ER Nursing vs Floor Nursing

Sanuk · Nov 17, 2011

With the disclaimer that this is JMO:

1. Qualities: I would say assertiveness - you need to be able to anticipate what will be done as more times than not by the time the physician is there, you've done most of the workup.

2. Aside from those, maybe TNCC

3. Can't answer that for you. It will depend on how you cope with stress. All nurses have stress, just different ones.

4. :lol2: :lol2: :lol2:

5. Eh. Family can be horrible on the floor too. At least in the ER you don't have to deal with them for long (fingers crossed)

6. Again, I can't speak for you. I love it, but it's not everyone's cup of tea. Try it though, it can't hurt and you may love it.

DixieRedHead, ASN, RN · Nov 17, 2011

--What qualities do I need to be an ER nurse? A Level head, good feet, the ability to think critically and react quickly without panicking

--What are the certifications that I need to complete (aside from BLS/ACLS/PALS) to be more marketable in applying in the ER and the skills (and attitude) that I need to master to survive being in the ER? TNCC, then CEN after a while. Don't be too easy to get your feelings hurt. ED nurses are a particular breed not known to be er um shy about saying what they mean.

--Aside from saving lives (which is the most important part), does the level of stress EQUALS the pay? The stress level is what it is.

--Are the doctors nicer in the ER? They expect more but give you more respect, in my experience.

--How do u deal with (multiple) nasty family members in a professional way on top of being busy with other patients? Say Ma'am and sir, then call security.

--Is it worth it if i leave floor nursing and be an ER nurse? YES YES YES YES. Think about how much of your day is spent clarifying orders, calling doctors, trying to get orders. relaying complaints. In the ED all that is easy, the doctor is IN.

Y

RN_survivor · Nov 17, 2011

With the disclaimer that this is JMO:
1. Qualities: I would say assertiveness - you need to be able to anticipate what will be done as more times than not by the time the physician is there, you've done most of the workup.
2. Aside from those, maybe TNCC
3. Can't answer that for you. It will depend on how you cope with stress. All nurses have stress, just different ones.
4. :lol2:
5. Eh. Family can be horrible on the floor too. At least in the ER you don't have to deal with them for long (fingers crossed)
6. Again, I can't speak for you. I love it, but it's not everyone's cup of tea. Try it though, it can't hurt and you may love it.

THANKS, Sanuk!! :)

1. i agree that u gotta think quick and anticipate what needs to be done when the patient comes in. hopefully, i get a good training so the doctor wouldnt have to yell at me in front of the patient haha;

2. im having a hard time finding a TNCC course

3. thats true. im a night shift nurse, so i dont know the stress level in the ER at night haha well i guess thats when we get the banana bag people on weekends haha;

4. to see is to believe haha;

5. i agree. u only deal with them for a few hours (well ... it can be a while, though. depends if all beds on the floor is "dirty") haha

6. i think i'll give it a try! thanks!!

Sanuk · Nov 17, 2011

I will concur with dixieredhead that ER doctors usually work more collegially with the nurses - we're all in it together kind of thing. If you demonstrate competence, they learn to trust you and value your judgement. As to whether that makes them nicer, not so sure. As far as TNCC, if you have a big hospital system near you, just call up and ask for their nursing educater / department and ask if they allow non-emplyees to take TNCC there. Usually they do, they just charge you more.

Good Luck and let us know how it goes!

darkangel83 · Nov 17, 2011

I haven't been an ER nurse for very long...but I'll offer my opinion anyways :)

--What qualities do I need to be an ER nurse?

You probably already have a lot of them from floor nursing! I agree that assertiveness is EXTREMELY important! The ability to think critically, calmly, and anticipate orders will all serve you well :)

--What are the certifications that I need to complete (aside from BLS/ACLS/PALS) to be more marketable in applying in the ER and the skills (and attitude) that I need to master to survive being in the ER?

All of those and TNCC

The most important things I am learning are to let the trivial things roll off your back and focus on what is important and to always listen to your gut!

Ask for help when you need it!

--Aside from saving lives (which is the most important part), does the level of stress EQUALS the pay?

Depends on how you handle stress. The stress is the reason I work in the ER :)

However, there are some days you can't pay me enough to stay for an extra few hours of OT!

--Are the doctors nicer in the ER?

I agree...they expect a lot more, but I receive more respect in return. I find our docs value our opinion and are often willing to teach us new things. I feel I work WITH them in the ER...on the floor the docs often made me feel like I worked FOR them.

--How do u deal with (multiple) nasty family members in a professional way on top of being busy with other patients?

If they have a valid complaint and we are having a 'grown-up' discussion, I will give them 5 minutes of my time. If they are being rude/abusive/argumentative I give them about 30 seconds, which usually includes me telling them I'd be willing to have a civil discussion with them when they have calmed down. If they don't calm down...security is just a few steps away!

--Is it worth it if i leave floor nursing and be an ER nurse?

Only you can answer that question! Give yourself some time to adjust...it is VERY different! At this moment...I will NEVER return to floor nursing! I love all of the craziness/spontaneity/variety of the ER!

Good luck!

RN_survivor · Nov 17, 2011

--What qualities do I need to be an ER nurse? A Level head, good feet, the ability to think critically and react quickly without panicking
--What are the certifications that I need to complete (aside from BLS/ACLS/PALS) to be more marketable in applying in the ER and the skills (and attitude) that I need to master to survive being in the ER? TNCC, then CEN after a while. Don't be too easy to get your feelings hurt. ED nurses are a particular breed not known to be er um shy about saying what they mean.
--Aside from saving lives (which is the most important part), does the level of stress EQUALS the pay? The stress level is what it is.
--Are the doctors nicer in the ER? They expect more but give you more respect, in my experience.
--How do u deal with (multiple) nasty family members in a professional way on top of being busy with other patients? Say Ma'am and sir, then call security.
--Is it worth it if i leave floor nursing and be an ER nurse? YES YES YES YES. Think about how much of your day is spent clarifying orders, calling doctors, trying to get orders. relaying complaints. In the ED all that is easy, the doctor is IN.
Y

THANKS, DixieRedHead!! :)

--thanks for the tip! i think im gonna have to work on cutting down my panic attacks haha i guess when i build more confidence and ER experience, i might loosen up a little bit ... i need to practice haha

--yup, ED nurses are pretty straight!! they are kind, yet firm (ok fine, sometimes aggressive haha jk!) as for the certifications, i am trying to find a TNCC course and a book for CEN -- hopefully, ill pass!

--i guess thats true that they give u more respect because you guys are a team in the ER :) well, thats cool :)

--*****! true that! call security and ship them out (to their homes or on the floor!! haha -- and then WE deal with them UGH! haha)

--yes, u have a point about this MDs are everywhere in the ER versus the floor where u gotta page them (& i work at night) so i cant count how many times i got yelled at on the phone at 2 in the morning because they forgot to order a pain medication to a post-laminectomy patient.

THANKS! i think im gonna give ER a try! :) :)

8mpg · Nov 17, 2011

I have worked in an ER for 3 years then went to med/surg and now ICU

ER is a great place just be aware that its not all "saving lives". Unless you work a major trauma hospital and are on that side of the ER, its not all THAT exciting. You will see some cool stuff, but realize that many ER's are used as after hour clinics by people with insurance and all day clinics for people without. You will meet many ungrateful people and eventually become jaded with these people. ER is all about turn around time. It is nice to only see some of the patients for 30 minutes to say 2 hours. ER is a totally different mentality.

You need to be able to stay calm and collected during any emergency. One thing I learned early on from my favorite ER doc... he said "Im not dying...what is there to freak out about". When people code and what not, you need to stay calm and think clearly about what you are doing. You cannot get caught up in the emotion. People think that ER staff can be rude or wrong because they can joke around and smile during a CPR. Its just one of those things that you cannot let ruin your day when someone dies.

Since ER is considered critical care, Id apply to places with internships and learn the formal education that goes with it. Dont just get thrown into it and get your 60 days of following.

RN_survivor · Nov 17, 2011

I haven't been an ER nurse for very long...but I'll offer my opinion anyways :)
--What qualities do I need to be an ER nurse?
You probably already have a lot of them from floor nursing! I agree that assertiveness is EXTREMELY important! The ability to think critically, calmly, and anticipate orders will all serve you well :)
--What are the certifications that I need to complete (aside from BLS/ACLS/PALS) to be more marketable in applying in the ER and the skills (and attitude) that I need to master to survive being in the ER?
All of those and TNCC
The most important things I am learning are to let the trivial things roll off your back and focus on what is important and to always listen to your gut!
Ask for help when you need it!
--Aside from saving lives (which is the most important part), does the level of stress EQUALS the pay?
Depends on how you handle stress. The stress is the reason I work in the ER :)
However, there are some days you can't pay me enough to stay for an extra few hours of OT!
--Are the doctors nicer in the ER?
I agree...they expect a lot more, but I receive more respect in return. I find our docs value our opinion and are often willing to teach us new things. I feel I work WITH them in the ER...on the floor the docs often made me feel like I worked FOR them.
--How do u deal with (multiple) nasty family members in a professional way on top of being busy with other patients?
If they have a valid complaint and we are having a 'grown-up' discussion, I will give them 5 minutes of my time. If they are being rude/abusive/argumentative I give them about 30 seconds, which usually includes me telling them I'd be willing to have a civil discussion with them when they have calmed down. If they don't calm down...security is just a few steps away!
--Is it worth it if i leave floor nursing and be an ER nurse?
Only you can answer that question! Give you yourself some time to adjust...it is VERY different! At this moment...I will NEVER return to floor nursing! I love all of the craziness/spontaneity/variety of the ER!
Good luck!

THANKS, darkangel83!! :)

--that's true! being calm on a crazy / busy unit while your brain is doing its critical thinking can be a challenge, so yup i guess its all a matter of having the real experience of it to survive! :)

--yup, i am trying to find a TNCC course; and i hope that i get to work with helpful nurses who will train me good and not those old(er), experienced, grumpy nurses who does nothing but whine and judges you and then asks you, WHAT SCHOOL DID YOU GRADUATE FROM??! ugh OMG i cant stand them.

--good job! u convert that stress to some form of adrenaline rush and save people's lives!! :) but ER gets paid more right compared to floor nursing?

--i agree when u said nurses usually work FOR them on the floor! i guess its really different when you're WITH them on the actual unit :)

--phew! we have those people on the floor too but i guess they're more anxious down there because its THEE "emergency department" haha

--im gna take the challenge, follow "my gut" as u said haha and try ER nursing! i guess dealing with different people everyday helps u learn more in the world of nursing! :)

thanks!! :) i really appreciate it!

RN_survivor · Nov 17, 2011

I have worked in an ER for 3 years then went to med/surg and now ICU
ER is a great place just be aware that its not all "saving lives". Unless you work a major trauma hospital and are on that side of the ER, its not all THAT exciting. You will see some cool stuff, but realize that many ER's are used as after hour clinics by people with insurance and all day clinics for people without. You will meet many ungrateful people and eventually become jaded with these people. ER is all about turn around time. It is nice to only see some of the patients for 30 minutes to say 2 hours. ER is a totally different mentality.
You need to be able to stay calm and collected during any emergency. One thing I learned early on from my favorite ER doc... he said "Im not dying...what is there to freak out about". When people code and what not, you need to stay calm and think clearly about what you are doing. You cannot get caught up in the emotion. People think that ER staff can be rude or wrong because they can joke around and smile during a CPR. Its just one of those things that you cannot let ruin your day when someone dies.
Since ER is considered critical care, Id apply to places with internships and learn the formal education that goes with it. Dont just get thrown into it and get your 60 days of following.

THANKS, 8mpg! Great advice of a real picture in the ER! :) so.. where would u suggest that i get internships / formal education from? do hospitals offer that? or is there like a training center for it?

darkangel83 · Nov 17, 2011

--good job! u convert that stress to some form of adrenaline rush and save people's lives!! :) but ER gets paid more right compared to floor nursing?

I'm not sure how it works in the US...where I work in Canada our pay scale is based on years of experience, not necessarily the area you work in! So all 1st year nurses will be paid the same...all 2nd year paid the same...etc.

shoegalRN, RN · Nov 17, 2011

I am an ER nurse as well as SANE, so I will try to answer some of your questions for you.

--What qualities do I need to be an ER nurse?

You need to be assertive. You need to be able to think fast on your feet, and anticipate for the doctor will do. This is where it differs from the floor. You will not have a diganosis on your patient, you need to know your protocols like the back of your hand, and you need to be take initative. By the time the doctor gets in to see your pt, you should already have your pt worked up. Try to stay one step ahead. Also, you need to keep a level head in a REAL emergency (trauma, code, STEMI) and have a sense of urgency. You can't get flustered during critical times.

--What are the certifications that I need to complete (aside from BLS/ACLS/PALS) to be more marketable in applying in the ER and the skills (and attitude) that I need to master to survive being in the ER?

You will need all those and TNCC if your hospital is a trauma center. Even if your hospital is not trauma, it's still good to have TNCC. Also go for CEN about a year or so after being in the ER.

--Aside from saving lives (which is the most important part), does the level of stress EQUALS the pay?

In all honesty, I think I handle the stress very well. The be honest, I work well under pressure and I love the choas, the trauma and all the drama that comes with working in the ER. I work weekend nights and look forward to going to work every weekend. I know I'm going to be well entertained and it's worth the pay for me.

--Are the doctors nicer in the ER?

I work in a Level I trauma teaching hospital and I deal with residents and attendings. We work together as a team. The residents sometimes look to the nurses for advice. They will come to trust you, as well as the attendings.

--How do u deal with (multiple) nasty family members in a professional way on top of being busy with other patients?

Security.

--Is it worth it if i leave floor nursing and be an ER nurse?

Yes! I don't think I could go back to floor nursing, even if I wanted to. I sometimes work Stepdown and I count the minutes to the end of the shift.

YES, i need your help. Doesnt matter if you're a new grad, experienced or retired :) Your advices, opinions and suggestions will be greatly appreciated!!

THANKS!:heartbeat