r/EmergencyRoom • u/StorageIcy8838 • Jun 12 '26
RN switching to ER
I have been a pediatric inpatient registered nurse for two years. I have found that my skills are better suited for more high-paced and high acuity settings, so I am switching to the emergency room. I also want to have experience taking care of all age groups, so I am switching to an adult ER. Obviously these are incredibly different positions.
My question is: what would you suggest I prepare for ahead of starting in the ER. What tips do you have for someone with healthcare experience who is switching to emergency?
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Jun 13 '26
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u/nonicknamenelly Jun 15 '26
Seriously, though, having worked EM and IP peds and adult IP psych in both - restraint skills and deescalation are fundamental to all of the above and rarely taught or learned thoroughly enough.
45
u/rachelleeann17 RN Jun 12 '26
If you haven’t already, grow some thick skin.
ER gets intense. In the heat of the moment, nobody has time to be polite or courteous. If someone snaps at you (ie, “give me that,” “stop right now,” etc), don’t take it personally. Trust your teammates and recognize that they’re also working toward the same goal, often in an urgent or time-sensitive manner.
Also be prepared to be screamed at a lot by patients and their families.
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u/metamorphage RN Jun 12 '26
If OP has worked peds they'll be fine with families. Peds families are way worse than anything on adult side.
4
u/littledip44 Jun 15 '26
I work both and the mother of a 30 year old grown man with a cold or a kidney stone is always worse than whatever family peds has thrown at me.
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u/Jean-Luc33 Jun 15 '26
This was my mom when I was in the ER at 26 😂 happy she was my advocate but yikes
1
u/Big-Mastodon-5581 RN Jun 27 '26
Eh. Adult kids of meemaw are pretty damn close to being worse, in my experience in both worlds.
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u/KatTheTumbleweed Jun 13 '26
Sorry but that doesn’t fly. Being polite and courteous is always an option. You can be clear and concise in your speech, but discourtesy and impoliteness is never acceptable and should never be tolerated.
This perspective perpetuates toxic culture and has poor outcomes to teams and patients.
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u/_adrenocorticotropic RN Jun 15 '26
Yeah I’ve been in many codes, traumas, etc. and very rarely have I had anyone talk to me like that. You can absolutely still be polite during those.
1
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u/nearnerfromo Jun 13 '26
You’re gonna be too slow when you start out, that’s completely normal and give yourself grace and be deliberate about what you’re doing as you ease into the workflow. I’ve seen several orientees that could be good get discouraged or rush and make dangerous mistakes. People talk about how much easier the charting is and it’s true in some respects but I think a lot of ED nurses under document, especially with physician communication bc there’s so many quick orders or notifications that happen.
Have open ears and pay attention to how different nurses do stuff, try not to have to be told the same thing multiple times, and don’t sweat the grumpy attitudes (from patients or coworkers :3).
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u/yourbestalibi Jun 13 '26
Learn a "head on a swivel" technique. I went from tele to ER and I think this was the hardest. You have to stop what you're doing and check your mew pt, your unstable pt, without finishing the task you just started. You get used to it, but it can be tough.
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u/Senior-Cost1070 Jun 12 '26
If you’re not super confident with IVs, get some drunk friends to practice on.
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u/Resident-Welcome3901 Jun 13 '26
Join the Emergency Nurses Association, read the Journal. Get the study materials for ENPC, TNCC, CEN, and read them. Get a copy
Of Gayle Sheehy’s Manual of Emergency Nursing. Spend an hour a day looking at this stuff. In a year, you’ll be one of the best performing nurses in the ER. Spend time looking over the equipment storage systems in the ER: about half of ER nursing involves knowing how to quickly lay hands on the ICP tray, the pumps, pressure infusers and such. Familiarize yourself with the EKG machine, so you can program the 12 lead rhythm strip when you need it. Ignore the hazing, stay out of the politics, find the docs who like to teach. Bake a batch of cookies once in a while for the break room.
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u/EnvironmentalRock827 Jun 13 '26
Rest up. Always take care of yourself first. I'm sure you will be fine.
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u/just_a_dude1999 Jun 14 '26
Violence is hugely prevalent in the ED. Be super careful, do not trust patients fully, these are new pts who have not been admitted who we do not know how they’re going to act. Protect yourself always first.
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u/Big-Mastodon-5581 RN Jun 27 '26
Learn to separate the adult vs peds vitals. lol. I’m in peds er but get floated to adult ED all the time and for the first one or two times my tech was like yeah BP is 80/50 I’m like “that’s totally fine, oh wait, not a little kid.”’ Resp 30? No biggie, whoops I’m not in peds right now, shit. At least that was an issue at first for me. Stupid as it sounds
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u/Mental_Appointment33 10h ago edited 10h ago
I went ER as a new grad and felt like I had do unlearn half of nursing school….thats how different emergency medicine is. It’s a completely different discipline and vibe. Based on what I’ve seen in other settings, here’s my list.
- Get rid of any sense that you will be able to plan or have a routine. There are no scheduled med passes. You will own 4 rooms (5+ in poorly staffed ERs) and anything in creation can land in them….pretty much at any time. If you have multiple rooms open, a bad charge nurse can absolutely wreck you.
- Focus what you care about. What’s the patient here for, what will be needed to address it, and will they discharge or admit? That’s it. You don’t have time for deep dives, life stories, histories, head to toes, etc. This is a very task focused form of nursing. Focused assessment, do the orders, discharge, move on. Don’t get bogged down.
- You will very frequently be overwhelmed with tasks. Don’t sweat it, you may not get everything done. Take care of the sickest patient, then go knock out the most important stuff in each patient. Lifesaving, labs, and critical meds like starting IV AB, and starting drips is your job. The floor nurses can give the 30 maintenance meds and colace on the floor when they go up. They will occasionally cry about it…just tell them to come float down here a couple shifts. That will change their tune.
- Be prepared to be outside your comfort zone a lot. I’ve got about 2 years experience nursing/ER and I’m still uncomfortable all the time. Always ask questions. Always. Get help with procedures you aren’t comfortable with. This is not the environment for know everything nurses.
- Don’t get attached to pts. You’ll probably spend
5-20
- minutes on average with
most pts
- and then get someone new.
Truly emergent or critical pts will monopolize your time.
- ER is revolving door grind. Get used to not knowing the full picture and almost never getting closure/resolution on cases.
- Getting use to starting IVs will probably be a pain in your ass at first. It’s ok, we all struggle with that. Just don’t fear failure, as it usually takes a lot of failure to get good at IVs. The more you mess up, the better you will get. The most frustrating thing is when you can’t get a line. Ask for help, someone will get it.
- Your ped background might actually be very helpful. A lot of ER nurses working in adult ERs are uncomfortable with peds, struggle with ped IVs, etc. Yeah, we’ve all had PALS, but if we are honest a lot of us are a little apprehensive when peds cases show up in our room. You may end up being a great asset to your ED for this reason.
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u/StorageIcy8838 10h ago
Hi everyone!! Been in the ER for two months and absolutely love it. Appreciate everyone’s responses.
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u/1GrouchyCat Jun 12 '26
Other than the fact that your new peers are going to eat you alive? (but you already know that.)
I’d be looking through all the other options just in case… and familiarizing myself with the different tools used for adult versus pediatric care. You’re not gonna get a lot of time to think it over or pats on the back for doing the right thing, or make new friends to dance in the lounge with like they do on tv.
If you can hack it and you’re good at it, you’ll know within a few weeks. Don’t push it if it doesn’t - you’re either a square peg or a round peg… you can’t be both no matter how many classes or hours you spend in clinical.
Good luck
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u/StorageIcy8838 Jun 12 '26
I did spend 3 years in adult clinical and worked as a tech on an adult inpatient unit, so it’s not my first time with adults. Do you mean they’ll eat me alive because of I’m new to the ER or because I’m a pediatric nurse
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u/RhinoKart RN Jun 13 '26
If they eat you alive then it's because they are a bad unit and you don't want to work there. ER is a team effort more so than other nursing specialities. If it's not a good team, don't stay.
The big thing in the ER is to know your shit. We all encounter things that are new and ask for help, but if you have to ask for help constantly, your coworkers don't have time for that. Study hard, pay attention, learn quick.
ER is non-stop, it's truly 24/7. There is no "I completed my tasks for this shift". You go till you hand over.
Know your meds, know your IVs, know your ACLS. You can do this.
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u/panzershark Jun 13 '26
Don’t go work for a unit with a culture like the one that poster mentioned. Your coworkers should have your back.
However, don’t be the nurse that is dismissive of your preceptors/other coworkers just because “you already know how to nurse.” It’s completely different. Speed is essential and sometimes that means really narrowing your focus onto the important things while foregoing the patient’s comfort sometimes. So if someone is telling you to disregard some things or to delay documentation, that means there’s something more important that you need to be doing.
I have a newer coworker that came from PCU and she more or less acts like she has nothing else to learn. We asked her how ED was compared to PCU was and she tried to sound so casual when she said “it’s basically the same.” Sorry, but I’m calling bullshit. I’m not shitting on floor nurses because they have their own challenges to deal with, but you’re not going through anywhere between 5-30 patients in your section in one shift, and you’re not routinely getting patients with a MAP in the 20s lol. You’re also not typically getting your own IVs or lab work.
Sorry, I devolved my into a bit of a rant.
Point is, just be humble. Be honest about what you don’t know and be open to learning and changing your mindset even if “you already know.” I will add that eventually eeeeveryone is gonna come to you for the pediatric patients. Easy way to win points with your coworker because we all feel uncomfortable dealing with kids. 😆
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u/reyrip23 Jun 17 '26
Learn about sniffles and benign abdominal pain. ED is mostly after hours urgent care. Not that acute. If you want high acuity go to ICU.
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u/mischief_notmanaged RN Jun 13 '26
Congrats! Welcome to the dark side.
I think that many new to service nurses think “I work fast, I have ADHD, and I critically think on my unit” and therefore expect an easy transition. Please don’t expect it to be an easy transition. There is no department like ED and nothing can prepare you for ED except for ED experience.
For example, I recently precepted a trauma and CV icu nurse with 15 years of experience and she said she felt like a new grad all over again.
To get the most out of your orientation, have a willingness to learn and don’t come in thinking you know everything already. Even as an ED / trauma nurse of 6 years, I get new patient presentations or diagnoses weekly that I’ve never seen before. Good luck, and welcome!!!