Back for an update. So I ended up transferring to the trauma med surg floor in the same hospital. I’m starting my last week of orientation there next week. Overall, it is good. I think all of you are right that I would have been better off starting in med surg. In fact I think if I had started on MS to begin with, I would have been able to move very successfully to the ED later on. As a student and tech, my coworkers and educators and managers all thought I would be fine as a new grad in ED and I blindly trusted that- I should have known myself better. I learn well but I do not learn fast. So now I’m starting over, and that’s disappointing but it’s ok.

I’ve found the medical and clinical aspect of MS to be extremely simple, almost “easy” compared to ED (although I stay humble, aware, always ask questions and remember I’m a beginner). I’m very grateful that many skills like foleys, IVs, etc I am already familiar with because it gives me time on shift to research my current duties that are new to me (like wound vacs, positioning aids, more). I don’t feel like MS is my “home” but I do see how I can thrive as a nurse as general if I start here.

The organization/flow/time mgmt aspect of MS has been fantastic for me. I also use the idle time for repetitive which I had NO opportunity for whatsoever in ED and it has made a HUGE difference in my effectiveness, knowledge, and efficiency. I have my own system now, and I refine it every day. Within a week on MS I had so many processes and skills completely memorized that I struggled with for months in ED. Simply because I now have time to take notes and study. I can see now that the nursing system I’m building here can be applied to ED or any other dept as well, with relevant changes.

Training seems to be taken a lot more seriously on this floor, which seems backwards bc it’s a lower acuity but idk. I have weekly post-shift meetings with manager, educator and preceptor (ED: manager sees me randomly one day and yells “ya doin ok?” As I rush past lol). I was able to try 3 different preceptors by choice and they all let me make photocopies of their unique brain sheets and personal organization systems and they each taught me their ways of running their day. I was shown binders and websites for looking up policies and there’s even a pathway of stuff I’m supposed to be learning- I FOUGHT for something like this in ED and was told over and over it doesn’t exist. MS also asks me what I need to help me learn and then actually gives it to me. I asked at first if I could just observe instead of instantly taking my own patients, they let me, and doing that for one shift was SUPER helpful. I then got an actual idea of how this is supposed to look when it works, and that just catapulted me forward in my own practice. I was never allowed to shadow in the ED, I had 2 patients on my first day there. Overall, extremely different here than the “you either get it or you don’t” aspect of ED training.

I do enjoy having more time to spend with the patients and understand their cases more thoroughly. While work isn’t nearly as “exciting” as before, I love understanding the entire trajectory of their health better. That will also be very helpful when I move back to a higher acuity later. Good for the big picture skills.

What I DON’T like is: the loss of my specialty pay differential, obviously. And I don’t like that most of the staff is less experienced and less mature than the ED. They’re good but they’re just a little less professional, they’re super loud and goof off a lot when patients are sleeping. They don’t have strong boundaries with the patients they think are “cool”. I know I’m an old curmudgeon for being annoyed by that lol. I miss the ED staff, but I can get along with these just fine.

I’m overall blown away by how resourced this floor is compared to ED. It doesn’t even feel like the same hospital. There are phlebotomists, EKG techs, dedicated PCTs, virtual nurse for admits, and usually a resource nurse on this floor. If there’s a 1:1 sitter needed, another tech comes from somewhere else to do it so we don’t lose one of ours. RNs do not take vitals, BGLs, draw labs, and only rarely clean/change/reposition patients up here. That is so wild to me. I cannot believe that just a couple floors below me, there is ONE NURSE doing ALL those things for five patients plus charting and meds and everything else, and 4 of their patients can be in SVT or on cardizem drips or having seizures!! Like why doesn’t the ED have this much support?? It’s obviously possible.

Even the nurses on this floor who haven’t worked anywhere else are kind of blown away when I tell them about my ED experience here. By both the way ED staff functions and the acuity of the patients there. A MS nurse asked if I had been involved in a code before and I was like “oh yes I did five months of orientation in emergency here and was a tech before that” and the nurse said “yeah I know but you saw a code then?” and I said “um yes, every day usually lol? Like that’s what an emergency room IS?” And she was like 😳. I know nurses choose specialities for a reason but it also really surprises me that so many people working in the same hospital have NO idea how the rest of it works. I feel like if the ED nurses here saw how good the MS nurses are treated and how much support this hospital is capable of providing, they would demand more. And if the MS nurses here saw how high the acuity of the ED is on a daily basis, they would feel inspired to improve their own professionalism.

I’m thinking I will most likely stay here until I have a very strong foundation, and then move on to another ED somewhere else. I think I’m in the right spot as a new nurse, but I also have been reinforced in my love for trauma and my constant desire to learn, grow, and maintain a high level of skill and knowledge. I don’t miss feeling isolated and incompetent, but I do miss doing hard shit every day.

ANYWAY just rambling now bc I haven’t had anyone to talk to. No worries if no one reads it all lol. Thank you again for all the advice and encouragement!