squidnurse

(wistful sigh) Ah, Brevitol. How I miss thee...

I would take (and I did take) the CEN. Be aware that the questions are geared towards a nurse with an average minimum of 5 years of ED experience. There are plenty of study aids available for the CEN; I'd recommend picking up a review manual that comes with a CD-ROM for your computer. The CD contains old CEN exam questions set up in an identical format to the test you will take. Try and find two or three other nurses interested in taking the exam: ENA offers a discount on the testing fees if there are multiple applicants. As for "everyone fails it the first time?" Not true. I (and most of the CENs I work with) passed the first time and did quite well, depending on how much study we each did. Glad to hear that your facility honors the CEN with a higher pay scale. Wish mine did...

I worked in a float pool, primarily telemetry, before moving to the ED. My memory of working upstairs is that it required a different skill set than I utilize in the ED, not necessarily a better one, just one more appropriate to that work setting. In returning to school to pursue a BSN, I ended up making acquaintance with many nurses who work upstairs and voice some of the same frustrations with the ED as Angie O' Plasty and others on this thread have. I don't take offense at this at all (for one thing, I am an ED nurse with the requisite thick skin). Rather, I've had an opportunity to build bridges with some of the folks upstairs. I've been able to listen to their reasons for their frustration and gained a new perspective on how what I do impacts my patient's hospitalization. Likewise, I've had a chance to explain what we're faced with in the ED. And it's made for better experiences for us all when we return to work--it's a lot easier when there's a face to the name you give report to. I've even officially suggested that we implement a kind of "exchange" program where ED nurses and floor nurses can observe the work on each other's unit for a shift to gain an appreciation for the unique challenges presented in each setting. Informally, I go out, not just with my ED co-workers and paramedics, but also with some of the floor and ICU nurses. And beer unites us all. I don't think there's anything qualitatively different about ED nurses vs. floor nurses vs. ICU nurses that's really worth talking about, except as it applies to an individual who's making a decision about what area best suits their expertise and personality. The "ED nurses are the best/floor nurses suck" stuff just bores and embarrasses me. I'm a more complete and informed nurse for having worked upstairs in the past, and can anticipate some of the things that will make the patient's admission, and consequently their hospitalization, go more smoothly.

We (nurses) wear black scrubs in our ED, and are the only unit in our facility with this color. The rationale for a unique color was two-fold: first, we respond to the codes, and we need to be quickly and easily identified as the code nurse in the god-awful press of people that'll inevitably show up. Second, it was decided that we needed a way to readily identify who the ED nurses were should we ever face a community disaster or mass casualty situation where nurses from other units would be floated down to assist us. We do have to provide our own scrubs, which seems to be par for the course these days. The last ED I worked at had hospital-provided OR scrubs for us to wear.

It was moderately and appropriately challenging. I'd second the recommendation to get a CEN review manual of some sort, preferably with a CD-Rom so you can take some practice exams on your home computer (which closely approximates the experience of the computer-based test). Also, see if the ENA in your area is offering any review courses; many times these are taught by people who wrote previous test questions and can give you insight on some of the test-taking tips, i.e. how to read the question. Your employer may reimburse you or even pay you for your time in the course, and there's CEUs, too. If you're looking for a book to study, find a copy of Sheehan's Emergency Nursing--that's a good resource. I'd also recommend finding a few other nurses interested in the exam to study with and send in your applications together (you get a $20 discount if four or more of you send it in the same envelope). This has the extra incentive of creating a "deadline" by which you must take the exam, which can be helpful if you have the same super power as I do: procrastination. Good fortune!

We use the Emergency Severity Index (ESI) 5-level system, and have for about a year-and-a-half. Prior to that, we had a three-level (Emergent/Urgent/Non-urgent) system. The ESI system has been pretty well-received, and seems to have removed a certain degree of ambiguity inherent to the three-level system. Ambulance patients are triaged at the garage door; usually we get a brief report prior to their arrival via an alpha-numeric pager text message. Coming by ambulance does not guarantee a bed (at least when I'm triaging) unless the patient's condition warrants it. I'm more than willing to help someone into a wheelchair and place them in the lobby to wait their turn if they took the ambulance in for UTI symptoms (which does happen). We also have a Fast Track area in our ED during certain hours for triage level 4 or level 5 patients.