L&D to ER; how to prepare for transition?

Jennifer, RN · Mar 3, 2007

I have heard from some doctors that they consider L&D and ER similar in respect that anything can happen and as a nurse one has to be a good problem solver and critical thinker (and work well under stress). I would suggest that you read up on peds and adult pts, maybe get an emergency care manual to look at, maybe an emergency/critical care book. Also, look over meds, esp cardiac meds. Not only do you need to know a little about the meds you administer, but also the meds pt's are on. If you have a pt on coumadin or altace you need to know what these meds are used for and what side effects they may have. You might want to brush up on some A&P as well, esp bones and muscles.

Trauma Columnist · Mar 3, 2007

I would definitely do a peds review. The ENA course ENPC (Emegency Nurse Pediatric Course) is definitely a down and dirty look at peds emergencies and how to keep them breathing and living. Other things - do you already have a date to transfer to the ER? If so, I might shadow an RN there to see what other knowledge might be needed. Then..plan accordingly. Good luck - I loved the ER>)

alwayslearnin · Mar 6, 2007

I did Med/surg for three years, then L&D for three, then to ER. Big difference for me. Most of our moms where healthy (except of coorifice PIH, Pre-eclamptic, Gest. Diabetic -the usual. Yes, I could respond to an emergent situation, but it was pretty limited to what they were.

In the ER you see anything and everything and all ages with frequent multiple co-morbidities.

Find out if your ER has a "specialty." for example, my ER is in a facility that also has one of the leading cardiac units in the state. So, of course, we get alot of cardiac patients so I really had to bone-up on cardiology. Get familiar with rhythm analysis and cardiac meds. Also Code meds. Sheehey's "Emergency Nursing Manual" is a recommended read in many institutions. You might want to talk with the nurse educator for the ER for some helpful resources.

The pace is different also. In L&D onece a woman was in active labor it was 1:1, maybe 2:1 depending on the labor. In ER We are caring for 5-6 patients, some who can be quite complex and sick. So give yourself lots of adjustment time.

Good luck to you-I hope that it is a good fit.

alwayslearnin

meandragonbrett · Mar 6, 2007

icufaqs.org is a great site for some moderate elements of critical care that would be useful to an ER newbie.

Trauma Columnist · Mar 6, 2007

Another thing - make sure you orientation is long enough - 12 weeks isn't unreasonable for a level one trauma center.

RunnerRN, BSN, RN · Mar 6, 2007

Try to get into a TNCC course. It is a lot of good information about trauma care, and very systematic - once you get it into your head, you'll never forget it. ENPC is awesome too. Know your ACLS backwards and forwards, and just keep an open mind. ER is a lot of fun, but very different from L&D in that our patients generally aren't getting a reward at the end of their pain (except for those drug seekers who are getting their narcs!!) People can be hateful!! Practice your noncommital smile and say "I apologize for your wait. I was pulled in to help with a very ill person who wasn't breathing. Here is your pillow and warm blanket, both fluffed and scented with lavender"

RunnerRN, BSN, RN · Mar 6, 2007

Try to get into a TNCC course. It is a lot of good information about trauma care, and very systematic - once you get it into your head, you'll never forget it. ENPC is an awesome class too. Know your ACLS backwards and forwards, and just keep an open mind. ER is a lot of fun, but very different from L&D in that our patients generally aren't getting a reward at the end of their pain (except for those drug seekers who are getting their narcs!!) People can be hateful!! Practice your noncommital smile and say "I apologize for your wait. I was pulled in to help with a very ill person who wasn't breathing. Here is your pillow and warm blanket, both fluffed and scented with lavender" :lol2:

enfermeraSG · Mar 8, 2007

Wow! Thanks for all of the wonderful tips! I am going to take a PALS, ENPC, and TNCC course by the end of the year. I don't have a date yet but expect to transfer this fall. The orientation in our ER is 12 wks with precepting and classroom time. This ER is not a designated trauma ER, so I'd imagine that 12 wks is pretty good. I think the biggest challenge will be all the med info I need to absorb, and the wide range of illness, injury and age/ranges. We have lots (at least one per shift) of emergencies on my L&D unit because we are the designated high-risk OB and extremely busy, but that's so different because the focus is narrow compared to the ER.

Can't wait though!

SG