From Med/Surg to ED

twinmommy+2, ADN, BSN, MSN · Jan 14, 2008

I have been a MS nurse for 2 years, thinking about going to the ED. Have any of you switched from M/S to ED......if yes, how did the transition go? I have floated to our ED a few times and I must say, ED does not deal with much paperwork/charting.....which is a big bonus. And I don't see how it can be anymor stressful than M/S, unless you are working as a trauma nurse. Am I wrong?

I came to the er out of med/surg 6 months ago after working 1.5 years there. We deal with ALOT of charting. There are so many different reasons on why you would chart so much. You basically have to cya and chart as defensivly as you can. Anyone can come back and say that you did something wrong especially when you are working in an environment that is so fast paced.

Actually, I think er is more stressful than med/surg. We are lucky not to be understaffed, chaos will rain in through the triage/ambulance doors at any given minute, and every single patient in there really believes that their pain is more of an emergency than the rest. I actually was on a code in one room when another room was saying "well if we could just get some nurses off of that stupid code in there". You would be suprised at how many people don't have the ability to put themselves in another persons shoes.

Don't get me wrong, med/surg is stressful. I just think the ER is more so. But I do go home at night most nights feeling like I really made a difference in someones life today.

If my writing was rambling, I just got off of three twelves in a row and yesterday was hellish. Forgive me lol

MikeyBSN · Jan 15, 2008

If you don't think you have to do a lot of charting or paperwork in the ED, I would re-check the way you're charting. We have had many people come to the ED from the floors, most of them go back before they're done with orientation. All of our float nurses agree that the ED is harder than any other unit because of patient turnover, but this might be different in your facility.

bill4745, RN · Jan 16, 2008

I've worked in M/S, ICU, tele, home health, and now ER. ER is the most stressful thing I've ever done, and the most rewarding. In my hospital, the floors and ICU have the luxury of having no admissions during shift change, and have a maximun number of patients per nurse. Can we lock the ambulance entrance for an hour at shift change? Can we refuse the GI bleed that walked in the door with a BP of 70/30 just because I already have my maximum number of patients? When you have 2 critical patients and still have to deal with two or three other patients (abd pains, flu symptoms, etc) it can be overwhelming. I don't think we have any less charting than M/S. But as I said before, it is the most rewarding work I've ever done. There is a sense of pride that comes with being able to deal with the non-stop stress and chaos, and most days I thrive on it. I also have found that relations with co-workers is different in the ER-we have become a close-knit team, something I never had in the other areas I worked.

Dempather, RN · Jan 16, 2008

"I actually was on a code in one room when another room was saying "well if we could just get some nurses off of that stupid code in there"".

Hah. Funny that you mention that. I was in a full-blown code while working in my tele step-down unit a while ago. In the midsts of it all, another patient's family member interrupted me to ask if I could move her father's arm because he looked uncomfortable.

:) Some people...

Dempather, RN · Jan 16, 2008

"I actually was on a code in one room when another room was saying "well if we could just get some nurses off of that stupid code in there"".

Hah. Funny that you mention that. I was in a full-blown code while working in my tele step-down unit a while ago. In the midsts of it all, another patient's family member interrupted me to ask if I could move her father's arm because he looked uncomfortable.

:) Some people...

Djuna · Jan 16, 2008

And I don't see how it can be anymor stressful than M/S, unless you are working as a trauma nurse. Am I wrong?

Very wrong. ED is an area where you must be multi-talented and an expert multi-tasker.

I have worked in many areas of nursing and I have to say I have had more stress/excitement/adrenalin-charged days in ED, than ANY other specialty.

GilaRRT · Jan 22, 2008

All a matter of opinion and quite subjective. However, I think ER is pretty easy compared to MedSurge. Heck, part of my job includes dumping my mess on other units. Come on, I will have 4 possibly 5 patients. Then, look at the MS bubbas rolling with 7-9 patients all night long.

SDS_RN, RN · Jan 23, 2008

Our medical and surgical floors are not together but I started out on surg and floated to med so I know the stressors of both floors. I do think that the ER is more stressful than the floors. At least on the floor you know the amount of patients you will have most of the time but in the ER you never know what's coming but from my experience so far they all like to pile in at one time. The charting is much more extensive I think becasue you are charting every little thing that is going on with that patient and the 3 or four others you have at that time. On the floors you don't have to chart when the patient had lab drawn or went to CT or came back from CT or when the doc is on the phone with the PCP. I think that the charting is definatly more in depth than floor charting. On the floor we have a profile that has everything we need on it and if anything is abnormal that's what we charted on the floor.

I hope that your transition to the ER goes well. I've only been there for a few months and I already love it.

mom2michael, MSN, RN, NP · Jan 23, 2008

The ER is a place where you are always shifting priorities, always re-arranging tasks and always change your mode from super sonic speed to super sonic speed plus. You have to be able to quickly and effectivly change pace all day long and you have to do it with a smile on your face. And your vague abd. pain in room 10 might be WAY more challenging as a patient than your MI guy in room 2 or the multi trauma in bed 3. And ER's almost always run chronically short on staff. We don't get the luxury of not taking a patient while awaiting on the nurse that was called in to come to work, we have to take that next EMS even if we are already full and every single hall bed is filled with patients AND every nurse already has their max patient load.

Teamwork becomes a HUGE thing in the ER and for that very reason a lot of people love to work in the ER. Our co-workers are a huge reason why most of us stay sane during a 12 hour shift.

The stress of ER will be your own perception. For some people, that constant running around and shifting of priorities is highly stressful, for others it's simply all they know and it's how they function at work.

As far as paper work, you chart a great deal in ER but it's a different type of charting. It's not a lot of narative reports of the patient but you do have to chart everything that happens to that patient (as well as the rest of the patients you have) because the age old rule....if it's not charted it didn't happen. And you have to chart RIGHT NOW on every patient you come into contact with so orders don't get missed or duplicated. Plus you can have your hands on 25+ patients in 1-12 hour shift, so you chart and you can chart a lot.

BrnEyedGirl, BSN, MSN, RN, APRN · Jan 24, 2008

raindrop

I spent almost 8yrs on a cardiac stepdown unit before transferring to ED a little over a year ago. Many of my co workers laugh when I say the ED is less stressful (for me) than the floor I left. It is a different kind of stress. I remember many a night on the floor when I was in charge, precepting a new grad and was being asked to accept my 11th pt for the night. The other 3 RN's on the floor were less than a year out of school and had 9 pts each. For those who have never had floor/unit experience, the huge amount of "tasks" and charting that is expected of you is overwhelming. I was frequently still at work an hour after clock out time just trying to catch up on the computer charting. It was very frustrating for me and I honestly felt that I could no longer give the care my pts deserved. I worked with some really great people on that floor and we had some exceptional team work,.but you can only do so much in a short amount of time. I left and went to the ED,.I love it! It was difficult at first not knowing everything about my pt,.learning to chart (by hand and briefly) immediately, not waiting for "down time" to catch up (there is no down time). The focus in the ED is emergency care,.treat what is emergent now and send the pt on to the floor,unit,OR, home wherever. It is very fast paced, but you take care of this one,.move on to the next. When the next shift arrives tell them where they need to pick up and go home! There is always a Dr (another thing that was hard to get used to),.if Rm 3 is vomiting ask Dr A if you can give 4 of Zofran and go give it,.no calling the service, waiting for the Dr to call back,.get the order,.fax to pharm, wait for the med....you just do it! I've seen a lot of sad things, lots of bad things happen,.but for the most part I really do finally feel like I am helping people at a time when the really need some help! It's fast, we are on our feet most of the 12 hour shift but I wouldn't go back for anything! It does help that our ED is, at the moment, fully staffed and we have a great team that works well together! Good luck,.hope you are happy with your decision.

New2ED · Jan 24, 2008

Teamwork becomes a HUGE thing in the ER and for that very reason a lot of people love to work in the ER. Our co-workers are a huge reason why most of us stay sane during a 12 hour shift.
AMEN to TEAMWORK!!! That's what makes working in the ER the best! If you work in an ER with highstrung, non-helping-handed people then get out now, cause you will go home everynight stressed out.