Moving to ED

I too will be starting in the ED here in Sacramento in January and similar to you have 1 and half years of experience on a cardiac unit.

I don't have any advice but wanted to let you know that you are not alone in starting this ED adventure and wanted to wish you luck on your endeavor.

P2

Thanks and the same to you...

I transfered from a cardiac unit to the ED about three years ago,...same hospital. I had worked in the cardiac unit for 8yrs and had been an ED tech for three years before that. I think the hardest part about the transfer is changing your mindset to ED nursing,.not floor nursing. The ED has different protocols, different priorities and the goal is to see the pt and get them out of the dept as fast as possible,...dc'd home, to OR, admit whatever,....there are always people waiting to be seen and the longer you have a pt in the dept the longer someone sits in the waiting room. The first time I had labs come back on a pt with blood glucose of 385 and the doc wasn't concerned about it I couldn't believe it. I was ready to give some insulin and the rest of the staff looked at me like I was crazy,....then my preceptor gently reminded me,.."this pt is here for FX arm,..he is a diabetic and I expect his glucose to be high,...he's going to the OR so we aren't going to feed him,...they will address it after OR lets get him ready to go!" There were many situations similar to this one that made me have to step back and remember that we are here to treat what is life/limb threatening at the moment,..everthing else is handled by someone else!

I love the ED and work with some great people,.best of luck to you,..just keep an open mind and you'll be fine!

You guys wouldn't believe how many posts there are on this website with this exact topic...please, please, do a search you will find more info then you could ask for. I can't answer this question one more time...sorry.

Welcome to the ED and to a whole other aspect of nursing :-)

Book: Emergency & Critical Care ACLS Pocket Guide by Paula Derr

Welcome to the ED. I think the two main difference between the ED and floor nursing is the issue of prioritization and turnover. On the floor, you have the same patients most of the day; whereas in the ED your patients will turn over quickly. You need to do what needs to be done initially for your patient, finish up the chart and prepare them for discharge or admission. There will also be times where you need to really prioritize and be confident when assessing who needs your help first. As Cardiac RN pointed out, we don't worry about every issue in the ED. It's not uncommon that we get the diabetic guy with the ankle pain who has a sugar of 250. We don't normally treat that in the ED, it's something he has to manage with his doctor in an outpatient setting. Maybe he'll get a bad of fluids while he waits for his x-rays.

Another big issue is autonomy. The best part about the ED is your always have an attending right there to get orders from. However, the downside is that if all of the attendings are busy you might have to initiate some things on your own (if allowed by protocol). Even for regular patients we have advanced protocols. In my hospital if you think your patient has cardiac-related chest pain you can draw the blood, put in the orders for EKG, chest x-ray, 02 all that good stuff. Some nurses are not comfortable with this, so it takes a little getting used to and being sure of yourself.

The last big difference of the ED is the bane of my existence: triage. Although you probably won't get to triage until you are at least one year in, it is a tough job. You need to quickly and accurately do your assessment, dispo the pt to the correct area and determine who is the sickest, who can wait, who can't wait and deal with every person wants a pregnancy test, or wants to know where MRI is, or wants blood work done because the lab is closed today ect. I really hate triage.