Should I transition to the ER?

psnurse · Apr 16, 2005

Well I guess it would depend on who you ask. But since you are asking me, the ER is the only place I want to be. Went to nurse practitioner school to be a ER NP. I worked critical care before coming to the ED but found that the ED is the place that felt the most like "home". If it is ok to call it that.

I went on a float the first time and was quite nervous, but everyone was very helpful. I had such a good time that I floated every night until I was eligible to transfer and then I did.

I have always found a great team sort of environment. That might have to do with the fact that one doc cannot see the number of patients needing to be seen right away by himself. So there is some reliance on the judgement of the nurses he/she is working with to do what needs to be done.

It is not a place for the faint of heart. You will most likely do things and get the order later more than once. But there is one promise I can absolutely make to you...... You will never have exactly the same day twice in a row.

Good luck!!

EMTPTORN · Apr 16, 2005

I cannot compare working on the floor to the ER as I have only worked ER. The ER I work in sees 75,000 cases per year. Between Regular ER beds, Fasttrack beds, Peds beds, hall beds, and trauma beds, we are a 50 plus bed ER. Their are several assignments one can get as a Nurse in our ER. One night you may work triage getting 1 pt at a time, the next Fasttrack getting 5 pts at a time, and then the next taking an assignment in the core and having 3-6 pts at a time. The worst thing I can say is it totally sucks when you are short staffed. It is a very bad feeling in your gut when you walk in and you are 1-4 nurse down, the er is full, and the lobby has another 30pts triaged or waitingt triage. It is with certainty that you will not get any type of break if we are short. You will literally run for 12hrs. Smokers seem to go smoke but that is even rare. Full staffed is better, but you are still real busy and the only down time generally is for a 30min lunch. The pace is very fast (at least where I am); the minute you get an empty bed it is filled as the lobby is usually full. Many folks have transferred from floor to ER where I work; the majority make it and some don't. Most who do not make it cannot either take the pace (ie no relax time) or cannot learn to identify those who are FTD (fixin to die) and put their pt at risk. The relationship between nurse and ER dr I beleive is a very good one. Once you establish yourself as being competent then the Dr will generally give you anything you want. Co workers are willing to help, but sometimes are too busy to help. It really pays when you get a new pt to manage your time wisely. When you first go in to room to do assessment start your IV, draw your blood, do all the interventions you can at one time. If there is going to be a very long wait to see Dr then make sure all needed stuff labs, xrays etc is ordered. If you are unsure ask one of the docs...maximize your room time because in a few minutes you may get an EMS that needs triage, or you may get a walk in COPD pt that needs intubation, who knows...you never know. We do have a float nurse, but if there is a trauma alert, they are gone...so you can really only count on yourself.

I beleive the ER I work in is a fairly difficult one: we are a referral center for all peds cases and we have a written policy of never turning down any transfer adult or peds...s we can get and do get anything. I previously worked in a much smaller ER and it was totally different, there was free time, etc..just not a good place to get critical experience.

Your last question: I believe that the quality of care is an individual thing> Yes we work as a team, but not all drs are created equal. not all nurses are created equal. So, one can only make sure they provide the best care that is possible and remember to always first and foremost be your pts advocate. period.

good luck.

I am a registered nurse with 8 years experience (1 tele, 3 occ. health, 4 homecare). I've had it with the on call requirements and the high caseload. Like all other RNs out there that may be looking for a new job, it is a little overwhelming with so many choices. I would like to hear from some of you ER nurses on what the job is like, how the support is from docs and coworkers, how you rate the delivery of care compared to working on a medical floor? Thanks for any input.

jrring1019 · Apr 16, 2005

I am a registered nurse with 8 years experience (1 tele, 3 occ. health, 4 homecare). I've had it with the on call requirements and the high caseload. Like all other RNs out there that may be looking for a new job, it is a little overwhelming with so many choices. I would like to hear from some of you ER nurses on what the job is like, how the support is from docs and coworkers, how you rate the delivery of care compared to working on a medical floor? Thanks for any input.

I am transitioning to the ER now, I had 2 yrs tele and 8 yrs OB prior. I have only started, but I can tell you that the care is VERY different from floor nsg. It is hard to explain, but there is a different kind of responsibility you feel for your pts on the floor. In the ED, pts move so fast and you are very detached. You have to be very task oriented and learn to prioritize differently. The thing I really like is that you don't spend half of your day on the phone with docs, xray, PT, ect.. to manage your pts care. The docs see the pt and look up labs and other results and discharge/admit pts on their own so you spend a lot less time chasing people around, like you do on the floor. The people in the ED are great and very helpful. And the docs seem to have a lot of respect for the nurses. The pts are usually not as nice and the families even less nice, but they are in the Ed waiting a long time and they get grumpy. By the time they really start to make you nuts you are getting rid of them :) And as for the codes and such, there are SO MANY people who come in and they know what they are doing, so it is much more relaxed than on the floor. I say GO FOR IT!

Katnip, RN · Apr 16, 2005

I work in an ED that sees about 86,000 people a year. We're a 230 bed hospital. Yep, it's crazy.

I hated working IMCU. I don't like the same old routine day after day. And routine, you don't get in the ED.

Most of our docs are very collabarative. They have to be. There are usually 1-3 on depending on what time it is. That doesn't include the PAs and NPs in our urgent care and the 1-2 docs in the peds ED. The psych ED has a nurse, psych person and tech. The docs come in as necessary.

You'll see everything from a broken fingernail to massive MIs. We aren't a trauma center, but we still receive them now and then when they need to be stabilized before being sent on.

We're zoned by acuity, but that doesn't mean you won't wind up with a stroke or MI in the lower acuity section. And guaranteed, in the winter you'll have patients in the halls.

I wouldn't trade it for anything.

Katnip, RN · Apr 16, 2005

I work in an ED that sees about 86,000 people a year. We're a 230 bed hospital. Yep, it's crazy.
I hated working IMCU. I don't like the same old routine day after day. And routine, you don't get in the ED.
Most of our docs are very collabarative. They have to be. There are usually 1-3 on depending on what time it is. That doesn't include the PAs and NPs in our urgent care and the 1-2 docs in the peds ED. The psych ED has a nurse, psych person and tech. The docs come in as necessary.
You'll see everything from a broken fingernail to massive MIs. We aren't a trauma center, but we still receive them now and then when they need to be stabilized before being sent on.
We're zoned by acuity, but that doesn't mean you won't wind up with a stroke or MI in the lower acuity section. And guaranteed, in the winter you'll have patients in the halls.
In our place, we discharge when the docs write the scrips and discharge instructions, and we make sure admissions get done. The docs will write admission orders but it's up to us to track when the beds are ready and to get them up there.
I wouldn't trade it for anything.