Thinking about switching to ED

Lev, MSN, RN, NP · Jun 4, 2017

You will get all of those patients and then some but at least you won't have to deal with them for a whole shift (unless they are boarding in the ED).

Koalified · Jun 5, 2017

You will get all of those patients and then some but at least you won't have to deal with them for a whole shift (unless they are boarding in the ED).

I think the boarders in my hospital go to obs unit if I'm not mistaken. Obs is another unit I'm looking into. Ratio is 6:1 but I hear most are self care. What concerns me is that obs always have positions open. Sounds like a constant turnover to me. Sigh.

OlivetheRN, ADN, BSN, RN · Jun 5, 2017

I think the boarders in my hospital go to obs unit if I'm not mistaken. Obs is another unit I'm looking into. Ratio is 6:1 but I hear most are self care. What concerns me is that obs always have positions open. Sounds like a constant turnover to me. Sigh.

Obs is probably not for boarders, it's probably for observation patients that can, as you said, do self care. In the ED, depending on the facility, it's not unusual to have patients waiting for a rather long period of time for a bed to open up on the floor once admission orders have been put in. One facility I worked in, it wasn't unusual to have admitted chest pain patients discharged from the ER after serial troponins came back negative, they had an echo and a stress test or some other combination of tests and cardiology cleared them. Where I currently work, during our peak census times, we will sometimes have patients waiting for beds for half a shift or more.

Koalified · Jun 5, 2017

Obs is probably not for boarders, it's probably for observation patients that can, as you said, do self care.

I thought obs pts were people waiting for lab results or waiting to be taken down for tests or for some reason can't be discharged nor admitted. I thought obs took boarders too since it doesn't make sense to me for a stable pt to be occupying an ED bed. Whatever the case, I think having a PITA for just one or half of a shift sounds glorious compared to what I have now.

OlivetheRN, ADN, BSN, RN · Jun 5, 2017

I thought obs pts were people waiting for lab results or waiting to be taken down for tests or for some reason can't be discharged nor admitted. I thought obs took boarders too since it doesn't make sense to me for a stable pt to be occupying an ED bed. Whatever the case, I think having a PITA for just one or half of a shift sounds glorious compared to what I have now.

Obs units can be different from facility to facility. I have had the same PITA patient more than one shift in the same week either because they came in more than once or because they were still there waiting on placement (psych). At my previous workplace I came back to work the next night during a horribly high census time (flu season) and got the same patient assignment and had the same little old lady who was waiting on a bed assignment. Thank heavens she was nice and understanding.

What makes sense and what actually happens aren't always the same thing.

Editorial Team / Moderator · Jun 5, 2017

Whatever the case, I think having a PITA for just one or half of a shift sounds glorious compared to what I have now.

Now rather than a handful of PITAs you may have a busload! I highly suggest shadowing in the ER where you want to work so you will better understand the pace/workload/environment.

amzyRN · Jun 5, 2017

I have worked in cardiac step-down/tele and med surg on very busy units and the ED is more labor intensive. Perhaps I work in short staff facilities but from what I have been told, a difficult work load is the norm. When I mean difficult I mean lots of lifting, running around, and doing my own peri care and clean ups with minimal assistance. Plus the acuity is going to go up. You will have more unstable patients that possibly need more things done than a typical floor patient.

That being said, I do like the ED better because it is more interesting. I usually don't have to keep a patient for more than 4 hours (usually). I get to use my brain and make important decisions. I have improved my skills, IV starts, Foleys, accurate focused assessments, critical thinking, etc. I support the idea of shadowing in the ED. If you are seeking a more layed back environment, I don't think the ED will provide that. I have considered transferring to ICU at some point because I don't know if my body will be able to tolerate the pace at a certain point.

Koalified · Jun 5, 2017

If you are seeking a more layed back environment, I don't think the ED will provide that. I have considered transferring to ICU at some point because I don't know if my body will be able to tolerate the pace at a certain point.

I wouldn't dare think that ED is a laid back environment. I'm just tired of feeling like I work in a nursing home. The common theme I'm hearing is that in the ED, my tele pts will be there except it's usually for a short time. That makes sense since most pts are admitted through ED. Maybe that's the change I need.

~Mi Vida Loca~RN, ASN, RN · Jun 5, 2017

I thought obs pts were people waiting for lab results or waiting to be taken down for tests or for some reason can't be discharged nor admitted. I thought obs took boarders too since it doesn't make sense to me for a stable pt to be occupying an ED bed. Whatever the case, I think having a PITA for just one or half of a shift sounds glorious compared to what I have now.

Obs patients are patients anticipated in being in the hospital for less then "2 mindnights" (someone can correct me if I am wrong because I am trying to remember. It's more has to do with insurance purposes because some insurance companies like Medicare won't pay for obs for various reasons. So if the patient is not expected to be in the hospital for more than those two overnights but they need to be "admitted"obs is typically the solution. One of the most common patient types you will see in obs is Cardiac rule out. For example. Patient comes in and has an elevated troponin. EKG is fine. Or they have chest pain but EKG and Troponin is OK. The hospitalist might obs the patient to do serial troponins and EKG's just to make sure everything is OK. If second trop comes back higher than the first, or bumped when the first one was normal. Then the patient will typically then be moved to inpatient.

Obs patients typically should be walkie talkie self care patients. Not always but usually.

Boarders are patients that are admitted to inpatient (typically, you can have obs once in a while but that is usually corrected pretty soon) but there are no beds available inpatient. Night shift will get stuck boarding more patients because patients are typically discharged during the day and beds will open up. So it's not uncommon after lunch to magically have all your boarders get rooms.

It absolutely does not make since for a stable admitted patient to be occupying a bed in the ED. However it happens often in hospitals all over. Obs units will typically not take inaptient boarders because if they are inpatient they "require" a higher level of care then obs units take care of and those nurses ratios are based off of a lower level of care.

As far as not wanting to have the same patient the entire shift and for more than one shift. I am right there with you and it's one of the perks to working ED. Because even if I have a boarder when I come back next shift I am usually in a different zone and it's usually not hard to get assignment moved if not. But even in hospitals that boarded patients for long periods, I rarely ever had same patient twice for that case. (we get PITA frequent flyer patients all the time) Psych patients boarding being the exception but those are handled different as well.

Ben_Dover · Jun 5, 2017

Hey ED nurses - Tele nurse here thinking about changing jobs. Do you guys do a lot of heavy lifting in the ED? Do you deal with a lot of incontinence?
I go to work, I pick up my assignment sheet and hope that I won't get that demented, sundowning, 90 y.o. grandma who pees every 10 min. Another least favorite pt is that 350lb person from a nursing home who is incontinent of stool and urine with complicated sacral/coccyx dressing changes. Take 5 pts like these times 3 12h shifts in a row and that's my nursing life. I need to escape! Is ED the right answer?

Surprisingly, sounds like your typical shift is like dealing with: Demented patients, bladder/bowel issues, and decubs w/dressing changes on a "tele floor". I know how tiring and frustrating it can be.

But based on what you wrote: It sounds like tele floor does not include someone who's going in and out of VTACHs or uncontrolled Afib and to top it off you have a GI Bleed pt. requiring blood transfusion. Right?

Tell us the the number of years you have been working as a "Registered Nurse" and I'm sure a "well experienced" nurse will chime in. :nurse:

amzyRN · Jun 5, 2017

I wouldn't dare think that ED is a laid back environment. I'm just tired of feeling like I work in a nursing home. The common theme I'm hearing is that in the ED, my tele pts will be there except it's usually for a short time. That makes sense since most pts are admitted through ED. Maybe that's the change I need.

You will still get those patients who come from nursing homes with decubs and incontinent, but you likely won't have to deal with those day in day out. In the ED your primary goal is to stabilize and discharge (i.e. get the patient out as fast as possible).

The thing I like about the ED is that no 2 shifts are exactly the same. I dislike routine. Don't get me wrong there is routine is the ED, the workups for certain chief complaints and presentations are indeed routine, but you will see a wider variety of people.

The thing I kind of miss about the floor is downtime and more help from CNAs. Where I work, we don't have enough techs for the whole ER and I find myself doing primary nursing for 20 patients in a whole shift sometimes. That's exhausting after a while. Do try to shadow a shift. You might also concider ICU as a next step. I do think tele gets old after a whle and the amount of knowledge that can be gained is limited in that department. I was very bored in tele.