New to ED with 3 years under belt

[Jeana18, MSN, DNP, RN, APRN, NP]

I just made the transition from a med-surg tele/observation floor to the ED, with 3 years of experience under my belt in that atmosphere. It has been quite the challenge, especially when we are in our "habits." I find the most difficult task is changing my mentality to be aligned with the ED, but I am hopeful!

If anyone has any advice on how to make this transition mentally, I'd appreciate it! Also, any tools to help with the "task orientation" of what needs to be done in the ED for particular cases would be great :)

[Lev, MSN, RN, NP]

You will love the ER.

Any change in mental status, unexplained tachycardia or bradycardia, chest pain, seizures, overdose, etoh, or critically ill patient needs the monitor.

EKGs - seizures, tachycardia beyond borderline, chest pain/some abdominal pain, seizures, overdoses, electrolyte abnormalities

IV - losing fluids or appears dry, emergent condition, if need tele, IV antibiotics, extreme pain

asthma - solumedrol, albuterol, magnesium

allergic reaction - epi, pepcid, benadryl, solumedrol

hyperkalemia - insulin, dextrose, fluids, calcium, bicarb, continuous albuterol nebs, dialysis

sepsis - fluids + antibiotics

Headache - benadryl, reglan, morphine, decadron

You will pick up stuff with experience

[WKShadowNP, DNP, APRN]

It is a change in mentality, isn't it. I was strong med surg for 10 years before going into my desired slot of ED. Other than the tasks and expectations I had to learn and appreciate the team mentality. The floors say they are team players but when you request help and it begrudgingly comes, it makes you feel low. But in the ED, the team is the norm . Help is vital and usually available.

Not always. But prioritizing becomes second nature in a different way than the floor. Instead of slating your med passes around therapies and meals you are truly thinking on the fly, rearranging needs as your patient panel changes and the individual needs fluctuate.

My god, it's what I love about the ED.

[jbug1792]

It was a scary transition for me at first. The first six months I wasn't sure I had made the right decision. I was so use to being in control of everything on my old med surge unit. I could manage my days almost seamlessly even with the most difficult patients, and even when we were short staffed I became good at juggling the extra the responsibilities of the floor.

In the ED I quickly realized I didn't have control over anything, pt conditions are often brittle and can quickly deteriorate, assignments change with the flick of a pen as pts are moved through as quickly as possible to get them where they need to be in order to provide them the best care. You get good at quickly changing paces and quickly prioritizing the most important tasks. It was a big change to say the least, for a few months I was convinced I had made the wrong decision and my dream of working in trauma was quickly abandoned, however I stuck it out and I can tell you it does get better and it gets easier. I am glad I stuck around because now I can't imagine working anywhere else.

[Jeana18, MSN, DNP, RN, APRN, NP]

Thank you all so much for your advice. It makes me realize that this must not be as bad as I thought it was going to be; the sky is blue on the other side.

I look forward to learning more and really deeply developing myself as a nurse :)