Maintaining patho knowledge base in the ER

Honestly you will learn a ton and maintain more than you think. Yes there isn't the level of detail with one or 2 critically ill patients in the icu. But in the icu you may have those same 2 patients for weeks. Every day in the ER is different patients with different problems. Dissections, STEMIs, traumas, cardiac anomalies, LVADs, etc. typically trauma facilities have a great supportive environment with opportunities to learn a lot. Embrace it and learn all you can.

Im much more satisfied than I was in ICU, but everyone is different. Good luck!

you should still be able to learn a lot of detail. I agree with NickiLaughs, you can learn more than in ICU because you will see way more. There are things you might not learn in depth but you can talk to one of the intensivists or another MD who can educate you. You can also request to cross train. You can take an ICU class later. You will get exposed to ICU knowledge in the ED. Maybe at first you might be a little overwhelmed with the tasks, but you will be able to see the larger picture later. I have almost a year now and am now able to stand back and see more how everything works together.

Read emergency medicine and critical care journals.

Honestly you will learn a ton and maintain more than you think. Yes there isn't the level of detail with one or 2 critically ill patients in the icu. But in the icu you may have those same 2 patients for weeks. Every day in the ER is different patients with different problems. Dissections, STEMIs, traumas, cardiac anomalies, LVADs, etc. typically trauma facilities have a great supportive environment with opportunities to learn a lot. Embrace it and learn all you can.

Im much more satisfied than I was in ICU, but everyone is different. Good luck!

Thanks for the response! How long did you do ICU before moving to ER, and what specific things make you more satisfied?

you should still be able to learn a lot of detail. I agree with NickiLaughs, you can learn more than in ICU because you will see way more. There are things you might not learn in depth but you can talk to one of the intensivists or another MD who can educate you. You can also request to cross train. You can take an ICU class later. You will get exposed to ICU knowledge in the ED. Maybe at first you might be a little overwhelmed with the tasks, but you will be able to see the larger picture later. I have almost a year now and am now able to stand back and see more how everything works together.

Thank you so much. Once I'm further along I'll see if I can do this cross training...I would love that. And definitely good point about taking advantage of our proximity to the providers.

Read emergency medicine and critical care journals.

Thanks! Any particular ones you like?

EM podcasts!

Thanks for the tip! Are there any ones in particular you suggest ?

What makes you think you won't have an opportunity to delve into patho in the ED?

It definitely makes a difference as to what size hospital you're in but I've learned a ton from the super-sickies I've seen in the ED, though admittedly not quite as in-depth as in the ICU.

I'm with NickiLaughs: The ED suits me much more than does the ICU.

I think you are on the right path looking stuff up on your own! I love that stuff too and I don't get to really delve into on my crazy med-surg unit so I go to youtube and Periscope a lot. I also just found VuMedi but haven't signed up yet and thank you pixie.RN for the EMCrit link!!

As a former teacher I LOVE teaching and wish there was more time to teach in regular hospital nursing but there just isn't- for the most part. I would love to find a position with more or ALL teaching! I have a strong interest in Health Literacy and you probably do too. Check out Helen Osborne and also if your area has anything going on with Health Literacy.

Congrats on your job! That's exciting and such a relief to have a position lined up prior to graduation. I too worked ED as a new graduate, and was glad I did. You will find there is a lot of teaching with each patient discharge, about what they can and can't do, when to follow up, teaching regarding medications, etc. I encourage you to have thorough discharge instructions because many patients are not well informed about what is next—you will be helping them tremendously while also preventing some repeat customers.

I have also had a brief stint in the ICU, and in both positions there was rarely any down time (to study the patho)—too busy. In ED by the time you were caught up, the patient was getting discharged or admitted and it was time for the next patient (not to mention your other 2-3 rooms). In ICU you had four times as many meds (because you're also giving patients their daily meds on top of anything they need r/t why there are admitted), then hourly vitals, I&Os, turning and oral care q2h for vented patients, dealing with family, setting up meals, ambulating patients, leaving the floor for swallow study or CT, calling outside providers, intensivists, etc. In ICU it helped a great deal when you worked back-to-back and had the same patients on day two, because you were already familiar with their situation/plan of care.

As others have mentioned, you will have every opportunity to cross train…put in your one year of ED and then look for PRN jobs in the ICU (that's assuming you're still enjoying ED—if not you can just apply for full time ICU / other).

I found doctors both in ED and in ICU that loved to teach when both they and I had the time. You will also find several that don't want to take the time to teach you—but you will figure out which is which very quickly.

With your community health nurse goal in mind, I would say that ED is a better fit because of the variety and types of things you will be exposed to. ICU is a great learning environment as well, but when you are running your community health clinic in 6 years you won't need to teach them vent settings and ABGs, but it will be very helpful to know how to speak with a 19 year old that came in for a preg test and STD diagnosis—and you'll get plenty of that in ED, along with everything else under the sun.

The longer you are in any position, the easier it will get and that will free up more time to get further into the patho, etc. When you first start any job/department there are many little things that take up your brain space as you have to learn them, but then 3 months later those are routine and you're on to other things. Hopefully your ED has a good new grad training program—it can make a world of difference.

In addition to the other great suggestions of podcasts, journals, etc. you will find lots of info online with a quick google search—youtube, animated videos discussing a disease process, etc. I like your idea of a journal, that is something similar I started back in school. Basically I started a big 3-ring binder and divided it into sections as you would when you get report on patient…neuro, cardiac, respiratory, GI/GU, pysch, etc. Before you know it the binder is overflowing and you have to get a separate binder for each section. When I started in the ED, I made an extra copy of discharge instructions—ripped off all patient identifiers, and took the copy home for my personal information/education.

Good luck!