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ER to Floor...hating it

Emergency   (1,162 Views 13 Comments)
by iheartnursing91 iheartnursing91 (Member) Member

1,296 Profile Views; 43 Posts

Hey everyone just hoping for some advice here. 

I am an ER nurse who moved across the country and I took a job on a Cardiac stepdown unit. I'm having a hard time assimilating into the floor nursing mode. I took the job on that floor because I thought I wanted to try something new and have a new experience (I am doing ER per diem to keep my skills). I'm 3 weeks into training & I've noticed that this new floor is more like a "dump" floor for other floors (med surg, tele), and also used as extra space for the ED obs patients. I've honestly hardly seen many "cardiac " patients, which is the reason I wanted to work there. These are mostly the reasons why I hate it. I'm also having a hard time thinking like a "floor" nurse vs ED nurse. I hate the constant and lengthy documentation, care coordination rounds, daily routine, and to make it worse, some of the nurses have made some catty comments about ED nurses to me. I pay no mind, but I don't like it! Lol. I really miss starting IVs and resuscitating!! I miss the "family-like" feel I had in the ED with the other nurses and doctors. I hate calling and waiting for responses when in ED they are already there face to face. The docs who come to the floors act like they are untouchable or something and it's really weird. I dont know if I should go ahead and apply to ED jobs around here or if I should stick with this and push through. I'm really confused about what to do. What would you do? Thanks!

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19 Posts; 544 Profile Views

Hi There. Welcome to floor nursing. I found your post interesting because I'm trying to switch from floor nursing to the ED for many of the reasons you mentioned. I also work on a cardiac floor and for the most part, the patients are pretty stable, they just need to be on tele for various reasons. Once in a while I might see some RVR or some runs of Vtach, but for the most part, that's about it. The honest truth is that we don't see a whole lot of "action" on the floors. I feel like most of my shifts are tasking, med passing, and charting, oh and care plans... so many details. Occasionally I'll put someone in restraints, or have a patient circle the drain, but it's often rare for me. One of the things I have honestly found rewarding though, is that you get to know your patients (if you like that sorta thing). On my floor, we often get patients who are very ill and end up transitioning to comfort care. I find that getting to care for the patients and making them comfortable on their journey to the next life is an honor. I know patients expire in the ED as well, but it's not the same. That part is a nice bonus to working the floors. I agree with you that it can be really hard to get in touch with a doc to ask for orders, labs, or whatever. If you work nights, it's even worse. I've had docs brush me off after me contacting them multiple times suggesting the pt go to ICU. And guess what, they ended up getting super sick and were in the ICU by the end of shift after they totally decompensated. Super frustrating because had they listened, they might have gotten the care they needed sooner. So yeah, it's not the same kind of teamwork and collaboration that the ED has. Plus you will not see the same acuity. All your patients will be sick on the floors, but you aren't going to see the traumas, the codes, the frequent cardioverts etc... If you like the busy, critical care of ED, you won't enjoy floor nursing. My husband works in the ED and when we share work stories, mine are a snooze fest compared to his. Him: "Had 2 MVAs, 4 codes, I cardioverted 5 people today and put someone in locked restraints...etc" Me: "I took my patients to the bathroom, gave some IV morphine, and hung Zosyn" lol. You really can't compare them. 

As for the floor RNs talking smack about ED. A few thoughts: For one thing, we can get some really shoddy reports from the ED nurses and then receive a train wreck patient that is nothing like the report. That irks floor nurses. I know at my workplace (but I'm not saying this is everywhere) many ER nurses keep to themselves and can act very arrogant around the floor RNs as if we are less than. This sends out a bad vibe. We know you guys do more things than we do, but there are things floor RNs do that ER nurses don't know how to do either. Personally, I float to the ER once in a while, so I get to see the other side of things so I have gotten to know many of the nurses and I don't allow them or their cool knowledge to intimidate me. Many floor nurses do not understand how the ER operates and how much pressure there is to send a pt to the floor quickly to open up a bed for a new pt. I learned this for myself when I was working ED and the charge nurse was getting pissed at me because the receiving unit continually was refusing to take report for my pt. I was feeling the pressure, so I get it. Another thing is that many (not all) floor nurses are super tied up about the details they get in report. They don't like the quick and to the point reports that ED gives. Personally, I love them because I really could care less about what gauge their IV is or where it is.... I just want to know why there are here, if they are oriented and if they can ambulate. The rest I can figure out. Lol. But I've had my head bitten off by anal nurses when I give them report because they want every damn detail. I just tell them to look it up. Ha! But anyway, I do hear a lot of floor RNs complain about that. Don't take it personally. It probably doesn't help that the ER is sorta of closed off in most hospitals, so it's mysterious to RNs who don't work there and there isn't a whole lot of mingling between inpatient units and the ER, so that probably doesn't help unite us as RNs. 

I would say that you should do what kind of nursing makes you happy. It sounds like ED is your passion and where you feel comfortable. I would just apply for full time ED and be happy. If you're 3 weeks in and already unhappy, it will only get worse as you start to see everything you can possibly see on the floors. Follow your heart 🙂 Good luck 

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43 Posts; 1,296 Profile Views

Thanks so much for your reply. You are absolutely correct about everything you mentioned.

I miss the hustle and bustle (although it is exhausting), the codes, MVAs, traumas, starting about 40 to 50 IVs a day, lol! I feel like all I'm doing now is passing meds, documenting, meds, documenting, helping change them, then more meds and documenting. Very task oriented and routine-like. 

Only problem is, I love the hospital a lot, it's a great hospital to work for, I just picked the wrong unit🙄. I want to transfer to the ED (they just announced they are expaning now!) but it would be disrespectful to my current manager to leave so abruptly. Sigh.🙄

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19 Posts; 544 Profile Views

I’d say go for the transfer anyway. I get what you’re saying about your boss and that you just committed, but you have to take care of you first. Floor nursing is great, but it’s never going to be what you want/need it to be. I don’t know how cool your manager is, but maybe have a heart to heart with them and tell them why you feel it’s not a good fit? I recently did that with my own boss and she said she would do whatever she could to support my goal of going to the ER. Sadly, my hospital doesn’t hire RNs without prior ER experience, so I’m interviewing elsewhere for the opportunity. But I mention this because my boss encouraged me to do so and I was surprised how supportive she was. You never know. I applaud you for trying something new. It’s pretty rare to hear of an ER nurse changing to floor nursing. I appreciate your take on things. Wish you the best and hope you can get back to what you love soon! 

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1,668 Posts; 17,535 Profile Views

I have no helpful advice.

Your post pretty much sums up my concerns about ever working the floor.  I tried a shift (Floated from ICU).  Didn't like it.

What idiot decided that 6 patients should each get 10 meds at 0800?  

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61 Posts; 806 Profile Views

I worked multiple types of units prior to going to the ED, including med/surg tele, solid organ transplant & thoracic (I am in a non trauma ED). My co workers in the ED look at me like I am crazy when I tell them that the ED is easier.  Its a different kind of stress but it is not the same stress as constantly feeling like you aren't moving fast enough and leaving every shift feeling like your patients needed so much more that you could give. 

The animosity b/w ER an floor nurses is sadly very real. I have tried for years to get my coworkers to back off their complaints about floor nurses, but to little avail.Having never worked on the floor, they just don't get it. 

Another poster commented about the annoying habit of floor nurses needing ever single detail. That drove me crazy when I worked on the floor! I do not need to report to you that the patient had a shoulder replacement 12 years ago and today they are being admitted for a bowel obstruction. You can find those details in the chart.  We would all get out faster (and perhaps even on time) if RN's stuck to what is pertinent and didn't give extraneous details.  I think that this is one of those situations where people hear other nurses asking for those details ( Reporting off RN: "Mr X got PRBC during his surgery 12 days ago, no bleeding issues post op"- receiving RN interrupts "how many?"  Reporting RN " I'm not sure". Receiving RN- looks at you like you are an idiot and rolls their eyes) and then nurses think they HAVE to give ridiculously detailed reports. 

We need to be better communicators (and back off the shaming), have a better understanding of what is the most important and remember that a lot of information can be looked up.  We don't need to continue to highly detailed report just because thats what we've always done. ..... Sorry, report is a huge pet peeve of mine.

Anyhow, I congratulate you on wanting to try something new! While its a shame that is isn't a true stepdown unit you have now at least experienced the other side!  

Another poster mentioned some of the upsides on the floor.  You get to have a much better and deeper relationship with the patient.  Especially if it is a specialty floor.  You develop and use your teaching skills ( like discharge & med teaching) much more on the floor than in the ED.  If you go back to the ED, don't forget to incorporate what ever skills you learned! 

 

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43 Posts; 1,296 Profile Views

I completely agree with the above comment. Report time usually ends up being more than the 5 minutes you actually need. In ED our reports were concise and to the point, and we usually get the rolled eyes if you talk too much lol! 

To be honest I don't know if I care too much about getting to know the patients and families on a personal level🤷‍♀️. If something happens and they deteriorate I know its just going to affect me mentally. Maybe I feel that way coming from the ED where you have no time to waste for that! 

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82 Posts; 1,220 Profile Views

I would 100 percent transfer if possible. Go for what feels like family or home to you. Staff and patients can recognize when you like your job and it makes for a positive and healthy working environment.

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43 Posts; 1,296 Profile Views

I'm going to try and ask for a transfer to our ED, but there's a level 1 trauma center hiring near me as well, I think I'll put in an application in the meantime. I feel terrible that I cannot get used to working the floor, but oh well🤷‍♀️

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COERRN specializes in PACU/ER.

3 Articles; 4 Posts; 195 Profile Views

On 11/9/2019 at 9:55 AM, iheartnursing91 said:

Thanks so much for your reply. You are absolutely correct about everything you mentioned.

I miss the hustle and bustle (although it is exhausting), the codes, MVAs, traumas, starting about 40 to 50 IVs a day, lol! I feel like all I'm doing now is passing meds, documenting, meds, documenting, helping change them, then more meds and documenting. Very task oriented and routine-like. 

Only problem is, I love the hospital a lot, it's a great hospital to work for, I just picked the wrong unit🙄. I want to transfer to the ED (they just announced they are expaning now!) but it would be disrespectful to my current manager to leave so abruptly. Sigh.🙄

Have you tried talking to your current boss openly about your issues? I would explain that while you have enjoyed the new perspective of floor nursing, the ER is your "home" and that you would like to notify her that you'll be actively looking to transfer to the ER. She/he may be understanding of this. 

As an ER nurse who worked med/surg for 4 years prior to becoming an ER nurse, I would NEVER go back to the floor. It was a great foundation and I enjoyed it at the time, but there really is something so special about the ER that I could never walk away from. 

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CKPM2RN has 3 years experience as a ASN, EMT-P and specializes in Med-tele.

215 Posts; 7,489 Profile Views

On 11/9/2019 at 8:55 AM, iheartnursing91 said:

I miss the hustle and bustle (although it is exhausting), the codes, MVAs, traumas, starting about 40 to 50 IVs a day, lol! I feel like all I'm doing now is passing meds, documenting, meds, documenting, helping change them, then more meds and documenting. Very task oriented and routine-like. 

Only problem is, I love the hospital a lot, it's a great hospital to work for, I just picked the wrong unit🙄. I want to transfer to the ED (they just announced they are expaning now!) but it would be disrespectful to my current manager to leave so abruptly. Sigh.🙄

I've read your post and it actually helped to push me forward in what I need to do for myself.

I have an emergency background and also love the hustle/bustle, the codes, etc.  I took a job in med/tele because I thought I wanted to learn the "meat and potatoes" of nursing. I didn't realize it would be like this. The ridiculous med-pass scramble,  BS documentation, constant interruptions so nothing is seamless.  Honestly it feels like a horrible day at the SNF where I used to work. 

Long story short:  I was offered a per diem in the ED of the same hospital and took it. I love it for all the reasons you listed! But now I too am struggling with the feeling of betrayal to the manager that hired me on med/tele, not to mention all the great nurses I work with there.

But you have inspired me to go back to where things make sense. Where I'm happiest as a nurse. Thank you for the push. 

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43 Posts; 1,296 Profile Views

Love the above post! 

I'm glad my post helped you. And I agree about the interruptions. The AM med pass is already hard for me to get used to, and thats the same time the docs come to round and ask you questions. And I dont have the answer to some of them because I didnt even have a minute to sit down and read the notes. I have to get on the floor to get my meds on time which means I have to start right after report without wasting a minute. And during med pass the patient/family want you to get this and that, and I have to because I have to deal with them for a whole 12 hours, and probably have them again tomorrow! And by the time I sit down to do my AM documentation, its only an hour or 2 before I have to do my afternoon documentation. 🙄 Ugh!! If I have to work like this I might as well be busy in the ER! I feel like in ER I was thinking more critically, prioritizing, and actually managing my time more efficiently. And by the time the patient/family start annoying you, you get them the heck out! 

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