From med/surg to ED nursing

hereigoagain · Feb 19, 2009

I went from ED to med surg and believe me, I felt like a new grad. It is only about how much you like what you are doing and how willing your co-workers are to accomodate/teach you.

It is normal how you feel and it is great that you have med surg experience, you will know what to ask the ED docs to order for the pts that go upstairs and stuff (prn's etc.), you will always give good/useful report to the floor, because you have been there. And the rest, you're learning now.

Enjoy emergency room, there is nothing like it.

My friend that's a nurse for 18 years told me about the ER: just take care of one patient at a time and prioritize...she must know what she's talking about. I had my own strategy in ER: "keep your eyes on your patients at all times". I did feel that I didn't have enough time with them, but thinking retrospectively, I did. And I even meet a couple at the grocery store and they told me that I was so good to them...see, they remember you. A doctor at another facility embarassed me, he told me in front of the whole trauma team that I was the nicest RN at WBH, because I taught him how to draw blood...it made me blush.

You will be OK. Don't chicken out! That's how you say it? I am a foreigner and I don't want to say funny/innapropriate things.

Do your certifications as soon as you can, they say at least 6 month, but if the hospital doesn't want to pay, you pay for it, be smart. TNCC etc. and just take one day at a time. If you love it, stay!

Renald · Feb 19, 2009

Oh wow, the ED sounds really interesting. I am a new grad RN and I just received a position for the Los Angeles County as an ED nurse. Good luck with your training.

Roy Fokker, BSN, RN · Feb 19, 2009

I find the transition a little hard and overwhelming at times. I thought that if I got the med/surg experience it would be easy, however I feel like a new grad again!!!!!!!!

I'm not surprised (and neither should you!) Think about it - ED nursing is obviously not the same as med-surg nursing. Each discipline brings forth it's own set of skills and thought process.

Feel like I don't know anything.

I guarantee you that were you to shift to Dialysis or OB tomorrow (for example), you'd feel the same way! IMHO, the experience is akin to asking a Urologist to manage a stroke patient.....

The pace is faster in the ED and very intense b/c you don't know what the dx is for the pt. In med/surg the pt already had a dx so you kind of had an idea of what your plan of care would be for that pt. ED is totally different!!!!!!!!!!!!!

Agreed! Welcome to the crazy world of ED :)

On the floor I got to spend more time with pts--in the ED it's different-- or maybe it is just me trying to adjust.

I think it's a bit of both. I still manage to find time to spend with my patients every now and then... maybe you will too, once you become more comfortable with your ED role.

Any advise or words of wisdom would be helpful and appreciated!!!!!!!!!!

Like you, I too transitioned from the 'floor' (Med/Surg) to working the ED. My token suggestions:

1. "The ED is not the floor. The Floor is not the ED." As asinine as that sounds, the sooner you grasp the significance of this, the better.

2. Patience is a virtue - be willing to stop, take a breath and THINK. Remember - "Think first! Act second!" Find an 'old hand' (a nurse who has been working the ED for over 5-10 years) and latch on. They'll teach you things no doctor, no educator, no textbook can ever teach you...

3. Not everything in the ED is an "emergency". Unfortunately, there is no way anyone can be taught this skill in judgment. Remember the ancient adage: "Good judgment comes from experience. Good experience comes from bad judgment." Just remember point #2 above.

4. If you are faced with an emergency, remember to SLOW DOWN, THINK, ASSESS.... BEFORE you ACT. Taking the extra 2 seconds to think a situation through is FAR MORE valuable than jumping in helter-skelter.

5. The "Floor" definition of an 'emergency' is different from the "ED" definition of an 'emergency' (refer to point #1 above).

6. Keep your eyes and ears open and your mouth shut. Safest and fastest way to learn.

7. Chart as often as you can, as much as you can. Preferably, as soon as something was done by you - chart it. I cannot emphasize this enough.

8. Time and resource management are just as critical in the ED as they are on the floor. For example: You have just one nursing assistant. A patient needs to go to CT scan while another patient who has been waiting for over 5 hours needs to toilet. Which patient takes priority and ought to be delegated to the nursing assistant?

9. Pointed Questions. Pointed Questions. Pointed Questions. As much as you'd like to hear the patient's "whole story" - if they start to ramble, don't be afraid to 'cut them off' to proceed with your questioning. Trust me, you will NOT have the time. This doesn't necessarily make you a "bad/mean nurse"... it just makes you an efficient nurse. Remember, your ASSESSMENT of the patient determines your course of action (should I start a line? Should I order an X-ray? etc.)

10. My general policy is to tag-team with the Doc when it comes to little kids/infants*. Meaning? I don't do anything invasive by myself (check ear canal, check throat etc.) - children and infants are non-cooperative by nature... so I usually wait for a Doc to sign up and then we handle the pt. together (* unless I'm in triage - in which case I'll get a good set of vitals including a rectal temp and pre-medicate the pt. depending upon the age).

NOW, just because a pt. is a child/kid/infant doesn't mean I don't to nothing "till the Doc signs up". At the very basic, think of the ABCs - is the pt. suffering from respiratory distress/orthopnea/cough? Is the pt./parent complaining of lethargy/weakness/fatigue? Are the 'basics within limits' (assess lung and heart sounds, check circulation, assess from parents as to recent urine/stool output, recent food/fluid intake, are the shots up to date, was the pt. born premature etc)?

11. Finally - any good Emergency Department worth it's salt expects it's nurses to think independently. Based on the presenting symptoms, nurses are expected to act based on protocol - however, clinical judgment plays a heavy role (e.g.: Not EVERY ONE complaining of 'chest pain' gets a "chest pain protocol" workup).

The nice thing though is that you usually have residents, interns and the Docs themselves hanging around. Don't be afraid to approach them for ANY issue whatsoever.

e.g.: "Hey Dr. Smith. Can I run something by you real quick? I have a 40 year old male waiting to be seen. He's complaining of right lower quad. abd. pain - rates it as an intermittent cramping pain of 8/10 - for the past 4 hours. Pain is reproducible upon palpation but there is no rebound tenderness. He's not allergic to anything but his history is positive for hypertension, hyperglycemia and a gastric bypass. His vitals are stable except for the BP which is 170/83. What do you recommend I do? Should I start an IV and draw labs or wait for a doc to see the pt.?"

Most ED docs appreciate such input from nurses and would give orders (especially if they're backed up - be it ordering line/labs or stating 'don't do anything yet, let a physician see the patient first').

I hope my rather lengthy post has been somewhat helpful.

Welcome to the world of Emergency Nursing!

cheers,

Roy (former floor nurse, now working the ED)

hereigoagain · Feb 19, 2009

Roy, very good post!!! It should be in an ER manual, like "Survival Guide for New ER Employee".

NursingAgainstdaOdds · Feb 19, 2009

LOL why on earth did you think it'd be easy?

I just went from medical/telemetry to the ED. I am having a blast. I really don't feel the pace is faster than the floor I worked on - the patient turn-over is obviously faster, but the pace is the same or slower. I personally like the fast turn-over of patients in the ED. Keeps me interested.

I do have some of that "new grad" feeling, but overall I feel OK. I think learning a new area of nursing is simply an awkward process. Accept it, embrace it, laugh at yourself as appropriate, and ask everyone stupid questions. I don't care who it is, as long as they know where the thing/person I need is located.

WinterWolf90 · Feb 19, 2009

My final semester of nursing school is in the ER. the first couple of days I felt really lost and like I didn't know anything. After about the first 2 weeks I started to get used to it. One of the better things is that there is an assessment sheet for everything which makes it slightly easier. As a current student I find that small basics usually carry over to everything and that a good percentage of people that come in the ER aren't emergency cases, so you do find your nitch in learning to prioritize.

Aneroo, LPN · Feb 19, 2009

I think one thing that is hard for floor nurses to adjust to is the assessment. Sure, we do a head to toe if needed. But if you came in for a sprained ankle and there is nothing else involved, that's what get assessed- the ankle.

bubba04 · Feb 21, 2009

Thank you all for all your comments and words of wisdom. I had great days these last few days. I am loving it so far--learning new things. Today I got to work in the trauma rooms and I loved it!!!!!!!! there are things I am not familiar with , but I think I will get through it. I was told be the charge nurse and manager that I am doing a good job-- so that was cool to hear.

hereigoagain · Feb 21, 2009

Keep it up!!!!