My impressions on the ER so far

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I'm coming off new hire training at a small local ER after being transferred from Med-Surg/Tele. Being a floor nurse first really did help me put things into perspective when I would get annoyed by minor stuff when getting ER Admits.

1. At the floor you would have a patient cap, in the ER that does not exist.

2. It focuses a lot more on the team focused approach which I'm still not used to. I'm very used to just minding my own business getting my work done and going home.

3. I really feel like I'm betraying my former comrades by doing this but, I'm always under pressure to transfer patients up to the floors regardless if it's change of shift.

4. My former ICU coworkers expect more out of me when I give them report.

5. It's REALLY weird that there is a physician around all the time.

6. I've done more IV's in a month than I did a whole year on the floor.

7. 22 Gauges used to be my best friend on the floor for getting IV's but in the ER they are horrible for getting blood from and kink way too easily.

8. I really still am petrified of pediatrics.

9. lady partsl bleed patients are very difficult for me to assess since I am a male. My female coworkers always get called into the exam room since I can't go in.

10. Going home almost an hour earlier is a HUGE plus.

So far I'm excited to work in the ED now, and a lot of my old preconceptions have been mostly washed away. It's also letting me consider my future career choices from Acute Care NP and ED NP though the Acute Care track prefers having critical care experience and CCRN accreditation. I don't encounter that many critical patients sadly.

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Welcome to the dark side, muahahahahaaaaa!!!!!!!!

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1. At the floor you would have a patient cap, in the ER that does not exist.

Yes. True. We can't just turn on the "closed" sign, although that doesn't stop me from daydreaming about it sometimes.

2. It focuses a lot more on the team focused approach which I'm still not used to. I'm very used to just minding my own business getting my work done and going home.

The teamwork in my ER is really excellent. It is a far cry from the culture where you just take care of your patients and the other nurses take care of theirs. While there are times when I think the primary nurse needs to be doing the bulk of the care just for the sake of continuity and keeping things flowing smoothly, good teamwork requires that we be flexible enough to jump in where we're needed, not just on "our" patients.

3. I really feel like I'm betraying my former comrades by doing this but, I'm always under pressure to transfer patients up to the floors regardless if it's change of shift.

I know that feeling because I worked the floor prior to transferring to the ED, so I know how it feels from the floor nurse end of things, but in the ED, the patients don't wait until after shift change to come in, and efficient throughput is actually a patient safety issue. We just can't have an admitted patient hanging around taking up a bed when we have a full lobby and the medics keep coming. There need to be processes in place that help to expedite transfer to the floor that take both the needs of the receiving unit AND the needs of the ED into consideration, with the ultimate goal of patient safety in mind.

4. My former ICU coworkers expect more out of me when I give them report.

Yes, ICU is much more methodical and thorough by nature, while the ED tends to be more problem focused (as in, what is going to kill the person the quickest) and more "by the seat of your pants", especially when it's busy. If I have time, I will do a head to toe systems assessment, but sometimes all I can do is a focused assessment and give ICU a blow by blow of when the patient came in, where they came from and why, and what we've done since they came in and what they look like now. In a way it often resembles a medic report more than your traditional nursing report.

5. It's REALLY weird that there is a physician around all the time.

I love it. It feels less hierarchical and more like we work together as a team- different functions but equally important. I like working with docs who like to teach. I have lots of questions about things, and it's nice to be able to just ask when we have a little down time. When a patient crumps, I don't have to page or call. The doc is within earshot.

6. I've done more IV's in a month than I did a whole year on the floor.

Yep. Our hospital doesn't have an IV team. The ER nurses are the IV team. Rather than feel bothered when Med/Surg calls for an IV start, I feel proud of us, and I'm happy to be of help. I've had to call Med/Surg for favors with things I hardly ever do, so it's nice to be able to promote good will between our departments by helping them when they need it.

7. 22 Gauges used to be my best friend on the floor for getting IV's but in the ER they are horrible for getting blood from and kink way too easily.

If your 22 is kinking, there's something going on with your technique. Maybe you're withdrawing the needle too soon and/or trying to advance the catheter against too much resistance. Also, you should be able to get a good blood draw from a properly placed 22. I would think if you're having difficulty getting blood, it's more your vein selection than the size of the angiocath. It's hard to say without being there to see, though.

8. I really still am petrified of pediatrics.

I used to be too, but now I love taking care of kids. There's hope!

9. lady partsl bleed patients are very difficult for me to assess since I am a male. My female coworkers always get called into the exam room since I can't go in.

There is a lot you can do for the vag bleed patient even though you are male! You can assess perfusion- skin color, heart rate, pulse quality- you can ask how many pads have been used in the last 24 hours, you can also do most every intervention such as starting a line, drawing blood, and giving meds. You really only need the female nurse to chaperone the pelvic or do the femcath, but you can still be the primary even though you're male (so long as the patient is okay with it and you are able to accommodate the preference). Just know it's really good form to offer something in return to the female nurse!

10. Going home almost an hour earlier is a HUGE plus.

Are you referring to getting out on time as opposed to staying late to chart? Yes, it's true that while I occasionally stay late if things are crazy and I want to assure a smooth transition to the oncoming nurse, in general I do get out on time. That is a nice perk- although I think floor nurses should refuse to work off the clock. If you have to stay late to chart because you didn't have time to get everything done on your shift, I think you should get paid for that time. As long as nurses work off the clock, management can continue to turn a blind eye to staffing issues.

Anyway, yes, the ED is a different animal, and while I used to think I'd be a great ICU or OR nurse because I am so methodical and thorough and detail oriented, I've realized that ED is good for me because it requires a certain amount of flexibility that transfers well into other areas of my life and helps balance out my OCD tendencies. I think my family would agree that I've become easier to live with since I became an ED nurse, because I'm able to prioritize what *really* needs to be done as opposed to what I'd like to be done, and I find it much easier to say "good enough" instead of striving for perfection every waking moment.

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Specializes in Public Health, TB.

At least at my facility, gone are the days of a 'patient cap'. We take patients whether we are staffed for them or not, until we run out of rooms. I think we would put them in the halls if we had more beds and call lights.

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Specializes in Emergency Department.

I have only done a few shifts in the ED over the years as a student and my impression of the ED is that it is exactly like nothing you've ever done before. I have been a paramedic for about 7 years (working) and I have been lucky enough to do rotations in various units all over the hospital, and from what I've seen, the ED is just exactly like nothing I've ever seen before in terms of doing things, as a paramedic or as a (student) nurse. I suppose that it is kind of like putting an ICU, med/surg/tele floor, urgent care clinic, and an immobile ambulance all into a blender and whatever didn't hit the ceiling, well, that's the ED. That analogy may explain why ED's in different hospitals aren't exactly alike...

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I laugh when I try to call report. The er only has a clock when you're timing labs or a critical pt. otherwise, we have no existence of time.

Sorry that you just walked in, or you just got an admit. I'm giving you a human I can tell you everything about, when just an hour ago I didn't even know their name. You'll be stressed, but it will be ok.

The stable pt I'm admitting to an obs floor is taking up a precious bed. Vent to your coworkers about how snarky and uncaring the ER peeps are. Ain't nobody got time for that lol

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Specializes in ED.

3. I really feel like I'm betraying my former comrades by doing this but, I'm always under pressure to transfer patients up to the floors regardless if it's change of shift.

Of course we are! We can't hold patients. I hate it when I try to call report and I get either, "That nurse can't take report. She's on her lunch" or "Um...it is 6;15 and about to be shift change. Can't you call back after 7?"

No I can't. It will be shift change for ME too. I know you think we hold these patients down in the ER all day and wait until 6 to call you and ruin your day. Trust me. We don't.

I'm also really resentful when I get the "We are just so busy" routine too. Yeah, yeah, yeah. When you have 15 hall beds and every nurse has at least 3 high acuity patients on top of the traumas we keep getting, then you can talk to me about "busy." Not saying the floor doesn't get busy, but they do get a patient cap and don't take hall beds.

Sorry that you just walked in, or you just got an admit. I'm giving you a human I can tell you everything about, when just an hour ago I didn't even know their name. You'll be stressed, but it will be ok.

The stable pt I'm admitting to an obs floor is taking up a precious bed. Vent to your coworkers about how snarky and uncaring the ER peeps are. Ain't nobody got time for that lol

I am SO going to remember to use something like this as my reply now!!! Good stuff!!

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I've heard of ERs with no patient cap and am immensely grateful not work in one. We have 3-4 patient assignment and adhere very strictly to that. I don't care of it's change of shift when my patient goes up. Think I never get a train wreck or code at shift change? It happens. More than enough. Luckily we can send our regular floor patients up without a verbal report now so it's not at issue. I am apologetic if I'm handing off a ton of stuff (I take care of stat orders) because I've had a critical patient or crazy assignment, but for the most part, nurses are understanding. And I hate holding admit holds because I LOVE having my docs around.

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Specializes in Emergency Department; Neonatal ICU.

Yes. True. We can't just turn on the "closed" sign, although that doesn't stop me from daydreaming about.

Oh this reminds me of a day on a weekend when there was resurfacing work being done on the driveway leading into the hospital. It was a bit confusing driving in due to a portion of it being blocked off. At one point a patient finally said to me "I wasn't sure if you were open!" It was then that I made the connection between the construction work and our abnormally low volume!!!

Back to to the thread - OP, welcome to the ED :)

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Stargazer,

You have no idea how much your comments mean to me!!!

"Think I'd make a great ICU or OR RN because of detail-oriented, methodical nature ... balances out my OCD nature ... good enough vs perfection".

While I tend to do well on prioritization... I have tended to prefer slower & more accurate activities in the past.

Good to know there is the ability to adapt.

And "yes, I can do ER" (thinking positivity) If I can make a successful transition from a 20 year career to having a fantastic GPA for my ADN (studied like it was more important than breathing! LOL!) and passing NCLEX in 75 questions on 1st attempt, I can adapt to ER !

The options of non 7a-7p shifts... For example... 11a-11p or 3p-3a is very appealing.

Having a Dr always nearby is appealing. (Love to learn from them)

I like the idea of teamwork. I was not expecting the 1st interviewer's question.... "What is your idea of teamwork?" my reply was "being there for my fellow nurses when they need help". Which corresponds to my attitude in nursing school... I felt so fortunate to have those ahead of me give me guidance, in turn, I was very happy to help guide those behind me".

Mentors are a beautiful thing.

So I "blew" my first interview which happened to be the first interview I'd done in approximately 20 years. So my classmate ended up with the "new grad training program" in ER. Happy for her. Disappointing for me. I mean, what is the chance I get a 2nd chance at that type of interview???

It isn't like this opportunity is easy to come by.

It is not clear my next steps to "try again".

ACLS, PALS, Phlebotomy (wanna be good at hitting that vein), & RN-BSN are all on my agenda. Interviewing often enough where it is not so "foreign" to me might help me present myself in a positive fashion?

FEM

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If at first you don't succeed, try, try again.

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Welcome to the ER!

I'm also new to the ER as an RN. Been here awhile as a Tech, so they decided to give me a chance when I got licensed. Agree with all of your nuances about the ER versus floor except one. Caring for lady partsl bleeds.

Both my current hospital and the one I did my clinicals at weren't just fine with males providing care for females, but expected it from us. My first cath was a postpartum woman who hadn't gone all day and was in pain from the distension. Believe me, she was VERY happy that I got the job done. If the woman has reservations about a male providing care, we have to address it. But just think of all the male patients who are not happy about a female they don't know handling their genitalia or disimpacting them...it's not personal, it's just business. And if your ER gets swamped like mine, finding an RN to chaperone can significantly delay patient care for either your or their patients if there are several patients who need to be triaged/stabilized/medicated.

Stepping down from the soapbox.

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