Observation Unit NP

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Specializes in ER, SCTU, PACU.

I have been investigating the possibility of a job as an NP for an ER Clinical Decision Unit after graduation. I currently work PACU (close to 2.5 years by the time I am done with school), and prior to that I worked for 5.5 years in various ERs (peds, adult, mixed) and interfacility critical care transport. This CDU is looking for an NP with ER experience as an RN or NP (ding ding ding! :cool:), to top it off I am already familiar with the hospital layout, policies/procedures, turn-around-times for common tests, and the EHR system. I will graduate as an Adult-Gero Acute Care NP, which is fine for CDU since they do not do peds observation. The CDU provider always has access to an ER attending physician downstairs for consults, questions, etc.

Can anyone give me an idea of what your typical day is like in an observation unit? What are you responsible for? How much help do you get/expect from your attending? Do most of the patients get discharged home or transferred within the hospital to an inpatient bed? Are you reprimanded if a patient LOS is longer than 23 hours?

Thank you!

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Following because I am working on setting up the specialty portion of my clinicals in an ER/CDU. Do you mind sharing salary Information​ for this position, as well as what area of the country you are in? Thanks!

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Specializes in Ambulatory Case Management, Clinic, Psychiatry.

also following-- interested in cdu as an rn

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Specializes in ER, PCU, UCC, Observation medicine.

I'll give you my feedback. So I've been a NP for almost 5 years. Three of these years I've worked full time in a observation unit. Here's what I recommend:

CDU is easy, mostly all protocol driven. In all honesty a monkey can do it because all you're doing is following a protocol. There is on occasion some effort and expertise that goes on for patients with multiple comorbidities. That being said, I wouldn't recommend this job right out of school. The reason is, it's too easy!! Personally, I wanted a job out of school that was challenging, where I was exposed to a lot of stuff and a place where I absorbed lots of knowledge. Working in cdu is really a dead end job, seriously. There is no advancement. The other reason why I don't recommend it is because of autonomy. My er attendings want nothing to do with these patients because they are busy in the ED. So you really need to be experienced when you do get abnormal results. You need to know how to interpret them and then dispo them. You need to know who to call, when to call them, and you need to be experienced in procedures. From time to time I do EJ's, I&D, etc. So you need to be proficient in procedures as well.

If this is something you're looking to do long term then it may work out for you. But if you do this for a year or two and decide to apply for a different job I don't think this position will give you any added boost to the resume if you're competing with other APPs. Also, it doesn't give you a lot of experience or broaden your knowledge.

As as far as salary goes, they pay me well. I've made 120+ for 3 consecutive years.

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Specializes in ER, PCU, UCC, Observation medicine.

I kinda went off topic on my first post, here are the answers to:

Can anyone give me an idea of what your typical day is like in an observation unit?

What are you responsible for? How much help do you get/expect from your attending? Do most of the patients get discharged home or transferred within the hospital to an inpatient bed? Are you reprimanded if a patient LOS is longer than 23 hours?

My typical day I start off looking at the census, print my work sheet out and look at each pts ED note, labs, vitals, and rad results. Then I do H&P on pts and document in EHR. I make sure the workup for each protocol has been correctly entered in the computer for each pt if they were admitted overnight because my cdu does not have 24hr APP coverage. After I finish my h&p I determine who can go home and who needs more time. Throughout the day I'm just admitting and discharging patients.

I am responsible for everything.

I get no no help from my attendings. When I first started this they would round everyday, now I don't even see them. They just co-sign my notes.

As far as discharging pts; the national avg of patients who get admitted to the hospital from cdu is 20%. My cdu admits 10% of our pts.

Technically we we can keep pts up to 48 hours according to medicare. The goal is to d.c. most of them in 24 hours or less. So the answer to your question is no I have never ever been reprimanded.

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Specializes in Ambulatory Case Management, Clinic, Psychiatry.

Youtube-- How do the staff RNs seem to like it? Any feedback?

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Specializes in ER, PCU, UCC, Observation medicine.

I think there are mixed feelings. It's different than being an ER nurse, slower paced, much more documentation. Some like it, some don't. In one of the cdu's I use to work all the RNs were travel assignment because the ER nurses didn't want to do it. So I guess it varies.

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Specializes in ER, SCTU, PACU.

Thanks Youtube, I was hoping to use that time as my practice with a collaborating physician, since I need X amount of hours working with a collaborating physician before practicing independently. I don't mind "following" protocols in the beginning, for me, that kind of "auto-pilot" allows me to focus on everything else (the underlying patho, what complications to expect, what meds are they on, what's the long-term plan and what was the thought process behind the admission).

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