I totally understand what you're going through!!! I was a float pool nurse and requested to cross train to ER. It was such a reality check at how different the two worlds are!!! Especially to then go to icu from ER LOL! I felt like a complete moron when I first started training in the ER even though I had four years nursing experience under my belt. I remember how intimidating it was initially, and it was very strange adjusting to such a different pace and expectations. You should be proud of yourself for jumping in and pushing yourself beyond your comfort zone! Remind yourself that you are not a new grad- you have a lot of experience and have seen all kinds of different diagnoses and how to react/treat them. You're getting these same patients upstairs ! You have the knowledge, you just have to switch up the way in which you give care. I pretty much had to mentally drop everything I would normally do on the floor, and switch to a whole other mind set to fit the ED. Forget the floor routine and learn this routine with a new set of eyes :) The floor is a more controlled environment with somewhat expected schedules throughout the day, and very detailed assessments and charting. You (mostly) know your patients in detail, diagnoses, course of hospitalization, treatment, etc. ED is the flip side lol. That's what is so exciting though! You are like a detective. You don't know what kind of patient is going to walk through those doors, so you have to use your critical thinking/assessment skills as soon as you lay eyes on them. Your priorities are triage, stabilize, then send them up or send them home. If they need to go up, move them out fast since they will start having new orders/tests rolling through. Plus, there are patients waiting for their bed that need to be helped. This is why the ER and floor nurses can sometimes get frustrated with one another lol. The units are two different beasts. ER doesn't have time to get all of the information the floor may want because its not a priority- they have limited time the patient can sit in the ER... Plus Probably dealing with dual codes and Alphas and combative patients coming in all at once :) ! They just don't have time. I remember when I was a new grad I had an ER nurse laugh their butt off when I asked when their last bowel movement was lol!!! You truly understand both worlds :). If a patient is icu status, get them as stable as possible (so if they code it won't be during transport) then move them out ASAP. Make sure they have iv access before they travel and go to the icu. Have extra staff with you with these patients, esp RT. Always have a monitor on your patient during transport. With your level 1 trauma ER, I'm sure they have an especially organized system in place when initially getting a patient settled, and when a patient starts to deteriorate/code. Whenever we got a patient in, the whole team came in at once and had the patient set up within minutes. It's pretty cool to witness and be a part of. One person would get them in a gown and get them on the monitor/taking vitals, while one person would put an IV in and draw blood to send out, another one getting history/meds to start getting an idea of what's going on, etc .. It was like a well oiled machine and is really impressive. Make sure your rooms are set up, esp with bag, suction, Christmas tree.. start frequent vitals (helps monitor your other patients when you can't check on them as much as you would like). Know where your line cart is, crash cart, where to find emergent items/meds. Be proactive according to your ER (ie chest pain? Get an ekg instead of waiting for the doc order). You will have more independence in that respect compared to the floor where you have to wait or page out to get an order to put in. Remind yourself that you have seen these complaints/diagnoses before with all of your experience and already know different things to expect. But I think whats the most important thing is tapping into your nurse gut/intuition. You've seen those patients on the floor- where you take one look at them and know they're going to crash any minute. You will use this a lot in the ER, which is very important since you don't know the reason why this patient is here. They become priority. Never make assumptions. Even a simple abdominal pain or a walky talky with stable vitals could turn into a total **** show within the next five minutes! Don't rely solely on vitals, since those are often abnormal when the patient is already deteriorating. Make sure you have good access at all times. Go for an 18/20G in a big vein in case you need to bolus/give them blood/contrast. Tell your mates and doc ASAP when you get a bad feeling. Your team is everything since it can get so hectic- everyone takes care of each other's patients. Get to know the people you work with and help as much as you can. If you feel like you're drowning, tell them ASAP and they will step in and help. Accept that your shift will always be unpredictable and that you have to be flexible with whatever goes down :) you won't be able to give super detailed care like you would on the floor because you just don't have the time. So don't be hard on yourself about that, you have to focus on stabilizing and getting people out to where they need to go. Focus on the patients complaint and anything that could relate to that, not a whole head to toe assessment. Keep working on your critical thinking skills... this can always be improved no matter how long you're in nursing! Be proactive with this as well. You can practice doing this with coworkers or friends. Example: someone comes in throwing up blood. What do you expect to do while they are with you? (The answer to every patient is always get them on the monitor, vitals, send out blood and urine, etc....if you don't know what to do in a situation always start with that!). Get at least two large bore IVs in. Prepare for possible blood transfusion. Get lab called in ASAP to start type and screen. Send out labs. Ekg. Spike and prep to bolus at least 1 NS bag since they're probably hypovolemic. Maybe get a pressure bag in the room just in case, and blood transfusion tubing ready. Print the consent out for the doc ASAP. NPO. Freq vitals. If they're diaphoretic and pale you know they're in shock and deteriorating. Meanwhile try to get a history and meds. Drinker? NSAIDs? Etc. You will get better at multitasking this all at the same time. Always think one step ahead. "Prepare for the worst and hope for the best". I always keep an eye on the I'll looking older patients and more stubborn/stoic patients that won't tell you they feel well until they suddenly deteriorate. * I recommend taking TNCC if they don't make this mandatory. Re-Prioritize your patients constantly. Keep paper and pen on you at all times, you will always be needing to write down random stuff lol. Make a cheat sheet to keep on you with phone numbers, door codes, etc. Find a mentor(s) that can help support/guide you, and give you feedback. You can be honest with your peers and just say how you are so excited, but nervous about starting since it's so different, and to please give any feedback to help you be a better ED nurse :) teams are crucial, and they will want to help; They won't let you drown. you are never alone so always ask for help as soon as you have a question or feel something isn't right. Lastly, don't forget about you! Bathroom breaks, keep bottled water at your desk, try at least steal a few minutes for a snack on and off. Sorry for the essay but I SOO know how you feel... and my ideas are all over the place since my last one didn't go through lol anyways, You will be great, just go with the flow and support your team. Let us know how it goes !