Transferring to the ED

Good luck on your interview!

The ED will not have a rhythm like what you are used to. Patients come and go at different times and you are not giving routine meds. At the beginning of your shift you will get report on your rooms (if they are all full) and are expected to pick up where the last nurse left off, if that means triage a new patient, medicate a patient, start an IV/access a port, etc. Some days you will be pushing yourself to move as fast as you can and some days you will be so bored with no patients you will ask to be sent home early.

I am planning to get my CEN after I get my MSN. At my hospital you get bonuses for both.

Not everyone is a type A personality. I would not consider myself one. I think I work well in the ED because I get along with all sorts of personalities and am able to shift priorities at a moment's notice. I put my foot down when things HAVE to be my way, but otherwise I find compromise goes a long way with patients and coworkers.

And yes, you become closer with the docs after all that face to face time. When everyone is not busy, I like to chat with the docs about their outside interests. It took me a long time to realize I was allowed to have that sort of casual relationship with them, probably longer than most nurses, because I was a new grad and was worried about being disrespectful. I was wrong! They are people too, and it helped my working relationships to break the ice.

It'll be the same in that you'll come to work, get report on your pat, oh wait, they cleared house before you got in and you have 4 empty rooms. Let the fun begin.....

It'll be different. We're expected to be aggressive in starting care. This doesn't mean you have to be type A, type B's work out just fine. Your routine will be no routine as you constantly reprioritize your priorities which will then promptly be reprioritized.

You will be (when away from the pts) on a 1st name basis with the er docs and quite a few of the hospitalists and specialists. The er is a team sport.

The ER is the opposite of a planned routine. It's planned ciaos when it's done right. It's exhausting, hard work that will drain you on many days. However, it's also so rewarding it's impossible to explain. Last shift, I shipped two people with brain bleeds from two different traumas, and shipped one with an active MI. Three patients who's lives were totally dependent upon us doing the right thing, who are here now because of us. I was totally exhausted at the end of that day, but you know what, I didn't mind it one bit. It's a great feeling to have a hand in doing that for someone.

So, what is important. There are a million different answers to this one, but what I'm looking for in a co-worker coming to the ER for the first time:

1) Learn. Be ready to ask questions and learn. You won't know everything, no one does. If you don't know it, simply ask and we will teach you.

2) Eager. Be eager to learn, to do, to try. Be willing to help others and they will help you. Teamwork is where it's at in my facility. If you are a good team player, you are the one getting up and asking others if they want you to hang that med, or restart the IV when the pt gets back from radiology, or answering the callbell for your colleagues, then they will do the same for you and the shift will go so much easier.

All of the rest is stuff you will learn. Drips, ACLS, TNCC, etc. All stuff you can learn as you go. Open eyes, do what you can, help others, and ask for help when you need it. That's the key stuff in my opinion.

CEN is the certification for ER nursing yes.

Personality trait. I don't believe you have to be a Type A, but you have to be a hard worker. And being able to remain calm helps alot too. It's a trait that most have to learn, it's not what comes naturally, but it will help you once you learn to remain calm and think in a situation.

As for Docs, and other providers, yes you will get to know them far more personally. The providers I work with (most of them anyway) think of the ER as a team. They show me respect and I show them respect. They listen to my report because if I'm concerned about a patient they know they should be too, and I listen to them for the same reason. In general if you show that you care about the well being of the patients and your questions/reports make sense, your docs will want to work with you.

Thank you for the replies You guys are awesome! I wanted to "like" all your posts but couldn't find the button to hit lol. From what I gathered, as long as you're a team player, focused, can stay calm in situations then you'll start out as a good Er nurse. After my interview last week the manager asked if I would like to shadow one of her nurses the next day. Of course I said yes!, and only though I was there for a short time..I was already learning things! I loved it..I liked how it wasn't the monotonous day to day stuff I deal with at work now. I love the people I work with now on nights, we always have each other's back during a code or any issue we run into. I'm just hoping I'll find that in ED Thanks for the replies, those were some of things I was curious about

Got the job- yay!! Now the fun begins.. Working nights in the ED

Congrats! Enjoy the ride. Remember where you came from, give yourself time to acclimate, always learn, and most of all always celebrate your accomplishments more than you get down on yourself for your shortcomings.

Got the job- yay!! Now the fun begins.. Working nights in the ED

Congrats! Noc-nursing is where it's at! I love my night crew!!! Night shift usually has great teamwork; we have less resources so we work together and help each other out. Hopefully it's the same where you are.

As others have mentioned, there's no structure...or atleast structure in a sense as what you are used to. Very overwhelming at first but keep an open mind and just go with the flow.

Prioritize, ask questions, and be flexible. Adaptability is the key to success. Don't get too caught up in writing things down, patients come and go too much. Just write down your initial report (I tend to write only the key things, Important things like why they are there, relevant stuff like patient is diabetic, then I'll write a quick checklist. I'll ask the previous nurse, "What does the patient need?" Ok they need to go to CT scan at 1945, we need a 2nd troponin at 2300, they need a bolus and unasyn. I write them as a checklist to refer back to.)

Find out how you can get the patient out as quickly as possible, whether that means discharged, admitted, or to a holding area (if you have them) until they get a bed.

After my initial cliff notes I get in report, I don't write much else down. Try to stay ahead of the game and ask the doctor what the plan is. Round on your patients to keep them happy, especially when the doctor is swamped. Just showing face every now and again (reevaluating pain, updating them on the plan of care, and seeing if they need anything), this can do wonders in terms of damage control. Patients get angry (rightfully so) when they're sitting and waiting and don't know what they're waiting for. So if the doc is taking forever just keep popping in so they don't feel like they've been forgotten. Throw in an IV and grab bloodwork while they wait, ask the doctor if you can "get them started" before hand, "Hey doctor, new patient Ms. R in room 4B has been c/o N&V x3 days. No allergies, no medical hx, can we give her zofran and some fluids?" Many doctors are cool with this.

Half the time us ER nurses have the patient worked up before the MD even sees the patient if it's a busy night.

Good luck!

I coach new hires in our ED and the biggest thing / difference I see when training nurses that come from "the floor" is having to retrain time management.

The pace is very different and it is different day to day. You will not have hours to give meds and get assessments and other duties done. You will not chart most of your shift either.

Your patient's will come and go several times over and you will HAVE to learn to consolidate work with your patients. You must stay current on your charting - most hospitals require "charting minimum" time. At my facility, most patients require charting at least every two hours and reassessments every 1 or 2 hours too. Even if it is an IV hydration reassessment or pain med reassessment. Our higher priority patients could even require q15 min neuro reassessments. If you have that patient you need to make sure you are caught up on your other patient or make sure your team can help you too.

Speaking of that....team work is essential whereas I don't see that quite as much from the floor. In my opinion you get what you give. If you are always willing to help others when you are able, you will get that back from your co-workers.

I do think a lot of ED nurses are Type As. Not saying all are, but most of them tend to be. It is a weird mix though sometimes. I've also worked on the floor and see more personality conflicts and friction from the floor nurses I worked with than the overly Type A types in the ED. I can't explain it but it seems like maybe we just don't have time for petty BS in the ED.

The biggest difference that I see is the level of autonomy. It is much greater in the ED and I love that. We are allowed to enter some general "protocol" orders for our patients to at least get a ball rolling before the MD can see the pt. It is a huge time saver for us and we can get a lot done in a short period of time. There is a slight learning curve sometimes with the docs. You'll see that some docs order everything but the kitchen sink but others are minimalists. Both work well for me sometimes but it just takes a while to learn what to expect from each one.

With that said, I do think ED docs tend to be more in the mix with the nurses than what I've seen on the floor. We are more work friends and get really close to some of our docs and in turn we can often work a trauma with hardly a word spoken because we KNOW what to expect from each other. I love that!

That's just my rambling for the day. I do hope you enjoy the ED as much as I do!