Floor to ED transition

BecomingNursey · Jun 20, 2015

Hi there! What type of unit do you work on now?

I went straight from school into the ER so I haven't experienced this myself, but other nurses that I work with have told me that it was quite an adjustment for them to come to the ER from the floor. What they've expressed to me as being difficult was mainly the time management and prioritizing your care. Such as you have a chest pain and you have a shortness of breath? Which do you assess first? On the floor you don't have to think like that. Your care is based around things like the tech is giving them a bath now so I should go do a skin assessment and go ahead and give the meds while I'm in there.

But you can do it. There's always an adjustment periods when it comes to switching specialties but it's nothing that can't be learned :) Good luck!

LadyFree28, BSN, LPN, RN · Jun 20, 2015

I worked in a Post-Acute environment before working in the ED; some of the "habits" I had to relearn:

Prioritizing the most acute person: early on, I would get anxious, worrying about my other pts; what helped was delegating to other nurses and if it was something a Tech could do, I would ask the Tech to so so, making it easier to manage my time and pt flow.

Delegating effectively and/or lasting for help: most of time I had to do it ALL, so I would find myself thinking I had to do it all for my pts; I learned quickly to delegate and keep everyone in the loop; one of my physician colleagues pearls is "a talkative nurse is a knowledgable nurse." I learned quickly to keep providers in the loop, keep bouncing off plans of care and make sure my pts were getting what they needed in a timely manner.

Those are the ones I can think of; I think it is possible to relearn or rather, improve on one's practice in order to bridge their foundation to the specialty; one should still have good time management, good assessment skills and good communication skills. :yes:

guest901464 · Jun 20, 2015

Hi there! What type of unit do you work on now?
I went straight from school into the ER so I haven't experienced this myself, but other nurses that I work with have told me that it was quite an adjustment for them to come to the ER from the floor. What they've expressed to me as being difficult was mainly the time management and prioritizing your care. Such as you have a chest pain and you have a shortness of breath? Which do you assess first? On the floor you don't have to think like that. Your care is based around things like the tech is giving them a bath now so I should go do a skin assessment and go ahead and give the meds while I'm in there.
But you can do it. There's always an adjustment periods when it comes to switching specialties but it's nothing that can't be learned :) Good luck!

I'm actually still in school and would like to go straight into the ED through a new grad program/residency. BUT, if I do not get that opportunity I was wondering what type of actions or bad habits I should be cognizant of not picking up on a floor? I have a pretty good connection with a manager on an Intermediate/Trauma floor and that's where I would start if I can't get into a residency.

Collor · Jun 20, 2015

Having worked med-surg for a few years before heading to ER....my advice is to not make the ER wait to give report. When I worked med-surg, even if the nurse was available to take report, there was some pleasure in telling the ER nurse they have to call them back to get report. (my hope is that this happens less frequently, but still...grrr)

PacoUSA, BSN, RN · Jun 22, 2015

The ER always seems to call when I'm in an isolation room with a C. diff + patient pushing Lasix ... ðŸ˜’

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FlyingScot, RN · Jun 22, 2015

I think one of the biggest challenges is the transition from a "head to toe" assessment to the ED "focused assessment". In general in the emergency department we just don't do head to toes. There isn't time and it isn't needed. We also don't do pressure sore assessments. I can't tell you the number of times I have report only to have a horrified nurse ask me why these things weren't done. It's because this is the emergency department not the floor.

pugmom79 · Jun 22, 2015

I worked as a floor nurse for 2 years. A couple of things I had to adjust to (which wasn't too hard since it's why I wanted er in the first place)

Autonomy to make decisions and do interventions. This rocks. No more " I need to get an order for the lifesaving O2 I put on them"

Focused assessment. Unless their stomach is distended and their chief complaint is constipation/abd pain, I don't care when they last pooped.

Learning that your patient with chronic Htn who is here for another reason is probably not going to get their BP addressed in the ER of 190/100 unless they are symptomatic. The floor nurses always freak out over this saying this is unstable and we have to address it down here.

Skin intact. Again, unless my pt is a little old lady from a nursing home who looks like ****, or is here with a cc related to a wound, I'm not doing a great skin assessment. I'm more worried about their stemi/stroke alert/sepsis/trauma etc.

Take report when we call!! My other hospital didn't let us not take report when er called. If we couldn't, charge had to. When we have 25+ in the waiting room, and have a ton of holds, we need the beds moved asap. You will be capped out at 4 pts etc. They keep coming in the ER, and we flex up when we can to get people seen faster. Meaning we really can't wait the 10 minutes for you to call us back. Triage needs that bed for the little old septic lady who came in, or the medics need it for the guy with the open fracture. I worked floor. It sucks to get pts at change of shift or when we are in a contact room etc. But you have some time to get them settled, and you will be maxed out at your assignment. Our pts keep coming and don't stop.

Please don't give us attitude when you ask an obscure question (or see above about skin/BM) and we say we don't know. It's not cause we are bad nurses. We just have a different priority.

Good luck!!!

AJJKRN · Jun 22, 2015

Hi there! What type of unit do you work on now?
I went straight from school into the ER so I haven't experienced this myself, but other nurses that I work with have told me that it was quite an adjustment for them to come to the ER from the floor. What they've expressed to me as being difficult was mainly the time management and prioritizing your care. Such as you have a chest pain and you have a shortness of breath? Which do you assess first? On the floor you don't have to think like that. Your care is based around things like the tech is giving them a bath now so I should go do a skin assessment and go ahead and give the meds while I'm in there.
But you can do it. There's always an adjustment periods when it comes to switching specialties but it's nothing that can't be learned :) Good luck!

I don't think you meant to be dismissive or rude in anyway but really?!? I'm guessing those nurses who used to work the floor didn't work in high acuity settings. I think my day (or night shift) would be pretty damn boring if I only had to worry about interrupting a Pt's bath time, instead of balancing out preventing three out of five (or sometimes six) of my Pt's from coding on me. Sheesh! I would think that the biggest transition would be the differences in charting requirements, assessments needing to be more focused (as a PP already pointed out), and the amount of turnover of Pt's to get used to. I think my "brain" would be significantly different as well or just completely thrown out the window. Moving from an all adult population to one of mixed ages would freak me out too (which is why I stay in adult med-surg).

BecomingNursey · Jun 22, 2015

I don't think you meant to be dismissive or rude in anyway but really?!? I'm guessing those nurses who used to work the floor didn't work in high acuity settings. I think my day (or night shift) would be pretty damn boring if I only had to worry about interrupting a Pt's bath time, instead of balancing out preventing three out of five (or sometimes six) of my Pt's from coding on me. Sheesh! I would think that the biggest transition would be the differences in charting requirements, assessments needing to be more focused (as a PP already pointed out), and the amount of turnover of Pt's to get used to. I think my "brain" would be significantly different as well or just completely thrown out the window. Moving from an all adult population to one of mixed ages would freak me out too (which is why I stay in adult med-surg).

I wasn't being rude or demeaning of floor nurses in any way. I totally and completely respect floor nurses and couldn't imagine doing what you do. But it is two totally different ways of thinking.

The OP was asking what challenges nurses face coming from the floor to the ED and I answered by telling the OP what nurses that I work with have told me regarding their experience.

Lev, MSN, RN, NP · Jun 24, 2015

I went from med surg to the ER. The hardest part for me was to get out of my routine and stop being so task/documentation oriented. I came from a unit with very heavy charting requirements. A big part of my focus had to be documentation and doing all the tasks that needed to be documented and checking it all off my mental list if I wanted to leave at a decent hour which was usually 20 minutes to half hour after we were allowed to leave at 730. In the ER, prioritization is so so important. It is also important in med surg and its important not to lose sight of it when things get crazy. (I don't mind toileting patients but when your patient is saying they're going to wet themselves if they don't use the bathroom NOW, and I just got a new patient next door or if I just grabbed some labetolol for my patient with a critically high BP, I scream internally. Even worse if I have to clean a commode for them. This is not why I went to nursing school. OK end rant.) Anyhow, OP. Unless your job requires it and in med surg med times are stressed, be less concerned about making sure your patients got their multivitamin or other non critical meds exactly on time and more on preventing harm. Remember that your critical patient trumps all others and utilize your fellow nurses and charge nurse when you need help. I didn't think anything could be crazier than med surg until I went to the ER. I've gotten 3 new patients in the span of 45 minutes. Thankfully I have truly awesome coworkers who helped me out. Also, not every ED does the focused assessment thing for all their patients. In my ED ESI 1-3 patients require a full head to toe assessment. But yeah, I'm not asking about last BM unless they're having abdominal pain, nausea, constipation, or diarrhea.

anneuhbanana · Jul 1, 2015

Well, as someone who moved from floor to ED... the best advice I can give is just to fly by the seat of your pants. Don't expect routine, and don't get upset when things change. It was the best thing I ever did, I've honestly become a better nurse because of it.