Med/Surg to ER: General work flow in ER at night

emtb2rn, BSN, RN, EMT-B · Nov 10, 2015

Wait a minute! Did you actually ask if an er nurse would seriously consider administering routine meds to be a higher priority than treating a crashing pt?!?!

PocketSize, BSN, RN · Nov 10, 2015

Wait a minute! Did you actually ask if an er nurse would seriously consider administering routine meds to be a higher priority than treating a crashing pt?!?!

I think she means how often those events happen. I work in the ED...once you're established in your own ED you start getting a feel of the patient population and what each day brings but alas, it's a very unpredictable environment so I can't offer any help.

I'll say it's extremely fast paced and high stress. It requires a lot of flexibility and resilience. If that's what your really want to do though, don't hesitate!

NurseOnAMotorcycle, ASN, RN · Nov 10, 2015

I love ER nursing! I get to use all of my skills that I've learned in and out of the hospital (including the occasional jiu jitsu move!).

Try shadowing for a shift. You'll be hooked.

ohiobobcat · Nov 10, 2015

You don't typically have "med passes" in the ER. You medicate to treat symptoms, continually evaluating and re-evaluating your patients and their priorities. I worked in a 12 bed ER and we averaged 40-50 patients a day. Maybe 17,000 patients per year? "Admission" to the ER is a triage process. The sickest patients get seen first. You tend to do focused assessments in the ER, instead of full head to toe assessments on every patient (although often those are necessary depending on the patient complaint). Patients leave the ER by discharge, transfer, inpatient admission or body bag.

Documentation varies by facility. Shadowing in the ER is a great way to get a taste for what ER nursing entails. That's how I got started as an ER nurse. It's fast-paced, chaotic and busy. Good luck.

Lev, MSN, RN, NP · Nov 11, 2015

The amount of patients I see each shift depends on the area of the ER I'm working in. I work in a 40+ bed ER (I'm talking main ER, not including fast track rooms, and obs unit). I'm working in the lower acuity area (fast track area) where people are in and out I can easily see 20 patients a shift. Otherwise, It probably averages around 10 patients a shift. I may or may not discharge 1/2 of them. I may get 2-3 new patients all within 45 minutes of each other. It really does depend on what is going with your assignment. If I have an ICU patient, it may be 3-4 hours before they go up to the unit and I probably won't get any new patients until they get settled. Some days, patients come in and go home and other days you board patients for several hours. When you have a critical patient, you have to take care of them. Your other patients meds will be late, but that is not priority. As a PP mentioned, most med orders in the ER are one time orders and are entered as things happen. Oh, the white count came back elevated ok draw cultures and hang abx. Oh, patient has a HA. 1x order for tylenol. The documentation in the ER is lighter than floor documentation, at least in my experience.

AZQuik · Nov 11, 2015

Very different than floor nursing as others have said. Sometimes I'm just babysitting sleeping drunks, other times I'm giving blood and prepping for the or while another pt of mine is getting a tube, while another is waiting for an ICU bed and already tubed, and then another has generalized sx and is on their call light all night for pain meds and a roast beef sandwich (with three packets of mustard). Good times. Shadow a shift. Go sit in the waiting room for a bit and get the feel. A lot of treat n street. Then sanitize the ones who are coming in.

ArrowRN, BSN, RN · Nov 12, 2015

I think she means how often those events happen. I work in the ED...once you're established in your own ED you start getting a feel of the patient population and what each day brings but alas, it's a very unpredictable environment so I can't offer any help.
I'll say it's extremely fast paced and high stress. It requires a lot of flexibility and resilience. If that's what your really want to do though, don't hesitate!

Well last I checked I am "HE" lol, and yes That is what I meant, in addition to who picks up the slack for the other pt's? I was an EMT I know everyone will basically run to a coding pt.

ArrowRN, BSN, RN · Nov 12, 2015

Thanks Lev

Lev, MSN, RN, NP · Nov 12, 2015

Thanks Lev

Wow that is a BIG ER! You will love it, I promise.

Roy Fokker, BSN, RN · Nov 13, 2015

I'd like to know from ER nurses who work nights what their shift is normally like.

I now work days, but I worked nights for over 6 years. The contrast is not all that different from med/surg (I worked that too! lol) - the easiest commonality would be reduction in staff - fewer nurses/techs/secretaries/docs etc.

The one thing that I had to adjust to big time from being a floor nurse (besides the obvious differences in priorities etc.) was the presence of a Doc in the department 24/7. Yeah, no more 'paging XYZ, MD for Pt. ABC' - you have a Doc on hand 24/7.

No 2 ERs are the same - your shifts (be they day/eve/night) - depend largely on the patient population you serve. It also depends on what facilities your hospital provides on an emergent/inpatient basis (dialysis, cardiac cath, open heart surgery, acute stroke, psych, OB/GYN etc.)

Take my example: I recently transferred from a Level-II in a somewhat "poor" region to a Level-II in a comparatively "more prosperous" region. At my old unit, there were rooms in fast track dedicated to GYN complaints (read: "lady partsl discharge". We used to call those rooms the 'whiney gyne alley' ) because of the sheer volume of GYN complaints that would walk through the door.

My new unit? I can't believe the number of patients I treat for 'constipation'... and no, these aren't 90 year old grandmas with an opiate prescription. They're like 40/50 year olds! Its unbelievable!

My old hospital did dialysis, cardiac caths (no open heart though), OB/GYN and psych. We shipped out acute trauma, acute stroke and non-voluntary psych. Cardiac caths for acute MIs were weird - we'd take 'em to cath lab but always had a transport crew on standby for transfer to a facility that could do a CABG, just in case.

How many pts admissions/discharges will you do a day

That depends on which section of the ER I'm working (acute side, fast track, rapid care) and who the docs/NPs/PAs are on duty and what kind of patients roll through the doors.

Quite frankly, there is no real way to tell how many patients will get admitted and how many will be discharged from the ER. Unlike the floor, where patient flow is static (pt. gets discharged, opens the bed, different patient gets admitted. Say you have 30 beds, once you hit 30 patients, you're done. No more "admissions". Doesn't work that way in the ER).

I can have 10 different patients walk in in a 20 minute period with complaints as varied from toe pain to chest pain to a EMS squad riding in while coding a patient.

what about passing med's versus taking care of a pt who is crashing and what about documentation requirements.

There are no 'scheduled med passes' in the ER. Heck! There is no "scheduled anything" in the ER! lol

Passing meds versus dealing with a crashing patient is similar on the floor as it is in the ER - the only difference being, on the floor you'd call Rapid Response or a Code Blue. In the ER - YOU are the Rapid Response/Code Blue! :up:

I was thinking maybe I could just help out in my ER to see what it's like, which is the best way to go, but I just don't want my manager to know just yet, but I think she will be supportive. I just want to get an idea of what I'm getting into and if its for me.

Many hospitals have a 'program' where staff nurses on the floor get to rotate and spend some time with their ER colleagues for "professional development" (I know in my current hospital I've had floor nurses come down to hone their IV start skills). Maybe you could bring this up to your Boss and say you'd like to improve your IV skills? Just a thought...

cheers,

ArrowRN, BSN, RN · Nov 23, 2015

Thanks Roy, I like the idea of not having to page a doc and hope they return my call. Last week I had the misfortune of checking myself into our ER, thankfully all tests were good, and I got clean bill of health. They took about 3 hours to see me and the waiting room was always full some people took 6 hrs to be seen, guess the ER was full cause some beds were in the hallway. My ER nurse did not spend much time beside just getting basic info and starting my iv. I rather not be a patient in an er...like most people of course but it was good to get first hand observation.