi 3,4. I will chart a full head to toe on a patient who is going to be admitted or an esi 2.

Kuriin, BSN, RN · Jun 8, 2017

Yep...we do full head to toes even with people with lacerations. Though, most people gloss over it and type in "WDL" because there's just not enough time to do an actual FULL assessment. It gets worse because we have to do a full skin assessment as well -- pictures included.

amzyRN · Jun 8, 2017

Yep...we do full head to toes even with people with lacerations. Though, most people gloss over it and type in "WDL" because there's just not enough time to do an actual FULL assessment. It gets worse because we have to do a full skin assessment as well -- pictures included.

Wow! We have to do photos only if a patient has decubs and is going to be admitted. Not on everyone!