Floor-nursing-to-ED: lessons learned

AvaRN22, MSN, RN · Oct 19, 2014

I once read another poster in this forum state that the "ED can break you down, chew you up, and spit you back out."

I was recently spit back out after being broken down and chewed up and I would like to take the time to share my lessons learned.

I think PCU or med-surg tele at the very least would be a good background to have when looking to transition to the ED. The ICU would be appropriate too because I know ICU nurses have a lot of knowledge and skills that are applicable to the ED. I think that PCU is great experience to have because you are dealing with at least 3-4 high-acuity patients at a time, which is similar to the acuity and RN-to-patient ratio of the ED.

I recently transferred to the ED from an OB floor and that was a bad idea, given the type of training program and it was (mostly on-the-job training within an ED with a high turn-over rate). I have done PCU/tele nursing before in the past and it would have been the best launching point to transfer to the ED, rather than from my OB floor.

Lessons learned if you want to transition to the ED from the floor:

- Make sure you have current tele skills

- Get your PALS, ACLS

- Study up on how to do focused assessments, but know that they come with time

- Try taking an ED nursing course to fill-in knowledge gaps. I found a local one through a university, but there's one through ENA too.

- Be reassured that it is a tough transition; you won't feel "fast enough" in the beginning, but keep at it.

- Don't worry that you don't have "good IV skills." I understand that we don't start IVs on every single one of our patients on the floor. In the ED, pretty much everyone gets an IV. Surprisingly, your IV skills come with weekly practice and confidence.

- Find a mentor, a confidant.

- Find out if the preceptors are trained and what the expectations are for each week, to make sure you are on track.

- Identify your resources at the beginning of your shift. You won't know everything when you come off orientation and this is normal; know who you can turn to.

The ED is like floor-nursing at hyper-speed. I was there for a little over a month and it was awesome. I have a lot of respect for ED nurses and look forward going back one day in the future.