Going back to work

[EFC1121]

After a 2 year hiatus staying home with my kids, I'm going back to work! My question is I only have about 2.5 years experience, and that was in a PCU. I've always wanted to try ED, but I had such horrific anxiety while working on the PCU unit I was on I felt like the ED would make it worse.

I don't know if it was just the unit I was on? The people were awesome, but we would end up with 7 PCU patients regularly. I was CONSTANTLY worried about my patients coding. Part of the reason I want to do ED is because I'm nervous about so many aspects of nursing that are experienced in the ED. So I want to kind of rip of the bandaid so to speak. I don't know if that's the right mentality BUT it's where I'm at. Should I give it go or go back and refresh my skills on a PCU? 

[TAKOO01, BSN]

Try out the ER. It sounds like you're excited about it. Just try to choose a place that has a good residency or preceptor.

[gere7404, BSN, RN]

Well, hopefully they have better ratios in the ER you're going to than the step-down unit -- my hospital has a 3:1 ratio for both units, so it's a lot less stressful to manage! Going back to the PCU isn't really going to help you much in the ER, they're very different and you'll want to try to relearn things the ER way. 

As a PCU nurse coming to the ER you're going to be an "advanced beginner;" you're going to be competent in some of the hands on skills and you'll have knowledge of medications and stuff, but it will be some rewiring to prioritize and think like an ER nurse.... Don't be afraid to say you don't know how to do something or ask for demonstrations, we do a lot more hands-on skills based tasks than most of the inpatient units, so if you have never done it or it's been a while just be up front and say so, so you can learn safely.

Things are not structured with times generally in the ER, you're going to have STAT orders thrown at you for all your patients frequently and recognizing which is important and which can wait is a big challenge when you first transition to the ER. 

Patients come in, get moved to imaging, get admitted and transferred upstairs constantly, so being able to reprioritize on the fly is crucial. We see people for their chief complaint, so we don't go digging into their charts or histories nearly as much as you would on the PCU. Hell, to be honest, most of the time I don't even remember my patients names because we flip our rooms so quickly. 

Sheehy's manual of emergency care is a great resource to read up on how different conditions may manifest, and what kind of tests/diagnostics you are going to be doing to help the doctor rule out things and come up with a diagnosis. I'd also recommend watching the CEN stuff for the major systems (cardiac, respiratory, neuro, abdominal) from Mark Boswell on Youtube. It's free, and it covers the workups and interventions for the more common things you'll see.