I accepted a position as a new graduate in a ED. It
is an adult trauma center but has pediatrics which is extremely appealing to me, as I love being able to work with both populations (especially the children!).
I'm currently completing my practicum here to prepare me for my impending orientation. I'm one of those students who truly enjoys pathophysiology and pharmacology, and teaching. One of my favorite parts of nursing is teaching, as my first degree is in public health and I eventually want to be a community health nurse or provider. I like when I can explain something to patients and see that they understand it better than they did before. The emergency department is great for teaching, which is another draw.
However, over the past several weeks I realized​ that there something that I am concerned about, and was wondering if I could get advice. Because the atmosphere is so quick, I'm realizing that everything is so reactive and very task-oriented... Of course nurses have to use quick critical thinking/assessment skills here, but I see I am not going to get the same ability to delve into patho as I would in the ICU setting.
I like the ER, I just wish there was a way I could figure out how to maintain and grow in my level of patho knowledge. I spoke with one of the ER nurses who used to be an ICU nurse, and she told me that even in the ICU, she still had to look things up.
So I began keeping a nursing journal where I write down the diagnoses that I encounter...& in in my free time I look them up, as well as common medical treatments. This is no substitute for the learning I would get on in an ICU or even a med surg / tele floor, but I'm just really worried that if I were to move to another specialty in the future I would have a hard time learning everything again. Plus I kind of just want this knowledge for myself so I can understand what's going on in the body.
Does anybody have any other suggestions as to how I can keep up with patho and critical thinking skills? I know that I'm going to have a hard enough time adjusting to the emergency department, and that this will not be a priority for a long time...but when I'm ready to return to it after I start finding my way around my new job, I'd like to have some ideas.
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.
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!
Wow thanks so much for the detailed response! That's a good idea about the binder and about the discharge instructions. My preceptor also encouraged me to ask the providers why he/she ordered a certain m ed or test, to help me think through the process, so thanks for confirming that.
And that's so true about how the ED is a good fit for my comm health goals...thanks for the encouragement about running my own clinic in 6 years
When you had your brief stint in the ICU, was that a PRN type thing? Did you find it hard to adjust since the environments are so different?
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.
Just because it's so fast I guess. But another poster who worked in an ICU also stated that she rarely had time to delve into patho on her own either. I guess they are both fast, in their own ways.
In the ER now we just move so quickly and have patients moving in and out so much that I don't have a lot of time to really think about the patient admitted for status asthmaticus or the one with ovarian torsion. But my new preceptor is better at teaching than my old one and asks me patho questions while we are doing things, which has certainly helped!
maydaymalone, BSN, RN
1 Article; 14 Posts
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!