campesina

Hi everyone! I'm a nurse with 6 years of experience, most of it ER and I'm looking to make a switch to peri-op. The position I'm applying for involved a lot of pre-op and post-op care and from what I understand not too much circulating type duties as they have separate nurses for that. The ER I love but it's draining and the hours and scheduling are very difficult. I'm a little burnt out and looking for a change. I came to this board to get some insight and I have to say I've been left a little freaked out, it sounds like every encounter with surgeons is bad lol! My rotations through pre-op, OR, and post-op through nursing school and mandatory job training for my other jobs have been really positive. I know surgeons and surgical PAs can be nasty, I worked on a neurosurgical floor at my first job. In the ER we have to deal with strong personalities too, especially with the specialists like cardiology and ICU docs that come through here, so I'm definitely not naive to those kinds of people. However I would like some comparison for any of you who have worked on different floors, in particular ICU and ED. I don't want to go to a place where I'm getting yelled at and belittled every day .

You weren't out of line. Patient and staff safety ALWAYS comes before charting. Personally I can't ever imagine turning down someone's request for help in a situation like that.

I used to be (and still a little bit am) like you. I beat myself up a lot. But now, with time and experience I'm learning that we are human and these people are sick and if they tank and we have done everything possible, it's NOT OUR FAULT. When I have a patient who I'm iffy about going up to the floor as opposed to the ICU, I call the admitting doctor and tell them my concerns about the patient going to a unit other than the ICU. The vast majority of the time they agree with me and will change the admission to the ICU. If they disagree with me, I just document. If the RRT is called a few minutes after they get upstairs, that's on the doctor and not me, as I did everything possible to advocate for my patient. It's great to care for your patients, that's our job, but I sense you are very very emotionally invested in these patient, as if they were your own mom or dad. That can serve a great purpose WHILE you are caring for them, but once they are out of your care in the ER (whether they be under the care of another nurse or admitted upstairs), there is no need to feel guilty about what happens after, you didn't do anything wrong.

Wrong thread! please delete

14 patients!? Wow that is insane. I work in an ER in NJ and our ratio is 5:1 and if we have a heavy critically ill patient or trauma patient usually someone will cover the rest of our pod for us so we can focus on that one patient (we also make the top 50 list of highest ER volume in the country, so it's definitely not a small or rural hospital). I guess we are very fortunate based on reading these responses, we have lots of staff and patients are moved in and out as quickly as possible so there is no backlog. I'm sorry you are going through that, I can't even imagine how challenging that must be, I would be looking for a new job, that's just not safe.

If the attending at told me to use Fentanyl and Versed as sedation, I would've not started the propofol at all and just would've started the other two drugs. The resident was a jerk for denying what he did and said, but I think it was still incorrect to have even started the prop AFTER the attending had stated that she wanted different drugs used. I think that's where you got yourself into trouble.

I think the ER is a shock to anyone, ranging from experienced ICU nurses to med-surg nurses to brand to grads. It's very fast paced and you have to be on your toes, and also the learning curve is immense. But with all of that being said, I'm sure you can do it! Like shaunrn mentioned too, ER doctors are typically much more pleasant to work with than surgeons. Give it a shot, and if you don't like it, you can always go back to the OR or try a new specialty!

I'm sure you have already taken it, but for those who haven't, the ENA book with 5 practice tests inside + 2 online tests helped me the most. I did the tests, read the rationales for the questions I got wrong, and then brushed up on the topic in the ENA study guide and/or the book Pass CEN (I found Pass CEN to be a little more helpful). My initial scores ranged from 65-76. When I restudied and took some of the tests again, my scores ranged from 81-90. I passed the CEN with an 83. Honestly I found that it's very important to UNDERSTAND body processes as opposed to just sheer memorization, which is impossible given the content that could be covered on the exam. Also, the CEN lectures on YouTube from Mark Boswell helped me a lot, I listened to them while I was in the car, it's a nice review of important topics the exam will touch on.