Medsurg nurse transition to ED

Crux1024 · Mar 26, 2014

Not at all. Your success in the ER depends entirely on the person you are. The rhythm of the ER is definitely different from floor nursing but it is doable. I came from a Cardiac/tele floor that mostly held M/S patients and I transitioned well. Ive been there almost 2.5 years now. Listen, look and ask questions. There will be patient populations and procedures that are entirely new to you and thats ok! Your success will be up to you. If you interview for a position ask about their orientation process: how long, if there are dedicated preceptors etc.

OCRN3 · Mar 26, 2014

Thank you for your response. I work tele per diem but I have always wanted to try ER.

zmansc, ASN, RN · Mar 26, 2014

Many of my ER coworkers started on the floor, got a year or two under their belt and for various reasons decide to try the ER. Now they are hooked

jallen326 · Mar 26, 2014

I think you will be fine as long as you keep an open mind. I came from a med/surg oncology background and transferred to ER about 7 years ago. I am still there. You just have to remember there is no specific routine like on the floor and once your patient is admitted your job is to get them out ASAP and not to continue doing stuff unless it's ordered stat! Part of you will want to help out the floor nurse and they may use it to their advantage but you have to remember that you are going to be getting another patient. The floor nurse will have her max patient but in the ER there is no such thing since you can't tell EMS to stop bringing patients. Good luck to you.

1fastRN · Mar 26, 2014

^^Ditto to the above poster. The best piece of advice someone gave me when I started: "The ER is like a game of chess. You want to figure out how you are going to get your patient in and out as fast as possible." You want to know the plan so you can "get rid of them ASAP". Otherwise, you'll be drowning before you know it. Talk to your doctors. If transport is backed up, push your patient to CT or wherever they need to go. The faster you work them up and know what the plan is, the faster they will be dispo'd. Discharge your people quick, and once their admitted get them the heck outta there! Whether that means to the floor (if they get a bed assignment) or to a holding area in the ER (if you have one). Because the patients won't stop rollin' in! If you see a patient just sitting there, ask the doctor what the deal is. They forget too! "Hey doc, Mr. Q's 2nd troponin just came back negative, are we discharging him?" Stay informed and on top of your patients.

I've seen plenty of M/S nurses adapt wonderfully to the ED! I am a firm believer when it comes to a nurse in the ED, you either "get it" or you don't. I went straight to the ED so I can't speak from personally experience. Others have said floor nurses can struggle because you have to get them to lose the "bad habits" they have from working on the floor. Not actual bad habits, but it's just completely different. It might feel different because we area a lot more independent as nurses in the ER, there are a lot of protocols we can utilize. We often put in our own orders for labs to fast track the patient. We almost tell the doctors what we are doing instead of asking, especially if you have a good relationship with the MD. (i.e. Doc, patient X is complaining of abd pain and nausea again, is it okay if I give him 4mg of zofran and 1mg of dilaudid? We have him the dilaudid 3 hours ago which did the trick; his sat is 100% and BP is 132/69.)

We know when a blood gas and respiratory treatment should be done, we order our own EKGs. We pull anticipated meds for the asthmatic patient before the doctor has seen them.

Note: We don't practice outside of our scope, but a lot of what we do is anticipate what would be done in this situation and follow accordingly. ER nurses work closely with our doctors and the MDs have a trusting relationship with their good nurses.

On a very busy night, it's not unusual for the nurse to have the patient fully worked up before the doc even gets to the room. It's a win-win for everyone.

And of course the pace and unpredictable nature.... the ER is a whole 'nother animal. Keep an open mind, roll with the punches and you'll be fine.

Good luck!

OCRN3 · Apr 6, 2014

Thanks for all the responses.

brekows · Apr 10, 2014

I am a first year nurse and I just transferred from a med/surg and telemetry floor to the ED a few weeks ago. I love it. I feel like I know nothing, and I really don't. Partly because I am a fairly new nurse and partly because my experience has been on a med/surg floor. Its like starting out brand new again, the skills I learned on the floor really are not useful in the ED. After my first few shifts I felt like I was disappointing my preceptor. I talked to a lot of friends who work in the ED and they reassured me that I will feel this way for awhile and one day it will just click, to just be patient and to always ask to help others. There are 'bad habits' to break from the floor, such as writing notes and charting etc. I have two other friends who also transferred from med/surg to the ED, they both agree the first few weeks are hard but after that the adjustment is a lot easier.

Guests · Apr 10, 2014

I jumped to the ED after a year on med-surg. It was a bit challenging because our med-surg patients were generally stable while a lot of the ED patients were not.

Mostly it was (and is) a matter of rapid-fire ADPIE over and over and over... often times minute by minute.

tjohns45 · Nov 11, 2017

And so do med-surg or cardiac tele RN's, we discharge, we get an admission...an attitude like that makes ER nurses sound lazy...that's too bad....

tjohns45 · Nov 11, 2017

Ive been a float RN for 11 years....thinking of going back to the ER...

tjohns45 · Nov 11, 2017

I can see you are speaking about floor RN's as if they have no experience...I have been a float Rn for 11 years...your autonomy depends on your experience and confidence, so the comments about putting in your own orders is chicken and dumplings...when I hear ER nurses talking about dumping on floor RN's it is quite aggravating...the truth is, I have done both and a lot of ER RN's can't do what floor RN's do and sometimes, vice versa..that statement makes ER nurses sound lazy....just givin an opinion, everyone has one....