Emergency Department Nurses

[Edson!]

Where are you all? It would be good to have some input here!

[GeorgeRN]

I'm here... just poked my head in the forum... I'm an ER / Critical Care Transport nurse...

[Edson!]

Hi GeorgeRN, I am thinking about making the move to ED. I am looking at EDs that have a good mix--a good number of peds, since I've been primary focused on critical care peds. And though I find many aspects of surgical cardiac recovery and mgt interesting, I have actually been finding that I have been more challenged with the PICU population. At least in the hospital I have been working, the PICU patients are considerably more challenging. I've felt, as I said, quite challenged and more of an adrenal pump with them. Now I am not one of those nurses that has to live for the rush. But it has been a boon for me to be stretched and challenged in different ways. I've worked predominately critical care, a lot of post-op surgical critical care--a lot of cardiac and CT surgery, and then moved to pediatrics cardiac ICU.

But I think with the ultimate goals in my career, I would benefit enormously from working in a challenging ED setting that gets a good mix of things. (My mom always told me that; she's a retired ED RN. But I blew that off for really honing in on what is going on with one or two patients. Though sometimes even high acuity areas, you can get more than 2 sick ICU pts. )

I know a good number of the patients that come into the ED can be obnoxious. But hey, so can a good number of the parents of kids in some settings I've worked. (. . .especially in high drug and trauma areas.) You just sort of have to rise above it.

Also, though I know this is not always the case, it seems that those in the ED in general work more as a true team--less petty competition and such between nurses--overall more collegial with each other and the physicians, etc--although, as I said, I know that that kind of attitude can come up anywhere.

So, George, with you experience, what do you think about this??? I'd love to read your feedback. Need a change--something more challenging that will help me become more well-rounded overall as practitioner. Don't get me wrong. I love honing in on one patient and scrutinizing everything in terms of looking and treating what is going on. But I want to try something a bit different.

Thanks in advance for your input.

[GeorgeRN]

While your ICU experience will be valuable, as is any experience, you'll find that the pacing, acuity levels, and tasks thrown at you will vary greatly than that of a unit. I did stepdown and tele before I jumped into the ER, and while my previous experiences gave me a good foundation, I was initially overwhelmed when I went from a 6 patient maximum assignment to one that varied from hour to hour. I wound up heeding my own advice to other nursing students and technicians about finding my own pace and routine, and once I established that, I began to adjust to the hectic pace of a level 1 trauma center's ER. In fact, within a month or two, I returned to my old unit as a per diem, and was shocked at what they called a "busy" shift. After a very short period of time in a very busy ER, I returned to my old 3-11 shift, had all my meds passed, my PM care done, and more or less had everything documented by 8:30 pm, and everyone else was still going nuts playing catch-up.

You will indeed see a broader spectrum of acuity, from the BS patient to the multisystem trauma, as well as seeing many routine cases. It's definitely another world.

As far as teamwork goes, that can vary from one place to another... In my facility, the ER nurses have a HUGE amount of autonomy, from sending for labwork, getting portable x-rays, ordering EKGs, just on the basis of patient presentation alone, and studies will be available to the attendings when they make their way into the patient's room for the first time. In other ERs, things can function on a "Mother, May I?" basis, where nurses are criticized or penalized for having independant thought and ordering tests comes from the doctor alone. In general, however, I have found that most ER nurses won't let one of their own drown if they see you're overwhelmed.

In terms of becoming more well-rounded, working the ER will definitely give you the benefit of seeing different medical conditions, in much the same way as a general med-surg floor would... the biggest difference would be the rhythm and pacing of the unit, and the chance of someone going south is a lot higher and frequent in the ER as opposed to a floor. Good luck!

[Edson!]

Hi George.

Thanks for your response.
Yes, I kind of get that you have to shift away from the intense focus of one or two really sick patients that are circling the bowl, so to speak. I guess this is the adjustment that scares me a bit. I mean what happens when you have that huge high acuity patient? At that time, do you not primarily focus in on him/her?

Also, I guess when I was referring to teamwork, I was talking about the unit cliqueness that can go on in soooo many places. In short, I don't like petty drama and petty competition. I like to work with folks that are secure in who they are, they don't get offended over every little thing, and those I don't have to walk on egg shells with--those that when push comes to shove, will focus on doing what is in the best interest of the patient comes first, but then afterward, there is not the drama issues that come up in the petty work settings.

I know there can be primadonna's and those that seek center of attention everywhere. I guess I am hoping that the nature of things in a seriously busy ED limits the amount of "primadonnaism." Specialty units can have more than their fair share of primadonnas.. .bleak. . .

Then again, maybe it is the day and age of things. People just get insecure and bent out of shape over such ridiculous things--they take offense way too easily and make mountains out of molehills. I mean if they were in a true military situation, how would they have time for such childish attitudes? They wouldn't. They'd have to learn to work with each other and depend on each other, and not run to some higher up and try to make serious issues out of non-issues. If there is one thing in nursing that has so tired me over the years, it is this kind of mentality.

I just want to work with folks that respect, support and work together--people that are secure and understand the concept, "You're OK. I'm OK." I guess I am hoping, besides the other things I previously mentioned, to find more of this in an ED setting; since it seems to me when everyone is forced to be on top of things and they are very busy, there is much less time for petty attitudes and antics. And you know, I usually have to question the true work ethic of the person that has time to stir junk up in the unit. Even when it is slow, there is always something productive that can be done--or a supportive attitude that can be given. I can take the stress of busting my butt. Its the catty nonsense that wears me down after a while.

Thanks again for the insight. Wonder what kind of orientation they give to experienced unit nurses?

[ahed]

very good ser

[nuangel2]

edson your icu experience will be a big help.you will see a good mix of conditions .you have to be able to treat the neonate to 100 year old .the fevers and little booboo to the traumas .you will never know whats coming next.i like that .i work in an ed that sees 120-150 pts a day .has fast track and main ed .staff is mix of nps md pa pa students emt students nurses -rns .sitters cna etc .i work with a great bunch of people we work well as a team .yes have the personalities like primadonnas also .i find them everywhere .are drs are top notch .we have a lot of autonomy .i have been doing ed now fro 5yrs after icu 12 and other things in b/w .good luck.

[Edson!]

edson your icu experience will be a big help.you will see a good mix of conditions .you have to be able to treat the neonate to 100 year old .the fevers and little booboo to the traumas .you will never know whats coming next.i like that .i work in an ed that sees 120-150 pts a day .has fast track and main ed .staff is mix of nps md pa pa students emt students nurses -rns .sitters cna etc .i work with a great bunch of people we work well as a team .yes have the personalities like primadonnas also .i find them everywhere .are drs are top notch .we have a lot of autonomy .i have been doing ed now fro 5yrs after icu 12 and other things in b/w .good luck.

Hey nuangle, thanks for the reply! I've been thinking of making this switch for quite some time. Have many things on many burners. . .and since I am not new 20's, as I was fresh out of nursing school, some have stated that ED might be too much. I laugh b/c I am not into ageism. It all depends on the individual and how much they are dedicated to keeping themselves healthy, strong, and sharp. It's why I push myself at the track and do a number of things.

I want to work doing something until someone pronounces me. lol So I am processing thoughts about some serious changes in my life, education, and work. People often don't know my age, so they end up asking me what it is or asking about my family--kids. Well, once they ask you how old your kids are, and they see that they are not babies anymore, why then they start jumping to conclusions about what you can do and what your lifestyle should or shouldn't be. Hogwash!

I am scheduling a Caribbean trip and am planning on scuba diving among other things. Just b/c I am not 20 does not mean I should be heading for a walker for heaven's sake. And that's why I don't tell people how old I am until I have to or something in my life tips them off. It is b/c people, ESPECIALLY AMERICANS, can be so incredibly ageistic. OMG, as if 40 should = death or selling everything off to go into a nursing home. LOL I love how all these hot women anymore are taking care of themselves and they are upper 30's, 40's, 50's, and up, and they look great--really hot. I say cougars are great! LOL

So, I believe since most of the raising of kids is done, unless I decide to adopt some, I am going to continue to pursue things that I would love to work at until I drop over. *grin*

I figured getting ED experience would help me get some more insight into finalizing my future education and career decisions. Plus there is great variety of things there. I don't want to say I get bored easily; but I do like variety.


BTW, do you use the same moniker on allnurses, or has someone else there stolen your name? I go there from time to time, b/c there are lot of topics and interactions. (I could have sworn I saw your name there.) I do also note a lot of somewhat "hyper-moderating" within discussions at allnurses. That kind of puts me off, and I guess that is one reason I've preferred this site.

Thanks again.

[Edson!]

I'm here... just poked my head in the forum... I'm an ER / Critical Care Transport nurse...

Hey George, I've had colleagues try to talk me into CC Transport. I just have to get over the fixed wing aircraft issue. My friends tell me that one hour in the air is equal to 3 on the ground.

[nuangel2]

hi edson.i have not been to this forum in quite a while.did you go to thje caribbean and scuba.i have never scuba only snorkeled.i recently went on vacation to alaska.my boyfriend actually has snorkeled in alaska.

and yes i am at allnurses as well.

[GeorgeRN]

Hey George, I've had colleagues try to talk me into CC Transport. I just have to get over the fixed wing aircraft issue. My friends tell me that one hour in the air is equal to 3 on the ground.

Where are you looking for fixed wing employment? I was also considering it, but I'm not finding a lot for my general area (NJ / NY metro area).

[jeanib99]

George,

I am new to this forum and have many questions about ER/CC transport. I am an Analyst for a new hospital project in the Middle East. It is a rsearch and academic facility with 550 beds. I have been a critical care/ED nurse for many years and now, I am called upon to develop transport policies and procedures for this facility. I have never had to do this before and find it a daunting task. Do you know or have a resource that you recommend to find that information? This hospital is planning many transports as our scope of services are limited and as you know, everyone comes regardless of what the hospital services. Hence, many transports to other regional hospitals. I appreciate any information that you have. Thanks

[mtelias]

hello everyone! im a new nurse in new jersey and i cant seem to find a job, i have worked in the hospital for 8 yrs in the emergency department as a unit secretary, but unfortunatly my hospital cant hire any more new grads. i love working in the emergency room but im not being picky right now i will take anything just to get experience and then i would love to do travel nursing. does anyone have any advice for me, it will be greatly appreciated.

[dakotaj70]

Hey Edson,
I worked ER trauma in the Detroit area for some time and really loved the pace. I worked MICU for a couple of years before working in the ER and I believe the background I got in ICU in the controlled environment made ER easier. I could quickly understand the EKGs and lab work for triage. The staff I worked with was very supportive and the doctors were much more open to opinions. We used to make wagers for fun on whose diagnosis after initial assessment would be right. the autonomy was nice. Also the experience helps with career growth. I think the biggest transition is the staff is fixed so if there is a multi trauma you can end up managing/coding a couple very sick patients and have to rely on techs and charge people to help. Ours was a definite team approach and you had to delegate at times. Also their are times when you will be physically attacked or come to the aid of someone else on your team who is being attacked. Not sure if that is everywhere but for our ER we would get some lively characters from the sheriff or the bar on night shift.


All in all I would do it again. I have a lot of stories to tell my kids now that they are teenagers. Mostly what not to do. I will probably go back to ER in a few years. I moved on to education and consulting after ER not nearly as fun but the money is better and home with the kids on weekends.

[Edson!]

Hey Edson,
I worked ER trauma in the Detroit area for some time and really loved the pace. I worked MICU for a couple of years before working in the ER and I believe the background I got in ICU in the controlled environment made ER easier. I could quickly understand the EKGs and lab work for triage. The staff I worked with was very supportive and the doctors were much more open to opinions. We used to make wagers for fun on whose diagnosis after initial assessment would be right. the autonomy was nice. Also the experience helps with career growth. I think the biggest transition is the staff is fixed so if there is a multi trauma you can end up managing/coding a couple very sick patients and have to rely on techs and charge people to help. Ours was a definite team approach and you had to delegate at times. Also their are times when you will be physically attacked or come to the aid of someone else on your team who is being attacked. Not sure if that is everywhere but for our ER we would get some lively characters from the sheriff or the bar on night shift.


All in all I would do it again. I have a lot of stories to tell my kids now that they are teenagers. Mostly what not to do. I will probably go back to ER in a few years. I moved on to education and consulting after ER not nearly as fun but the money is better and home with the kids on weekends.

Ahhhh the wonder and joy of supportive staff and such! This makes or breaks a job IMHO. You can deal with any patient nightmare if you have good and supportive people around you!

Being attacked. . .yep. . .especially working in inner city EDs.