M/S RN to ER?

I never "look down" at anyone new to the ED ... that would be pointless.

On rare occasion it becomes quickly apparent that someone did not have an accurate picture of what s/he was getting into and/or is unwilling to try understand why we do things the way that we do. Those few don't do well, but I suspect their experience would be the same no matter where they went.

Welcome to the ER! In my experience, the more the merrier :) I think you will find that ER nurses are generally helpful - there may be those who are more so than others. You have experience, just need to learn the flow and ER-specific tasks. That makes it easier for you to blend in rather than a new grad. What kind of orientation are they giving you?

I don't look down on any nurses, as long as they are ethical. Coming from a med/surg floor you will have some good experience to draw from when you get to the ER. You will also get to learn some pretty neat stuff. Good luck in your transition, I hope it's a positive one for you.

Thanks for the responses. I haven't transferred yet, so I'm not sure what all the orientation will consist of. I will begin the beginning of September.

I'd have to agree with altra and Fancypants: in my unit, we generally don't care where you came from, be it med-surg, critical care, peds or new grad. All we ask is that you're willing to learn, take care of your patients safely and effectively, and try to keep a positive attitude (or at least don't act too horrified about our occasional wacky hijinx ). Do that and you're fine by us.

Welcome to Emergency! Best of luck to you!

Having never worked med/surg but having only heard war stories, I would think a good med/surg RN would transition well to the ED. You're used to juggling quite a few heavy patients with tubes coming out of every orifice, hourly CBGs, insulin gtts, PCAs, lots of pain and nausea (two of the mainstays of ED work), and you can tell when a patient is going in the wrong direction. I have no doubt that you can handle the pace and can tell sick vs. not sick. Hopefully you'll get a good orientation, but even so, be prepared to feel like a deer in the headlights for a while!

I think it's great for medsurg nurses to come to the ER! I have precepted former medsurg nurses, and in my experience, there are struggling points that are common among them:

- IVs. On any given day, I may start anywhere from 4 to 15 (I'm not exaggerating!) IVs. From what I understand, medsurg nurses do not start very many IVs and don't perform peripheral blood draws. My advice is to do AS MANY as you possibly can while you are orienting. Don't ask techs to draw all of your blood. Do alot of your own blood draws. THIS WILL HELP YOU!

- In and out times. I've never worked medsurg, so I can not attest to what the common practice is on the floor... But former m/s nurses tend to spend too much time in each room in the ER. Now, everyone please don't stone me yet!!! I'm not saying that you shouldn't spend time, listen to, or care for your patients. What I'm saying is that TIME MANAGEMENT is everything! When you work in a "fast track" type area, treat it like fast track! If you have 6-7 other patients that need IVs, labs, meds, vitals, then don't spend 30 minutes in a room talking to your 25 year old patient about his penile discharge. Get in, do what you have to do, and get out. Do your FOCUSED ASSESSMENT, educate quickly, and move on! There are no scheduled meds, bed baths, or meal times in ER. Everything happens quickly and the quicker that you can turn over your patients, the quicker you can see the next one! PRIORITIZATION and TIME MANAGEMENT!

****EDIT: I work in a VERY busy ER. If you work in a 10 bed ER that sees 30 patient's a day, you may be able to spend more time. That's just my experience at this ER.****

- Last but certainly not least- EMOTIONS! There is no right, wrong, or easy way to handle this. You WILL see patients die on a regular basis. You will have a patient die under your care. Do whatever you need to deal with it. I'm a dude's dude, so I don't particularly do this, but if you need to, walk to the bathroom and ball your eyes out. It is OK to hug a patient's family member or pray with them (if they want to). Be careful not to become calloused. We had a 50 year old person that came in with a ICH, and when the MD told the family that she would not make it, they did not take it well. I told some one that night, "I hope I never completely get used to that!." They said, "Then you wouldn't be human."

These are just my observations of some struggling points of m/s nurses. Get in there, soak up the knowledge, and HAVE FUN! I DO!

JMHO

At our hospital we do begin many IV's, due to infiltration or the IV has been in for 72 hrs, thus requires to be changed (at least here we do that, to help prevent phlebitis, infx). Even so, I know it's not as many as ER has to start. That is a good point though, there are some pt's that it is difficult to begin IV's, like drug abuse pt's, very old pt's with fragile, non-resilient skin, etc.

At our hospital none of the nurses draw blood, not even in ER, the lab techs draw for all units. I see it is different in other hospitals.

Thanks for the suggestions and heads up, I will most definitely keep them in mind :redbeathe

We also deal with death on the floor, I mean some of the DNR pt's are basically admitted to the floor, waiting to die, all meds and lab draws d/c'd and only comfort care measures to be given. I think that will help some, but I see where that is not the same as the deaths witnessed in the ER, because many of those deaths are from a child drowning, car accident, or a situation where death is not expected. That will be a brand new experience for me, I will try to adapt.

I swear, your entire paradigm shifts. You will never again wonder "so you basically did nothing for him while he was down there?" or "this was ordered an hour ago, why wasn't it done?"

As a former floor nurse who has now been an ED nurse for approximately 6 months, I have to say the biggest thing I had to get used to was doing things without an official MD order. We have "protocols" for chest pain, abdominal pain, etc. to get things started before the MD or PA actually see the patient, and they are stretched quite a bit to fit pretty much every patient who walks in.

Example: I have a 15 year old patient, severe MR with history of pneumonia who presents with SOB but no fever. Pneumonia protocol specifically states patients over 60 with temp >100.6, so I do not initiate. Patient ends up waiting for > 2 hours to see MD. Nurse following me complains to management that I "didn't do anything" for the patient. I get spoken to by management. Point out protocol states over 60 with fever. Management: "Doesn't matter, should have gotten a verbal order."

So, now several months later, I throw an IV in every patient who walks in and get a full rainbow of labs, unless I'm sure their complaint is complete BS. Is it good nursing? I don't know, but I do what I need to to keep my job.

Patient ends up waiting for > 2 hours to see MD. Nurse following me complains to management that I "didn't do anything" for the patient.

The ER that I work at could be a model for others... Our average DOOR to MD time is about 12 minutes. There are very few days that a patient has to wait 2 hours to see a doc, especially a MR patient with SOB w/hx of pneumonia. So first, the ER and docs should work on their wait times. This is completely out of your control.

I throw an IV in every patient who walks in and get a full rainbow of labs, unless I'm sure their complaint is complete BS. Is it good nursing?

With the knowledge that our average wait time is 12 minutes, understand that the doctor alot of times makes it to the room before the nurse does. However, when he doesn't I still start IVs, hang fluids if called for, obtain EKGs, etc. Is it good nursing? ABSOLUTELY. Being newer to the ER, you may not have the knowledge or experience to make accurate calls on what needs to be done, but once you do, if you initiate care, then that can help streamline getting labs quicker, blood cultures done sooner, and subsequently ANTIBIOTICS.

Think about it, would you wait on the doctor to place a patient on o2 that needs it? Honestly, how many patients do you start IVs on, WITH AN ORDER, that don't need one? So if YOU think that they need one, then it's probably safe to initiate it. Now, naturally you can't give meds, order labs, or start fluids without an order or protocol, but if YOU feel that they need it, then you'd better be asking an MD!

JMHO