MedSurg Trauma RN transition to Emergency Nursing, what do I need to expect and know?

JKL33 · Jan 7, 2018

I am just literally nervous and excited at the same time.
Thanks in advance for any help that you can possibly extend!
-zhapper2002

Congrats! Of course you are nervous but enthusiasm and the desire to learn will take you far. :)

How about getting a good solid ED nursing book to work through, such as Sheehy's Manual of Emergency Care? [Find a used copy]

I know you're probably eager to start the learning process, but I hate to have new ED nurses stress themselves out ahead of time. :) They may have a very good orientation already planned out for you where learning can take place with a little bit of order/sequence, rather than you trying to learn random facts between now and then. I like the idea of you having a book because then you have something in your hands to review in some sort of systematic way.

Best wishes. Let us know how it's going!

zhapper2002, BSN, RN · Jan 8, 2018

Congrats! Of course you are nervous but enthusiasm and the desire to learn will take you far. :)
How about getting a good solid ED nursing book to work through, such as Sheehy's Manual of Emergency Care? [Find a used copy]
I know you're probably eager to start the learning process, but I hate to have new ED nurses stress themselves out ahead of time. :) They may have a very good orientation already planned out for you where learning can take place with a little bit of order/sequence, rather than you trying to learn random facts between now and then. I like the idea of you having a book because then you have something in your hands to review in some sort of systematic way.
Best wishes. Let us know how it's going!

Thanks for the response! I agree with you, I felt like I am stressing myself out too much. But I will for sure check on that book and have it as my go to reference.

I will just probably relax and get ready for the action! Will let you know once I start my orientation. It is going to be a roller coaster ride for sure!

TigraRN · Jan 8, 2018

Congratulations and welcome to organized chaos!

I will just list several things that were helpful for me:

* get a list of phone numbers and keep it close to you (lab, radiology, units, supervisor, security, EVS, etc)

* get yourself familiar with processes (assessments, discharges, admissions, transfers)

* assessments in ER are focused. For example, a patient with c/c left heel ulcer - check cap refill , pulses, color, temp, sensory-motor, BG if diabetic, etc. Expect Xray to rule out osteo.

* you may not have many patients with MI/stroke in the beginning, but one of your patients may develop one, so be prepared and know the procedure for those (when I started out, I wrote it all in a small notebook and kept it with me). If you are in a code, know who your code team members are (meds, procedure, family).

* when you get a new patient, talk to them while you are connect them to the monitor, ask how you can help, let them know you will be working on labs, XRays, etc. To chart assessment is important, but if you can draw the labs, you will actually save them time in ER. So, if I can speed up the process, I first get some things out of the way (have them provide UA sample etc) and then chart.

* my scissors on a lanyard are always with me and I use them a lot

* get to know the people you are working with: secretaries, transporters, housekeeping, security.... It is a lot, but if you learn one new name a day you will eventually know many and those people will be your life savers one day

* when you are offered a lunch/break - take it NOW if possible

* know at all times what is pending for the patients, if, for example, the blood was drawn 30-60 min ago, and still no results - call the lab

* look at your patient, then at the monitor, if concerned, seek a second opinion right away

* if a patient starts seizing - priority is to provide O2 via non-rebreather at 15 L/min and direct other nurse to give meds

If you ER has mentor/mentee program, it could be a great resource for you.

DayDreamin ER CRNP · Jan 11, 2018

Search this board. This topic has been discussed multiple times here.

The best advice I have for any floor nurse coming to the ED is to get out of "floor nurse" mode. In my opinion, floor nurses are not used to a team environment and are not as accustomed to a lot of people being in your room at one time doing things together. I also think a former floor nurse appears lazy because she doesn't get off the stool or chair to get up and help the arriving ambulance patient. ER nurses tend to be IN the rooms more and not so much at the desk. It is a big adjustment for a lot of nurses. Good luck!

gemmi999 · Jan 13, 2018

Biggest thing for ER is TEAMWORK. If you're caught up, help others. If other's ask for help, take the time to do it unless you have a critical situation. If a Code Blue in the ER is called, go even if you think they might have enough people. You can at least see if they need something like flushes, NS bolus primed, etc. TEAMWORK.

Also, be aware that ER staff might have some off color jokes. You see *a lot* in the ER and it can have a morbid effect on your sense of humor, etc.

Do before Chart, btw. Start the IV, draw the blood, get pt's on the monitor, medicate, photos if necessary, and then do one big charting on everything you did/assessment. It's always better to be ahead then play catch up.

MirageRN · Jan 18, 2018

Search this board. This topic has been discussed multiple times here.
The best advice I have for any floor nurse coming to the ED is to get out of "floor nurse" mode. In my opinion, floor nurses are not used to a team environment and are not as accustomed to a lot of people being in your room at one time doing things together. I also think a former floor nurse appears lazy because she doesn't get off the stool or chair to get up and help the arriving ambulance patient.

As an internationally trained and experienced former "floor nurse", all I can say is that I truly enjoyed munching on my donuts, sipping my warm caramel macchiato and talking to Sally about my 2 week vacation in the Carribean while all hell break loose in the unit, match it with never ending call lights that still kept ringing in my head even when I am in bed already contemplating about life and top it off with NPO and no bathroom privileges for the entirety of your shift while you juggle multiple things going on with your patients and their family members.

@zhapper2002 All I can say is that, whatever your experience is, make use of what you have learned and apply it in your new field. Have a healthy dose of anxiety to keep you focused and always keep an open mind (I guess it applies in all areas of nursing). You'll do fine. GL!

zhapper2002, BSN, RN · Jan 18, 2018

Search this board. This topic has been discussed multiple times here.
The best advice I have for any floor nurse coming to the ED is to get out of "floor nurse" mode. In my opinion, floor nurses are not used to a team environment and are not as accustomed to a lot of people being in your room at one time doing things together. I also think a former floor nurse appears lazy because she doesn't get off the stool or chair to get up and help the arriving ambulance patient. ER nurses tend to be IN the rooms more and not so much at the desk. It is a big adjustment for a lot of nurses. Good luck!

Thank you so much for your very opinionated response and for generalizing floor nurses. I really enjoyed eating my popcorn while chitchatting in the nurses station, sipping my freshly brewed coffee, ignoring the call lights and waiting for my time to clock out. I actually could've finished my online shopping too! Oh I'll probably do a Netflix marathon next time I come back for my shift. Need I say more?

How I wish! I work in one of the busiest County/Level I Trauma Hospitals in the Bay Area and in my 2 years working on the floor, I barely sit and I can't even remember that I ever look "lazy". Not even a bathroom break! Even my charge nurses are jumping into action!

I probably look wasted and defeated after 12 hours of dealing with hella stuff! I am the maintenance. I am the IT expert. I am the janitor. I am the kitchen person. I am the MSW. I am the counselor. I am everything! Sometimes I even forget if I am a nurse tho.

I am happy to invite you to see our hospital and tell me if floor nurses are just sitting and appear lazy.

zhapper2002, BSN, RN · Jan 18, 2018

Congratulations and welcome to organized chaos!
I will just list several things that were helpful for me:
* get a list of phone numbers and keep it close to you (lab, radiology, units, supervisor, security, EVS, etc)
* get yourself familiar with processes (assessments, discharges, admissions, transfers)
* assessments in ER are focused. For example, a patient with c/c left heel ulcer - check cap refill , pulses, color, temp, sensory-motor, BG if diabetic, etc. Expect Xray to rule out osteo.
* you may not have many patients with MI/stroke in the beginning, but one of your patients may develop one, so be prepared and know the procedure for those (when I started out, I wrote it all in a small notebook and kept it with me). If you are in a code, know who your code team members are (meds, procedure, family).
* when you get a new patient, talk to them while you are connect them to the monitor, ask how you can help, let them know you will be working on labs, XRays, etc. To chart assessment is important, but if you can draw the labs, you will actually save them time in ER. So, if I can speed up the process, I first get some things out of the way (have them provide UA sample etc) and then chart.
* my scissors on a lanyard are always with me and I use them a lot
* get to know the people you are working with: secretaries, transporters, housekeeping, security.... It is a lot, but if you learn one new name a day you will eventually know many and those people will be your life savers one day
* when you are offered a lunch/break - take it NOW if possible
* know at all times what is pending for the patients, if, for example, the blood was drawn 30-60 min ago, and still no results - call the lab
* look at your patient, then at the monitor, if concerned, seek a second opinion right away
* if a patient starts seizing - priority is to provide O2 via non-rebreather at 15 L/min and direct other nurse to give meds
If you ER has mentor/mentee program, it could be a great resource for you.

Thank you for your time and for a very detailed tips and response! I appreciate it! I will keep this as my reminder and guide too when I start orienting. It's good to hear from fellow nurses who are willing to share and empower nurses who are cross training from being a floor nurse up to becoming ED nurses. I admire the intention to help and to give a picture of what to expect and what to do in the ED setting. I can see how crucial time management and anticipating needs and thinking 10 steps ahead when it comes to Emergency Nursing. Again, thanks for the tips! :)

LilgirlRN, ADN, RN · Jan 19, 2018

Get ready for a different kind if rat race. You have more patients on the floor but also more time to get things done. Everything in EDland is stat. Everything is in hurry up mode. The only thing Americans are afraid of is inconvenience. They don't care that there's a code going on, they want their "spider bite" drained now!

More seriously, you will have a mentor. No question is dumb. There are only dumb mistakes because you didn't ask the question you wanted to. Know your weaknesses and share that with your mentor. Please and thank you go a very long way. I don't know if this is in a teaching hospital but if so watch while teaching is going on. Learn to collaborate with your fellow nurses. And NEVER be afraid to ask for help. But also, always help when you can.

zhapper2002, BSN, RN · Jan 21, 2018

Biggest thing for ER is TEAMWORK. If you're caught up, help others. If other's ask for help, take the time to do it unless you have a critical situation. If a Code Blue in the ER is called, go even if you think they might have enough people. You can at least see if they need something like flushes, NS bolus primed, etc. TEAMWORK.
Also, be aware that ER staff might have some off color jokes. You see *a lot* in the ER and it can have a morbid effect on your sense of humor, etc.
Do before Chart, btw. Start the IV, draw the blood, get pt's on the monitor, medicate, photos if necessary, and then do one big charting on everything you did/assessment. It's always better to be ahead then play catch up.

Thank you for your time in responding to my query! I appreciate it. That's what I notice about ER Nurses, they have a different humor but it's cool with me though. They have a cool vibe. I am preparing for my start date and I will for sure update this thread once I start. Thanks again!

zhapper2002, BSN, RN · Aug 8, 2018

Quick Update, it's been more than 6 months and so far I am loving the ED. Amazing teamwork, everyone's ready for anything all the time. I always anticipate everything and anything - which I learned being an ER. It may get stressful at times but I am loving the organized chaos.