Moving from tiny ER to a Level II

[canoehead, BSN, RN]

I've done a lot of different specialties including, pediatrics, OB, and a tiny bit of ICU relief work. I've worked the past 3 years in a 7 bed ER and been the only nurse on the night shift, sometimes the secretary would call out and I'd be the only person in the ER. Some nights I'd clean to stay awake, but other nights I'd get ambulance on ambulance, and lasso the security guard and EMS crew to help out. I can juggle patients extremely well, but I'm usually able to see the whole department, and know every patient.

I'm switching jobs to a 26 bed ER, and clearly you can't know everything about 26 people. The average assignment is 4 beds per nurse, but that flexes up according to what's going on in the department. Has anyone made a similar change?? What can I keep in mind, or do differently to make my orientation as pain free as possible??

[sissiesmama, ASN, RN]

Hello - I have worked in different sized facilities. I went from a 3 bed ER where I worked nights and there was only 1 RN on each shift, then moved and got a job in a larger ER , size wise would be similar to the one you are describing, maybe 24 beds, I think.

We rotated through charge position, and if staffing permitted, the charge would take 1 less room to do some of the other routine charge stuff. We would all have maybe 4 rooms each, and kind of divide up the trauma rooms where all of the big ones weren't given to just 1 nurse. Everyone all pitched in together in a code or trauma.

Anne, RNC

[JRapha'sRN]

Take comfort in your experience but don't dwell on it. By dwell on it I mean constantly say, "back at xx ER I used to..." Be eager to learn the flow of your new ER and the policies and procedures that may differ from where you just were. Relax, though, the patients and families stay the same regardless of where you are.

[canoehead, BSN, RN]

True, the illnesses don't change. I darn well hate having to learn a whole new set of policies (written and unwritten). It takes a good year before I feel semiknowledgeable about who to call for what. Until then I feel like a blowhole full of questions.

[Spidey's mom, ADN, BSN, RN]

I came from the same area and did the same thing. One piece of advice is don't let them assume just because you used to work in an ER, that you don't need a good orientation.

Good luck!

steph