RN s Rotating Pods in Emergency Dept.

[triage1]

We have designated areas in our emergency dept. There is triage, critical care, med-surg, and fast-track (clinic patients). We have nurses that are comfortable and skilled in certain area. Our unit counsel discussion is regarding nurse and tech retention. Our shifts are usually twelve hours and the triage nurse specializes in that area. My question is -What are the pros and cons to emergency dept. nurses rotating to the different pods (triage, critical care, med-surg, and fast-track)? Are there more pros than cons? or vice-versa.

[pererau]

I would die a terrible death if I had the same assignment every day. I love triage and I love fast track, but day in and day out would put me in the grave. Likewise, intubating patients every day and then having to clean up their poop three times before an ICU bed opens up is not my idea of a cup of tea.

Part of being an Emergency Nurse is having a broad skill set and being able to deal with whatever comes in the door. I think that over-specialization is not a good thing in an ER. The two exceptions that I can think of are peds and psych.

[triage1]

Thank you so much for your insight. We work twelve hour shifts. How often do you think a charge nurse should rotate the staff nurses. For example: if you work 3-4 twelve hour shifts per week, should one or two days be rotated to different pods?

[pererau]

I think it is important that everybody be able to do every task, but how often to rotate should also depend on what each nurse prefers. You want happy nurses, so if you have one who just loves fast track to death, then let them do fast track and only rotate them occasionally to keep their skills up. The last thing that you want is for you to be in a situation where you have to have Nurse Jimmy in the critical area and he hasn't done it for 2 years.

At the same time, there are people like me who love to have different assignments that you could rotate every day. Also, take into account that newer nurses will probably do best with most of their time spent in main ER or Fast Track, with only occasional forays into triage or critical care so that they do not get overwhelmed.

Don't be like the unions. Every nurse is different and should be treated as such.

Just my opinion.

[triage1]

Thank you so much. I will take your advice to our counsel. Thanks again for the quick response.

[Altra, BSN, RN]

Part of being an Emergency Nurse is having a broad skill set and being able to deal with whatever comes in the door. I think that over-specialization is not a good thing in an ER. The two exceptions that I can think of are peds and psych.

The last thing that you want is to be in a situation where you have to have Nurse Jimmy in the critical area and he hasn't done it for 2 years.

Agree!

I'm not even sold on the idea of dedicated triage nurses. After 2-3 years of doing nothing but triage ... will a nurse have lost some grounding in the protocols and practices of the ER docs? Knowledge of those practices and preferences influences triage decisions.

[Pepperlady]

We are just a small ER but we rotate through all our areas and change with each shift. Today I may have the cardiac/critical care area, tomorrow fast track and then the next day triage.

[Corey Narry, MSN, RN, NP]

I used to work in a Level I Trauma ER. Our staff nurses rotate different areas from triage, resuscitation room, chest pain and critical care area, non-critical care area, urgent care, pediatrics, and short stay. We also worked 3 12-hour shifts and actually rotate each day we worked. Some nurses who have expressed preference over specific areas such as Peds are usually accommodated for their requests. But a lot of the time when the assignments are made, nurses switch and trade areas with each other and this was allowed by management as well. Everyone was pretty happy with arrangement.

[ScrappyED, BSN, RN]

I also can't imagine having to do the same area everyday. I would go bonkers and would have no hair by the end of one week! I work in a Level 1 Trauma center and part of the thrill of the job, for me, is the endless variation of situations. That is why I would make a lousy floor nurse or ICU specialty nurse right now! Our ED rotates every single shift--and since I work a split shift (9a-9p) I many times even switch assignments once or twice during a single day. Maybe I'm closet ADHD :hpygrp:

[pererau]

Maybe I'm closet ADHD

You probably have ADOBSO : Attention Defic... Oooh! Bright Shiny Object!

[Larry77, RN]

We rotate where I work too, but we are not as formal as some mentioned. It is luck of the draw whether you are assigned triage, fast-track, critical, trauma, main, and some of us charge. More experienced RN's are placed in triage, charge, trauma, and critical care but all others are just shuffled around. My favorite part of ED nursing is that we have such different jobs available...I can't imagine going back to the floors where you do the same thing day in and day out...

[mmutk, BSN, RN, EMT-I]

I would die a terrible death if I had the same assignment every day.

I know of some patients that would die a terrible death if some of the fast track nurses came over to the critical care areas and worked a shift. As the same for our Trauma pod too. I say rotate within your means.