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Floor nurse to ER nurse. Help please!

Emergency   (7,422 Views 20 Comments)
by BrayaRN BrayaRN (New Member) New Member

BrayaRN has 2 years experience and specializes in Cardiac, NICU, ED.

3,674 Profile Views; 78 Posts

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Hi everyone,

I am completely new (8 weeks into orientation) to ER nursing. My previous experience is mostly cardiac/telemetry. I also did a short stint on a general medical floor and in a NICU.

I see many of the threads on this particular board are devoted to new grads. I have been a nurse for a little under 3 years, so I am not a new grad but still a fairly new nurse.

I am curious as to what experienced ER nurses to see as floor nursing habits and how to break them as well. My typical floor patient load was 4 patients and this is the typical assignment in my new job.

My difficulties appear to be:

Getting too attached to the one patient that is respectful and actually sick. I tend to dote on them more and meet their needs probably more than I actually have time for. Yet, I find the care part fulfilling.

Not getting assertive enough with the "faking" patients. These include fake seizures, fake pain, and the patient that fakes somnolence as well. I do have a quiter temperament, but I think my whole 100lbs holds me back as well.

Not being anywhere close to organized. Assessments are due at different times on all patients. I can look and see a patient is not due for 2 hours, but when I think about it again 4 hours have passed and I have to backdate.

Any suggestions or other things to watch out for? :nurse:

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MassED has 15 years experience as a BSN, RN and specializes in ER.

1 Article; 2,636 Posts; 20,204 Profile Views

I believe there is a thread on here somewhere specific to this topic. I want to say it was from an ICU nurse transitioning to the ER. I'll see if I can find it and link it.

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LouisVRN is a RN and specializes in Med/Surg.

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How do you know anyone is "faking" anything? Especially pain? While patients may not always manifest pain the same way I'd be hard pressed to know someone if definitely faking it. Also I hope by back dating you don't mean that you are charting your assessment done two hours late as being done on time...

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EmmyBnurse has 5 years experience and specializes in CCU.

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Sounds like you need to rearrange your idea of time management. Things are paced very differently in the ER and times are not as set in stone as they are on the floor (ex.assessments every 4 hours, vitals every 8). If you have not checked in on an ER patient in 4 hours you need to work on prioritzing as well. ER is a highly specialized area and it will take time to adjust to the new role. Ask lots of questions and openly communicate with your co-workers so they can help you if you are behind. My experience with ER staff is that they are usually great team players, use them.

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walk6miles specializes in ICU of all kinds, CVICU, Cath Lab, ER..

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here ttt

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BrnEyedGirl has 18 years experience as a BSN, MSN, RN, APRN and specializes in Cardiac, ER.

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Time is always a hard thing to adjust in the ER. You can't really schedule anything or have the same kind of routine you had as a floor nurse. I understand your dilemma with the really sick patients. It is very frustrating to have a very ill, sweet little lady that really needs your time,...then the drunk in the next room that you see at least once a week who demands all of your time. I also agree,..you often know exactly who's faking,...usually they were also faking the last 8 times you took care of them,...and then you have the ones who while maybe aren't faking,..are really over exaggerating. It seems that people seem to forget that they are in the ER,..we have emergencies and yes I agree that your sprained ankle probably hurts like the dickens,...it takes a back seat to the MI and the trauma that needs to get to the OR NOW!

Sometimes all you can do is smile and move on. It takes awhile to get used to the pace,...remember you have to stay very c/o focused and some things just have to wait. You'll get there,...watch some of the other nurses you know are good at their jobs,....ask questions,....you'll get your own system and work it out! Best of luck to you! I love the ER and don't see myself working anywhere else for a very long time.

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PAERRN20 has 3 years experience and specializes in ER.

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Grow a thick skin. Don't be afraid to speak up.....to the physician OR the patient. Sometimes you just have to say it like it is even if they don't want to hear it.

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20 Posts; 1,156 Profile Views

OP, I am also about 3 years into nursing, I've done it all in the ER though. I am constantly running my patients through my head, thinking what's next, always looking in their rooms as I pass, and I make a point about every hour to give them an update, even if I just say we are still waiting on results, how are you feeling, etc. I don't know how it is where you are, but the ERs I have been in have one major assessment when the patient gets there, and then just charting response to treatment, nurses notes, etc after that. I see my patient every hour, even if I don't talk to them, and I chart it. Are they on the phone, conversing with family? Up to the bathroom, how is their gait. pain meds given, etc. Assessments are more focused and quick. Often you can ask your co worker or CN to check on a patient for you while you are in the sick patient's room. Usually they don't mind and can get the patient simple things or communicate back to you if they need something more complicated. Hopefully your doctors will move patients through fast enough that you don't have too many hours of patients holding in the ER. Good luck!

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EmergencyNrse has 17 years experience and specializes in Emergency Medicine.

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hi everyone,

my difficulties appear to be:

getting too attached to the one patient that is respectful and actually sick. i tend to dote on them more and meet their needs probably more than i actually have time for. yet, i find the care part fulfilling.

any suggestions or other things to watch out for?

welcome to the er!

time management will be your biggest asset. spending extra time with a needy patient? sure but it will cost you.

bottom line is that you just don't have the time. you don't. people are waiting 4-6hrs to get that bed.

assessment, treatment and reassessment. it's perpetual...

there is no lull in your duties unless it's slow. done with one patient you get another immediately.

prioritization and critical thinking come next. you have to have a "sense" for the bs.

i caution you to say "fakers" because of the backlash you will receive from those that just don't know.

get in, assess, charting... be as brief as possible and look for orders to treat. you will get a feel for those that are there for knee pain x2 years, dental problems, chronic stuff that is far from life-threatening and put them on the back burner.

you have to be an a.d.d personality not o.c.d. you have little time to be thorough like in other areas. sometimes it serves that my "reassessment" happens as i run past a room and see someone sitting upright and still breathing.

if you have techs that can grab your vitals then your golden. monitored patients get q30 vitals set on auto so if i need to do it myself i know i always have fresh vitals when i blow through. really, no time for that care & comfort stuff if yours is a busy er.

is it right? no but that's the nature of emergency medicine. until they come up with a better way of screening non-acute, non-emergency patients and divert them to other areas you just can't spend the time you're looking for with the ones that need it.

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MassED has 15 years experience as a BSN, RN and specializes in ER.

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How do you know anyone is "faking" anything? Especially pain? While patients may not always manifest pain the same way I'd be hard pressed to know someone if definitely faking it. Also I hope by back dating you don't mean that you are charting your assessment done two hours late as being done on time...

I believe OP means there isn't time to chart, so you obviously have done your assessment, but either edit the time on your computer documentation, or chart the time you DID the assessment. That is ER nursing. You don't have time to jot everything down when you do it. You keep notes and chart when you can. That is the reality. It's a whole different animal than any other area of nursing.

And we all have our suspicions for those ones "faking" their pain for narcotics. Back pain, abdominal pain, etc. You only REALLY know after they've had a million dollar work up and no diagnosis, but received tons of narcs up until they're discharged. And you were the one that called it (if not out loud, but in your head) that this patient had nothing acutely wrong from the moment they hit the room. I trust my instincts and they do not steer me wrong.

Edited by MassED

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sistasoul specializes in neuro/ortho med surge 4.

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This thread confirms my susupicions that no matter what area of nursing you work in it is insane. Not enough time for charting and no time for TLC. It is this way on the floors also.

System seems to be broke don't ya think?

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