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The biggest thing ICU nurses have struggled with when coming down to ED where I work is time management and learning to juggle 5-9 patients at a time (9 is for if we are in subacute). Imagine having an ICU patient who really should have 1:1 nursing but you have to take care of 4 other patients in the meantime. Its challenging and I would definitely see if you could shadow to see how the teamwork is down there, because teamwork is key. Also in ED we do focused assessments, things are not anywheres near as detail oriented as they are in ICU. Its much more hectic and like PP said, organized chaos.

Just listen to your gut. When a patient is really and truly sick and needs immediate care, you will know, you will just know. Also, some small things to remember. 1.) MIs can present themselves as mid-back pain, one patient was triaged to subacute for back pain and the PA did an EKG "just in case" and it showed he was having a STEMI...off to the cath lab he went. So in triage, keep that in mind and ask more detailed questions related to their cardiac well-being if a patient comes in with that complaint. 2.) Always take a peek at sore throats, and make sure the patient isn't drooling. If the epiglottis looks really swollen that's an immediate ESI of 2 for me (not sure what system you use but 2 means needing emergent care NOW). Airway airway airway. 3.) When patients come in with MULTIPLE complaints and they appear to be completely fine, make them choose one, the one that bothers them the most. You need to get some people focused, for the receiving RN and MD's sanity. If they truly have major complaints that are multiple, they will make it known, but some people just like to complain.

Almost 2 years into this job and I have days where I feel like a fish out of water. I have no clue what I'm doing with certain patients. I've got a lot down, I'm comfortable with most patients, but sometimes I'll get something weird and out of the norm and I get immediate anxiety because I have no clue what to do and rely on my co-workers to help me. I suppose this is normal, but I want to hear from you experienced nurses, how long did it take for you to feel really comfortable in your position?

In my ED even some of the doctors (including our medical director) don't always listen to heart sounds. We just so focused assessments, what's the point of listening to the heart sounds of a shoulder dislocation or a lower extremity cellulitis, for example?

I don't think so. The student would still be completing the assignment and if it wasn't otherwise specified...don't really see a problem. But OP let us know what you decide to do, hope you get some good information for your assignment :).

Call me crazy but I think interviewing via email would be more than sufficient. Especially since it's an online course. Your instructor would never know and you would get the same information anyway!

In our ED there is only one nurse assigned to trauma and if we have no traumas they just float.

Yeah or they want us to call the attending/admitting doctor to ask about an order 2 minutes before they get sent up to the floor. Ah no, you can call them. I had one patient who was staying 93%-95% on RA and the floor nurse (from the infamously difficult floor) asked me to call the hospitalist for an admitting order. I told her the patient is fine and she can call if she feels like it's necessary! Mind you this is the same floor who would call RRTs for a patient's HR being 110 because they have a fever and are fighting an infection.

Thanks for taking the time to respond :). You are both very right in what you said.

Maybe they are just miserable people then lol. Thanks for making me feel better.

I admit I used to complain mildly about the ED when I worked on the floor but I never gave them problems personally. And if they called report at change of shift well I took it. At my new job however, one particular floor made every attempt to delay getting report and the patient. No joke we would be waiting 2 hours sometimes. And then when you would give them report you they would try to find every excuse in the book not to accept the patient. Oh, the patient is mildly tachycardic (low 100s) because they are running a temperature from pneumonia? Nope, should they go to telemetry? Ugh! Drives me nuts. Now if they don't take the patient within a half hour we have permission from our bosses to send the patient up with the ED records and chart. They hate it but well, they deserve it! PS, if I ever worked on a floor again I would never complain about ED again.

I think in general many people are selfish, entitled, and just don't give a crap. Like above people mentioned, there are exceptions to some of these complaints, but I hear ya. As for the nurse who has been a nurse for 10 years, I am surprised. You are in an extremely small minority of who don't call BS for what it is. OP was spot on in her post, people come for and complain of the most ridiculous things!

1.) Family repeatedly coming out to the desk. 2.) Pts with no insurance (and you pretty much KNOW they won't be paying their bill) demanding to see only a physician and not a PA for their finger pain or equally minuscule complaint. 3.) Complaining about hospital food. Go to the cafeteria and buy food you like then if the free stuff we give you isn't good enough! 4.) Patients who come in for STD checks. 5.) Family members who are always monitoring the monitors and advising you at every "critical"' BP of 175/90.

Man I did almost all of that! Got the central line in, labelled the IV tubing, sent down all of the bloodwork, cultures, etc. Got the Foley in. I couldn't believe how rude they were! Like I didn't even do anything haha. Whatever though, just more annoying than anything.

Please tell me it gets better with time. I'm a pretty new ED nurse and have noticed that it's a pretty cut throat environment and that's fine, it sort of has to be, but I have such a hard time dealing with the nasty and rude patients. Especially the ones with money who just berate you and put you down for things that aren't even your fault. A woman just "fired" me the other day because I mistakenly inserted her foley into her lady parts on my first attempt. Like seriously. My job makes me really dislike most human beings...when did everyone become so rude and entitled? Any tips on how to deal with people like that? I take it way too personally because I feel like I'm doing my best to help them and they act like that?

First of all, your preceptor was rude to say that. I'm not a new grad and I felt that way when I first started in ED. Now, onto time organization. Honestly, you just have to relax about outstanding orders and prioritize. You had a sick group of patients so there was just no way that you would be able to get through everyone fast. Just do the most pertinent things first and push everything else out of your head. I had a patient on 7 different drips today and very very unstable and guess what? My new onset neuropathy pain patient and my elderly lady who fell of her couch just were going to have to wait. If any doctor tried to say anything to me, well too bad, who is going to argue with me tending to a critically ill patient? Some days you will feel overwhelmed and it's also important to ask for help. Our ED has a great team and we always pitch in to help one another. I hope you have that support behind you because without it it's tough.

Man we are the most disliked place in the hospital and everyone has a complaint! Took a critically ill patient to ICU tonight with blood, two antibiotics, sandostatin drip, insulin drip, protonix drip, and fluids to the floor at 1850. We get the patient situated (which the ICU nurses did not want or appreciate my help at all) and then they are upset because I didn't do the 1900 glucose check for her insulin drip?! We get written up and complained about for ridiculous things (like forgetting to put our phone number on the paperwork we send up to the floor...um call the ED and ask to speak with me if you need me that badly). Anyone else have similar experiences?

Thank you everyone for your responses. I guess maybe I took it a little too personally. I am still not quite sure why she would be correcting me on a primarily nursing thing but maybe her intentions were good. And like someone said maybe my self doubt overshadowed this experience. I know I need to toughen up, hopefully with time :).

I think ER nurses have to be very assertive. Some of that comes with time and some people just have a very bold personality. You have to be quick on your toes and know a lot. You also have to be able to take crap from everyone. Many people like to hate on ED and write us up for any little thing. I just switched from the floor and I feel like I am better in an organized more calm environment like the floor. But I am still new so we will see. I am feeling pretty overwhelmed in ED.

Hi fellow nurses! I am a nurse with 3 years of med/surg experience behind me and I started in the ED a little over 3 months ago. I am officially off orientation and I feel so unprepared and dumb. On top of that there are a few ED docs who prey on my more quiet, non-confrontational behavior and make me feel so so dumb. It seems like they do it on purpose. Yesterday I missed an IV while one of the doctors was watching (on a really hard stick) and after we left the room she proceeded to tell me that I am too timid when I tell the patient I am going to stick them and that if I don't seem confident then the patient will be more anxious and it will e harder for them to endure the IV stick. Um...OK?? I felt so terrible afterwards because this isn't the first time she hasn't been very nice. I dont know if I'm in the wrong profession or if these feelings are normal. Did anyone else experience bullying or these feelings when they started in the ED?

I was given a warning for telling a patient that I was very busy with a few of my other patients and that I wouldn't be able to go off the unit to get her a food item she was requesting. She reported me to administration (she is an extremely difficult patient and very nasty to all of the staff) and I got in trouble. I am so angry! The justification was that it's unprofessional to tell a patient that you are busy with other ones. Aren't we taught to delegate and PRIORITIZE...sorry but my other patients' medications, IVF, and other needs are more important. Any insight into this? Has anyone else gone through this?