Getting into the Emergency department

You are fortunate- because ED is a complicated specialty.

The thing is that you see everything and anything--and even after your orientation, it is likely there is still "stuff" you did not see. Guaranteed you will see it on your first week on your own.

I got less than 14 weeks, but be grateful for having an orientation that is that long; and do not try and rush yourself off orientation.

Hello all, I am interested in transferring into the emergency department. I've been an nurse about 4 years, the last 2 years in cardiac ICU. BSN, CCRN.

I was recently called for an interview, but I was a bit surprised at the amount of training needed. I know ICU and ED are two different beasts and a lot of training is going to be needed.

It was a total of 14 weeks of training total, through classroom training and precepting. I didn't even train that long to get into the ICU. I am still very interested, but I am just curious if this is the standard everywhere.

There are varying practices for orienting new employees to the ED.

But you should thank your lucky stars, assuming it's a well-put-together 14 weeks. Sometimes CC nurses think the ED can't be that complicated based on the idea that we aren't providing the patient's full course of critical care down in the ED. One of the biggest reasons it's interesting, fun, and complicated/difficult is the aspect of starting from nothing and sorting through large numbers of patients who might look like nothing and be everything, or look like everything and be nothing - and all stops in-between.... :)

...in addition to critical interventions that some patients need randomly and immediately (no pre-planning other than knowing your role)...

...in addition to never being "full"...

...in addition to patients not being in any way sorted according to problem area (ortho, neuro, pulm, card, psych, hem-onc, ID, trauma, etc., etc.)

...in addition to managing a population with an inordinately high occurrence of psych and social factors influencing the presentation...

...in addition to "throughput" officially being one of our quality measures (aka how fast the patient moves through the course of care and gets moved out of the ED)...

And if it's a combo ED that includes all ages from "crowning" to 110y.o.

To try to put it in a nutshell, our challenge is, "Here. See all these people? Which ones are sick and which ones aren't, what's causing the problem here, and what are you going to do about it, whether that's immediately, soon, later, or never? GO!"

I would infinitely rather enter a situation where expectations are reasonable and I might have the chance to excel than a situation where I start out hobbled and simply remain under that cloud, never really becoming good at what I do. 14 weeks is actually what I would consider absolutely necessary for most people who have never worked in the ED before - more for a new grad.

But the real heartening thing about being offered a 14 week orientation as an experienced nurse is the possibility (increasingly rare) that this place cares about patients, cares about excellent nursing care, cares about the nurses providing it, and is willing to focus resources on these things. For your sake I sure hope that's the case.

Best of luck. I say go for it.

Interesting.

My ER orientation consisted of 6 shifts total.

I've done ICU 3 years prior and currently.

I felt like it was enough.

ICUman, I came from another unit and was originally granted 10 shifts, then deemed fit to be done with orientation earlier than that (I agreed). I'm sure somewhere there are "walk-ons" who never received any formal orientation. So what.

Someone's exceptional experience does not create a rule of thumb; it simply represents something that may work out okay occasionally...rarely...in some instances. In general, the facility's MO with regard to the type of orientation they offer says something about the way they want the nurse to function/the type of care they're interested in providing.

I was going to respond with "call an ambulance!" Haha. But as you will see, that will only get some people as far as the waiting room.

My first thought was similar as in "Here, hold my beer..."

Hi,

Remember in the ER you will eventually be expected to take care of whatever comes through the door. They could be 0 or 105 and could have any issue ranging from cardiac arrest, having a baby, respiratory arrest, trauma, to sepsis and whatever else! It's not as focused as the ICU is, and the assessments are also different. Say good bye to head to toe assessments and hello to focussed assessments. (I am mentioning the latter because this is generally where ICU transplants have the most trouble). The focus of the ER is also very different stabilize them and get the up or out the door, whichever, but just get them out of the bed space.

Good luck!

Annie

It's not as focused as the ICU is, and the assessments are also different. Say good bye to head to toe assessments and hello to focussed assessments. (I am mentioning the latter because this is generally where ICU transplants have the most trouble).

Excellent point. I've had nurses, and not just ICU nurses, ask me about pedal pulses in a pt being admitted for diverticulitis or about bowel sounds on someone with a pulseless, cold foot.

Yes, those are all important parts of assessment, but in the ED, a super focused assessment of the body part/body system is the name of the game.

I went to an all ages ED with a peds ED where I'd be working primarily (with the expectation that every 6 weeks or so due to schedule overlap I would be working in the more intermediate adult care areas) with several years of peds ED experience, certifications, etc. I was on orientation for 3 months, and I could have stayed on orientation another month without anyone batting an eye but I felt like I had as much proficiency with the grown ups as I wanted/was going to get.

You'll be very strong in some areas, and completely green in others. It doesn't seem unreasonable to me for a change in specialty.

In our ER it is about 6 weeks for transitional nurses and 14 weeks for newgrads. If an orientee needs more time, they get more time. Good luck, I hope you like it! I would say the nurse is ready to get off orientation when they are situationally aware of all their patients, can discharge/admit within 30 mins, can speed up the process and don't hesitate to ask MD to dispo the patients. Safety first, of course, knowing your limits, when you need help, who is the sickest, and helping coworkers. It can be super fun. Especially when you get the unexpected through the doors.