Forced to Orientate to ER

Super_RN, BSN, RN · May 20, 2005

Hi :) I've been a nurse for 2 years. My current position is in the replacement pool and I work Medicine, Surgery and ICU (for the past year). I recently got a letter saying that I would be orientating to ER. I feel that I just do not have the experience to work in ER yet. I do not have ACLS or TNCC and I expressed my concerns in writing to my nursing supervisor and the response I got was that I had no choice, I had to orientate. I have since contacted my union and will be writing another letter to my supervisor and director of nursing. Any input would be greatly appreciated :)
Thanks a Bunch!!

I know how you feel, believe me! I have only been a nurse for 2 years, I work in ICU. Howevever, I was forced to orient to ED after about 6 months or so. Our union does nothing to protect us, every line has something about administration seeing appropriate and such. My advice is to always always always fill out an assignment despite objection form, to cover your butt!

:) Jaime

CHATSDALE · May 20, 2005

Try and get it in writing that they will upgrade your qualifications within a specific range of time...this may be a blessing in disguise...the more that you know and the more versatile that you are the more valuable you will be both to this employer and to the future one if you choose to move

pricklypear · May 20, 2005

I got shoved into ER from ICU without any orientation. Just a quick this color means this, that color means that, if it's turned sideways you do this, blah.blah.blah. Got it? I found that for the most part, the patients that came into the ER were not that bad. In one shift we might get a few really sick people, but mostly headaches, I've had this cough for 2 weeks (it's 2am on Saturday). All I can say is make sure that they give you the easy stuff. Our ER staff is pretty good about that. But...we're not a trauma center. Anybody that bad gets helicopter ride.

Demonsthenes · May 21, 2005

Any medical person who takes on a medical task normally reserved for a person especially trained and certified for that position must provide the same standard of care as one who has the training, experience, and education requisite for the job.

Thus an R.N. who provides care which only a doctor is supposed to do, must live up to that same standard of care of a doctor.

If you are sued for malpractice because of negligence, your employer will be held liable under the doctrine of "respondeat superior", if negligence is proved. That is, your employer will be held legally responsible for your negligence. However, you, also, will be named in the law suit and you, also, may be subject to damages for medical malpractise.

In any case the employer must pay damages because of your not providing the requisite standard of care. The employer can also sue you for the damages assessed against him or her as a result of the same.

It's a "win win" for the employer as the employer's damages are probably covered by insurance and your assets. It's a "lose-lose" for nurses and other medical professionals who consent to do the same.

dm2 · May 21, 2005

Don't know alot of details but...... was recently told as of July 1, it was against JCAHO regulations to function in ED without ACLS current, not even for a shift. Our hospital is shuffling to get all current asap! Are you ACLS? If no, perhaps you have an easy out.

I love ER and have worked it many years (probably before you blessed this world) I want to be a triage queen when I peak at my career!

But I do merit great value in proper training and preceptorship guidance closely as you learn a specialty! We save lifes and that is worth preparing for!

Several great classes are out ther for teaching you the tricks of the ED nurse trade. TNCC, ENPC, ACLS, ATLS...... Certainly rarely a dull moment in the ED!

I came to ED from a 5 yr background iin adult ICU and ever so brief 6 months in a peds ICU. I think that was a great advantage in the criitical care aspects of ED (But alas I find it a fast paced knowledge base to keep up with these days!)

I wish you luck in your position of choice and adventures thru the world of nursing, young one! Welcome!

PS I have NEVER done but 2 shifts on a medical/surgical unit! Was inept when they pulled me there! Glad there are nurses for that too!!!! Such a blessedly diverse profession we are in!

Dinith88 · May 21, 2005

Hi :) I've been a nurse for 2 years. My current position is in the replacement pool and I work Medicine, Surgery and ICU (for the past year). I recently got a letter saying that I would be orientating to ER. I feel that I just do not have the experience to work in ER yet. I do not have ACLS or TNCC and I expressed my concerns in writing to my nursing supervisor and the response I got was that I had no choice, I had to orientate. I have since contacted my union and will be writing another letter to my supervisor and director of nursing. Any input would be greatly appreciated :)
Thanks a Bunch!!

It's surprising that you are comfortable in ICU but fearful of the ER because you 'don't have acls'. If you've been floating to ICU for the last year, your establishment should've already gotten that taken care of...or at least lined it up (shame on them!). When you float to ICU, what patients do they give you???...sounds like it may be a burden on the other nurses getting 'the hard ones'.???

Regardless, if you're comfortable working ICU you obviously didnt just jump in and swim. It took more than a few shifts i'm sure.

It'll be the same in ER.

Over the years i've floated to ER a handful of times...and yes if it's busy it can be absolutely nuts(KWAZY!). But i think you're wrong to be so wigged-out about it.

When the sickest of the sick come to the ER, where do you think they end up?? Yup...right in your ICU where you already work. Also, there'll always be a Doctor in the ER...so you'll be able to defer to him/her immediately if an issue arises that you're nervous about.

The hardest thing for me to adjust to (when the ER's hoppin) is the speed the people are processed. And i still get headaches thinking about all the crying kids, freaked-out parents, drunks, and hypochondriacs (sp?) that cram the waiting area. And if a big trauma or coding person comes through the doors, they wont assign these folks to you if you can't handle them. Thats when the ER teams really shine anyway...

You'll be surprised that the vast majority of ER patients are of a much more mundane variety than the patients you see on all the TV shows.

And (beleive me when i say this) if you're already caring for unstable patients in ICU, the ER will be much less intimidating than you're imagining it to be...

dm2 · May 21, 2005

You'll be surprised that the vast majority of ER patients are of a much more mundane variety than the patients you see on all the TV shows.

And (beleive me when i say this) if you're already caring for unstable patients in ICU, the ER will be much less intimidating than you're imagining it to be...

well said!

allnurses Guide · May 21, 2005

I think her point is that she is being forced to do something she doesn't want to do. And that is simply wrong.

When you signed on was there anything said about orienting to other departments? If so, you may be stuck, although I can't imagine being able to work legally in the ER w/o at least ACLS. I say stuck but actually you do have a choice - you can find another job.

We aren't slaves to our jobs, at the beck and call of whoever wants to tell us what to do.

We are professional nurses. And we can say no.

steph

nursing 101 · May 21, 2005

I think her point is that she is being forced to do something she doesn't want to do. And that is simply wrong.
When you signed on was there anything said about orienting to other departments? If so, you may be stuck, although I can't imagine being able to work legally in the ER w/o at least ACLS. I say stuck but actually you do have a choice - you can find another job.
We aren't slaves to our jobs, at the beck and call of whoever wants to tell us what to do.
We are professional nurses. And we can say no.
steph

Hi Stevielynn,

I admire your response because all I hear from everyone (instructors, nurses) is that you can't turn down or do this. We are professionals and we do have a right to say no! Yes we are trained as nurses but just like a mother if we don't have that safe gut feeling about handling a patient I don't think we should do it.

I just graduated from nursing school and I am scared of all the things that "I have to do" or else. Geez if we as nurses don't stand up for ourselves who will??

I already made a promise to myself to learn and be open to everything that comes my way but the day I mean no I mean it. Even if I have to quit my job!

I spent 3 years of nursing school living with the bare minimum if I have to live like that again for a couple of months to avoid a potential lawsuit so be it.

I hope most of us will feel that way. In clinicals I saw so many nurses being pushed around into doing stuff that wasn't in their capabilities.

barefootlady, ADN, RN · May 21, 2005

Since you have been given no choice but to orient to ER, attempt to look on the experience as a positive learning one. Be sure and tell the charge nurse you are not ACLS certified, fill out any form you have at your disposal to back up the claim that you are not fully trained and orientated to that unit. I would then take every opportunity given to me to learn about the work there and what my expectations are. It will be a blessing in disguise. Good luck.

BittyBabyGrower, MSN, RN · May 21, 2005

At least they are orienting you! Also, our hospital requires all ICU's and ER to have ACLS...do your ICU's have to have ACLS, if so that is one less worry. Also where I work, you know you will float between the areas in your service (ie trauma/critical care, peds/OB, medsurg, etc). Were you told about floating when you hired on?

It is scary, but this could be a great opportunity. Also, if you are uncomfortable with something you need to make that known right off the bat!