How to think like and ER nurse

[amzyRN]

I will start orientation in the ED in about a month. I have experience working on step-down, cardiac, med/surg floors. My shifts have a routine and I had an organizational tool that I used to guide my work flow. I know that will change once I'm in the ED and I'd like to know if there are any organizational guides any of you used in the beginning for time management and proper prioritization.

I'm kind of nervous about the upcoming learning process and want to give myself enough of a head start as possible. Any suggestions? Thank you.

[Altra, BSN, RN]

As someone who has worked in four different Northern California emergency departments, let me start by saying that there is no uniform experience nor rules. What is necessary, expected, or accepted in one facility may not be in another.

In one setting you may have RTs, pharmacists, phlebotomists, and techs. In another setting it may be just you and a doc.

In one setting you may be drilling intraosseous lines, placing IVs by ultrasound, drawing ABGs, doing internal cardiac compressions, or giving RSI meds - in other settings, you may not even be drawing labs.

In one setting, "straight to the OR" may be the word while in another, you may be sitting on that patient waiting for critical-care transport. In one setting, that transport might be a helicopter while in another, it might be you in the back of an ambulance because weather prevents aircraft extraction. In some facilities, or with some docs, you have a great deal of autonomy with the sure knowledge that the doc will back you up. In other places, though, you better not even start a saline lock without a direct order in place.

In one setting you might have your own dedicated police officers while in another the nearest cop might be 30 minutes away.

All that to say that (1) all the opinions on AN reflect the experience of the poster and may not apply to your situation and (2) learn the expectations and authorities of the place that you're working.

The ED is unlike anything else in the system and most people either dig it or despise it.

(And for heaven's sake, please do your part to tearing down the walls that so commonly exist between the ED and the ICUs... we're all on the same team but our roles are sooo different.)

A million likes for this excellent post!

[pedseraprn]

I use a med surg flow sheet for behavioral health but only because my Er separates them out and on a four to one ratio where I am holding them, it helps remind me to do all the hourly stuff. Otherwise, punt!!

[tracybrown6609RN]

It is an environment where any type of schedule for the day is out the window. There is no way to organize. You may walk out of a pt room after pushing 2 IV meds and a simple "complaint driven" assessment and walk into 3 additional patients that just walked in within 5 minutes of each other. It changes so quickly. I went from being a dialysis nurse to the ED. I was used to a pt schedule for everyday. I had a difficult time adjusting, and couldn't make the transition. I realized my struggle rather quickly and resigned from the position. It takes a nurse that can adjust to a fast paced, always changing, noisy, and chaotic environment. Best of luck to you.

[Workzalot]

Hi,

... Time will help

....learn from seasoned staff, don't think they can't help/teach etc

....we're all stressed in the job, the pace is increasing with new benchmarks, satisfaction, door to EKG times, door to cath lab, door to ct, time from admit order to admit bed, 5 mins or less to triage,.....etc etc etc...

....BE a team player, HELP your co workers when you can (it goes a long way), have a WORK ethic, BE KIND to your techs (help them too)

....stand up for yourself

.....get used to MORE THAN your pt assignment you had in your old unit...your turn over of pts can be dozens in a 12 hr shift...& you're responsible for assessing, re assessing, treating,medicating, teaching, cleaning your room, cleaning your pt, assessing re assessing, getting pts by w/c from outside, helping pts that aren't yours, answering calls from outside, dealing with EVERY Dept who always wants the NURSE!

.....the admit floors hate us, ICU thinks we do nothing... It can be a thankless job but it can be an amazing job.... You'll fall in love with your team mates, you'll hate your team mates, but in the end we're all a sort of big messed up happyish work family. You'll cry, laugh, give up, try again, be exhausted, be energetic.....all I can say is GOOD LUCK!!!!!! 😉

[NurseMedic28]

Everyone is either level 1 or level 5. You have one priority and everything else can wait. You are not there to make patients happy, you're there to save lives and get stuff done. Don't believe what patients say, believe the vitals and physiological signs. Be tough and be firm. You don't owe these people anything. Help out when your coworker is drowning. Get stuff done quick, don't let the "customer service" get in the way of getting things done. Lastly, humanity is more pathetic than you imagined.

Perfect. ED perfectly summarized.