Struggling with ED Orientation, advice appreciated

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Specializes in High-risk OB, Labor & Delivery.

Hi Everyone!

I'm going into my 3rd week of ED orientation next week and I'm struggling with the floor-to-ED transition. I'm contemplating turning back to my old unit until I gain more knowledge in emergency medicine. I came from an antepartum floor where my patients were mostly medically stable and low acuity. I have 3.5 years of experience with antepartum and I did tele/PCU for 1.5 years as a new grad. I'm rusty with my tele/PCU knowledge, which would have been VERY useful for me right now in the ED.

I've always wanted to be in the ED since nursing school, so I eagerly jumped at this ED training program opportunity at a sister hospital, even before I was truly "ready." However, I am finding that the teaching style of this training program is not working for me. It consists of self-learning via online ENA modules and 7 weeks of a preceptorship with one knowledgeable preceptor who had a few hours of preceptor training.

I feel like I would do better with a multimodal learning approach to orient me to the ED, as recommended by the ENA in their ED Nurse Orientation Position Statement (2011). This would include a traditional didactic classroom setting with lecture and discussion, scheduled out-time for return-demonstration skill-simulation, case scenarios, and a trained preceptor. Another hospital in our system is a magnet, "flag-ship" hospital with an ED training program that includes these components in their program.

I have identified some potential options for me at this point:

1. Stick it out at this current ED and take as many courses as I can in order to supplement my lack of ED knowledge, such as a CEN review course, which will be offered in January.

2. Contact my old manager on my other unit this week and prepare to transfer back and spend 1 year preparing myself through self-study, which would include PALS, EKG course, TNCC, CEN review. After a year of self-study, apply to the "Flag-Ship" Hospital with the stellar ED training program in July 2015 for a more thorough training program. The "Flag-Ship" Hospital is where I really want to be, FYI.

3. Complete my orientation and then decide if I should go back to my old unit.

4. Some 4th option that is unbeknownst to me (any ideas??)

Any advice on which direction I should take?

Thanks for reading :-)

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I feel you... I came from floor (1 and half yr) and I am almost done with my ED internship. This ED is one of those that run skeleton crew at night, so nurses do most of things. I am kind of person who learns quick and adapts fast; it took 8 from 12 weeks internship for first acute tele job, then 2 of 6 weeks offered when I moved to obs, so I am used to catching upto things quick and fast. When I started in ED, I obviously had no idea how hard this was going to be. you know they say "ER is different animal". No nurse will ever understand what kind of beast ER is until they do this. ICU complains a lot but they don't have the pace and load like we do. I have been a floor nurse, so I laugh when they complain that they are so busy. I honestly think there is no unit in hospital system busier and heavily paced like ER.

Having that said, the only thing I can tell you is just bite your teeth and soldier it out. I thought about quitting multiple times but quitting just is not in my nature. It's almost been 3 months since ED, and I'm sure I will need at least til 1 yr to be somewhat proficient, but that's the step everyone has to take especially at ED I think, and all experienced nurses tell me this. Good luck cohort! my anxiety is with you!

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Specializes in SICU/CVICU.
I feel you... I came from floor (1 and half yr) and I am almost done with my ED internship. This ED is one of those that run skeleton crew at night, so nurses do most of things. I am kind of person who learns quick and adapts fast; it took 8 from 12 weeks internship for first acute tele job, then 2 of 6 weeks offered when I moved to obs, so I am used to catching upto things quick and fast. When I started in ED, I obviously had no idea how hard this was going to be. you know they say "ER is different animal". No nurse will ever understand what kind of beast ER is until they do this. ICU complains a lot but they don't have the pace and load like we do. I have been a floor nurse, so I laugh when they complain that they are so busy. I honestly think there is no unit in hospital system busier and heavily paced like ER.

Having that said, the only thing I can tell you is just bite your teeth and soldier it out. I thought about quitting multiple times but quitting just is not in my nature. It's almost been 3 months since ED, and I'm sure I will need at least til 1 yr to be somewhat proficient, but that's the step everyone has to take especially at ED I think, and all experienced nurses tell me this. Good luck cohort! my anxiety is with you!

So, how much experience do you have in an ICU that you know anything about how busy they are?

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So, how much experience do you have in an ICU that you know anything about how busy they are?

went to task there. it was only one place but compared to walking fast at ED, there was lot of sitting. 2 is better than 4-5 after all

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Specializes in SICU/CVICU.
went to task there. it was only one place but compared to walking fast at ED, there was lot of sitting. 2 is better than 4-5 after all

It would depend how sick the 2 are. Until you work in and take a full patient assignment please do not denigrate what ICU nurses do. I have tasked in the ED but would never consider it thejames taking a patient assignment there

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It would depend how sick the 2 are. Until you work in and take a full patient assignment please do not denigrate what ICU nurses do. I have tasked in the ED but would never consider it thejames taking a patient assignment there

True true. You bad.

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Seven weeks with a dedicated preceptor is actually pretty nice. Remember that their goal isn't to bring you along at a pace that feels comfortable to you, it is to get you up and running and out on the floor as quickly as possible. While it is perfectly normal to feel in over your head when first transitioning to the ED, if you don't feel up to it, then I'd be looking at option 2- although keep in mind that this "flagship hospital" may not be all it's cracked up to be, so you may be in for more of the same.

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Number 3

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Specializes in ED.

1) This is not an ICU forum

2) What is your contribution to the OP's question?

So, how much experience do you have in an ICU that you know anything about how busy they are?
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Specializes in ED.

I would encourage you to keep your head up and work hard. Learn on the job. Look up stuff you don't know. Find a mentor and ask questions. Look stuff up in detail when you get home. Review patho of certain disease processes that you weren't fully comfortable with that day.

The fact that you desire to immerse yourself in knowledge and get up to speed shows that you can make it. Perhaps you expect too much of yourself too soon- I did. it was almost my downfall.

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Specializes in Emergency.

Keep going. Nobody expects you to be at the top of your game when you come off orientation. Ask questions, do supplemental reading and constantly learn. And give yourself about 2 years to become truly comfortable in the ER.

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So, how much experience do you have in an ICU that you know anything about how busy they are?

i meant to put my bad not "you bad" lol. phones suck. but if i was asked a yes or no question on which is busier, i will have no hesitation in that answer although icu is definitely as busy as er, just in different way.

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