Making the Transition to ED Nursing
Tuesday May 30, 2000
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Many nurses panic at the thought of how much appears beyond their control in a busy ED or trauma center, yet do not realize how much is really within the boundaries of normal work flow. ED patient flow has been described by emergency care professionals as "organized chaos." But what might appear chaotic to a nurse from another unit are usually well-orchestrated care patterns based on a blend of the nursing process with assertiveness, prioritization, and critical thinking skills - just what you already have mastered in your own area of expertise.
Emergency nurses must function at a high level of autonomy. Getting comfortable with autonomy is based on confidence, and nothing builds confidence like sharp assessment skills.
Physical assessment courses that help nurses to fine tune their skills are often offered by community colleges, nursing schools, and at conferences. Getting extra practice is easy - assessment skills can be practiced almost anywhere. The ability to interpret basic cardiac rhythms is also a must. Most hospitals and community colleges offer courses in cardiac rhythm interpretation.
Once you've gained confidence in assessment and cardiac rhythm interpretation, consider taking an advanced cardiac life support (ACLS) course. Certification in ACLS prepares healthcare providers to quickly and efficiently recognize and respond to life-threatening cardiopulmonary emergencies. In many EDs, certification in ACLS, as well as pediatric advanced life support, is mandatory. But don't be intimidated, even if you have no experience with advanced cardiopulmonary resuscitation. It is the goal of most instructors to ensure that students enjoy their experience and pass the course. Nurses from all backgrounds are welcome.
Other certifications or competency programs sponsored by hospitals, community colleges, private companies, and professional organizations that offer good preparation for aspiring emergency nurses include inserting IV lines, identifying heart and lung sounds, ventilator management, critical care skills, and caring for families in crisis. Because emergency nurses are often known as the "jacks-of-all-trades," continuing education classes covering nearly any topic are always worthwhile. In addition, don't underestimate the value of your nursing background. Your expertise in any area, including surgery, medical/surgical, psychiatric, critical care, ambulatory care, occupational health, or patient education can be a boon to care offered by the ED.
Finally, join the Emergency Nurses Association (ENA). Becoming a part of a professional organization will provide you with a wealth of networking and educational opportunities that support growth in the emergency nursing field. Membership also shows a potential employer that you're serious about developing your emergency care skills. For more information about ENA, call (800) 243-8362, or e-mail enainfo@ena.org.
Armed with your resume, a paper trail of continuing education certificates, membership to ENA, and the knowledge that your past experience would make a good addition to the department, apply for an ED nursing position. If the nurse manager is impressed with your effort to prepare yourself for the ED, but still looks at you with hesitation, ask if it would be possible to cross-train or "float" to the ED. This is often the most successful way for RNs without past ED experience to "break into" the department. If you are unable to float to the ED, maintain a relationship with the ED nurse manager. Keep him or her abreast of additional skills you have learned. Over lunch, share your clinical experiences, such as participating in cardiopulmonary resuscitation or dealing with an acute stroke patient. Ask to review a copy of the department's critical paths, standing orders, and/or standard operating procedures for paramedic field care. Hang in there, learn all you can, and before you know it, your phone will be ringing when the next position opens up.
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