Forced to Orientate to ER

markjrn · 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!!

From what I've experienced traveling, it's not uncommon for nurses to float between he ICU and ER (both perm and travel staff). I've done it alot, and actually found the ER to be a nice change from the ICU. Sometimes the ER isn't always swamped with critical patients, where in the ICU you are always dealing with a critical patient.

Is it possible to look at this as a positive opportunity for professional growth? I would definitely demand a decent orientation with training in ACLS and TNCC, at least. Maybe PALS too. Actually, you should likely have ACLS to be working in the ICU anyways.

Just my :twocents:

pricklypear · May 21, 2005

Sometimes the ER isn't always swamped with critical patients, where in the ICU you are always dealing with a critical patient.

As much as I whine about having to go to ER, my experiences there have been much less stressful than ICU. Thats not to say it doesn't get busy, just in a different way. It can be very entertaining at times, too. The biggest hang-up for me is the different paperwork and charting.

markjrn · May 21, 2005

It can be very entertaining at times, too.

That's for sure! :yeah: (I'm having too much fun with these smilies today!)

suzanne4, RN · May 21, 2005

The one problem that I see that no one is addressing is that you are signed up to work in your hospital's float pool. Which means that they can place you where they need help. And you are in Canada, where our JCAHO rulings have no bearing.

If you are working in ICU areas, then you should already hold an ACLS certificate. At least that is a requirement in the US.

Most nurses do not like to float from their safe area, but the ER staff is also not going to put you in the Trauma Room on your own. Normally, you would get assigned patients that you would see in an ICU or telemetry unit. such as chest pain or GI bleeds, etc. Nothing that you haven't seen before. They may only have you go around and taking vital signs, starting IVs, etc. Just let them know what you are comfortable with.

markjrn · May 21, 2005

If you are working in ICU areas, then you should already hold an ACLS certificate. At least that is a requirement in the US.

It's a common requirement, but it's actually not required everywhere.

fergus51 · May 21, 2005

What province are you in? When I was in BC it was the norm to have ICU and ER nurses float to eachother's floors and nurses can't just refuse to float (per BCNU and RNABC). They can fill out unsafe staffing forms (where you write why you weren't able to meet the standards of care according to RNABC practise standards) and insist on an orientation. But if they are willing to orient you, you really have no legitimate reason to refuse unless you want to look for another job. If you don't want to be bounced around the hospital, I'd suggest getting out of the float pool and applying for a casual or part time position on one unit.

rjflyn, ASN, RN · May 21, 2005

Also there is a nursing shortage so no one is FORCED to do anything. If you dont like it let your feet do the walking. Now that may be easier to say than to do but its about time nurses quit being door mats and stand up for whats right.

Rj

nursesarahca · Jun 12, 2005

Thank you for the responses. Just an update on the situation, I have started my ER orientation as of last night. Last night was a little crazy, I felt lost in the beginning however tonight was a lot better and I'm hoping that I will feel more comfortable as time passes. I still feel as though I am being forced to do something that I do not want to do. I have expressed my concerns and they have gone unanswered so I will just do the best that I can.

At our hospital if we are in the float pool we are not required to have ACLS for working ICU or ER. There are nurses here at present that have floated to ICU/ER for the past 8 years or more with no ACLS or TNCC. It seems as though lately however, they are encouraging us to get these courses. I have applied to do TNCC in the past and have been denied.

In response to the reply that I am being given the "easy patients" while working ICU, our ICU is small, only 3 beds and only staffed with one nurse (Big saferty issue here for a long time!) unless we have 3 patients in total or someone is REALLY sick. I have worked in ICU with a vented patient alone in the past. My biggest fear about working ER is my lack of experience (only 2 years) and I am still not completely comfortable in ICU yet I have to go to ER and get used to a whole new department.

When I was hired there was no mention of being orientated to other departments. We have the choice of whether or not we wish to do the ICU course and I chose to do it, not thinking I would be forced to work ER. Since that time there was also one day where I had to work recovery room as second nurse (no orientation). I express my concerns and they go unanswered. To be honest, after the summer I'm thinking about going casual (I can choose where I want to work then) or take a permanent position on medicine if I am offered one. I'm getting sick of being pushed around!:angryfire Trying to stay positive for now:chuckle

:) :balloons: :)

SmilingBluEyes · Jun 12, 2005

Based on your last post, I would have issues working there.........Is this a small rural facility far from others? Is there anyway you can work elsewhere?

ZASHAGALKA, RN · Jun 12, 2005

Most hospitals (and mine is no exception) hold the opinion that, if you can work in ICU, then you can work anywhere (except for a few specialty areas that have their own sets of qualification, such as L&D).

If you can work ICU, the theory is that there is nothing in the ER that is beyond your skills (even the worst ER case is just a transfer or surgery away from being an ICU patient).

and in many hospitals, ICU nurses DO float to many places and you have to be capable of doing it. The last place I worked would put their ICU floats in triage until they got the feel for the ER (theoretically, you wouldn't be an ICU nurse if your assessment skills weren't good enough to separate OH S*** from BS.)

Being able to float to ER is probably a requirement in your hospital for ICU nurses. And if all your peers in ICU have to take a turn floating to ER, it would be unfair for you not to have to bear that requirement. I don't think you should consider this a -but I don't want to work ER- situation, but instead as a -this is a requirement to work ICU- situation. If you don't want to do the ER floats, in reality, you have to reconsider working ICU if that's what's required to work ICU.

I like ER floats, actually. I will float out of turn to go to ER (because it's much better to use my turn there then having to go to medical the next shift --- no negative feedback on that last statement, I'm not dissing medical, used to work there and like it, but when you get used to 2 patients you can always see, 6 down the hall behind closed doors is a completely different and more stressful situation, and besides, my time management skills for 6 patients just aren't what they used to be).

~faith,

Timothy.