November 14, 2024 • 11 mins
My Workday in Pre-Op vs. The E.D.
In this episode, I discuss one of the most important aspects of navigating a career in nursing - "your fit." This has been a journey for me and most nurses. This episode is relevant whether you're a nursing student or you're already a nurse. You'll be able to understand and relate regardless of where you are in your career. The goal is that you walk away with new insight into these two areas of nursing.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
For me, the hardest thing was trying to figure out my fit.
(00:08):
And what I mean by my fit, I mean where I feel comfortable.
Because in nursing, you have a lot of different areas and it's like being a kid in a candy
store, but you may not fit in every area you practice.
I remember when I first became a nurse, my very first area was a cardiac step down unit.
(00:29):
And I left because I literally walked in my manager's office and told her that I wasn't
a fit for you.
I didn't feel comfortable.
I didn't really like the workflow.
So I left and I wound up going to the emergency department.
So again, when I say fit, it's going to be where you feel comfortable.
(00:52):
And honest with you, you may not find it for a bit.
You may have to go around from unit to unit until you find it.
I got a couple of friends of mine that are both in nursing school and they're struggling
with that right now.
And I told them, look, I'll be honest with you.
You're not going to know what you want to do until you actually get in it.
(01:17):
Because I had my own visions.
So I'm going to give you an insight on what it's like, what my day was in two areas.
And as I go on further into podcasts and I'm going to talk about the other areas, but these
two areas I want to talk about is what my day like in the ED and what my day like in
pre-op.
So welcome to my podcast.
(01:40):
So as a medic, I felt drawn to the ED.
And it was probably because that was the most interactions I had with an RN.
And that's why I took my patients.
And for some reason in my mind, I felt that EDRN and medics were kind of like the same
except higher pay.
(02:01):
And so that's probably what I want to be.
I would just want to be in an EDRN.
Now understanding, I had a lot of misconceptions about nursing before I started that now, like,
oh my God, I was just so far off.
For example, keep in mind, like I said, in my other podcasts, I wanted to be a PA.
(02:23):
And that kind of led me to nursing only because for the advanced practice.
And in my mind, I thought being in the ED would give me the experience that I need and
the knowledge I need to be a nurse practitioner.
And now I'm kind of looking like, what was I thinking?
First of all, which type of nurse practitioner, which type of advanced practice, you know,
(02:45):
you got neonatal nurse practitioners, pediatric nurse practitioners, you have certified midwives,
you have acute care, adult gerontology, clinical nurse specialist, CRNA.
I mean, I was like, had no idea, but that was just my thought process because that's
all I knew.
(03:06):
So don't beat me up on that.
I didn't know any better either.
But here's what I found out is that there's a lot more to being an RN than just the ED
because there are so many areas.
And the benefit that I had was as a paramedic, I was able to use my medic skills in all of
these areas.
(03:27):
And so just want to kind of give you what, tell you what my day was, especially in the
ED.
First, like I mentioned earlier, I felt drawn to the ED because I felt that it was an extension
of being a medic because that's why I brought my patients.
And to be honest with you, the transition from a medic to the ED is probably one of
(03:50):
the more easier ones.
I was able to have a short orientation because I already knew how to manage my patients.
So in the ED, I was able to use my paramedic assessment skills.
I was able to use my excellent IV skills.
I knew how to do a 12 lead.
I could read a 12 lead.
I can hang a drip faster than anyone can.
(04:11):
I already knew the basics of charting.
I mean, really the basic basics of doing patient care, you already know.
And so all you just really needed to know really was how to chart on the different narrators.
What's the procedures when you get into trauma?
What's the procedures when you get into cold stroke and things of that nature?
(04:37):
And also how to call a critical lab and how to do blood cultures and all that type of
stuff and a lot of compliance things, which you'll learn that during your orientation.
But the average day was really you had about huddle with the charge nurse about 15 minutes
before your shift starts.
(04:59):
So when you get there, you kind of sit around in a certain area or break area and then charge
nurse come in, kind of give you the patient assignments that you have and really it's
the rooms that you have or the bay or you may be in triage room or you may do fast track.
It just depending on where they send you.
(05:20):
And you go out and you meet those nurses and you get a report from each nurse.
Usually most EDs you're going to have about four patients.
So you get the reports on four patients.
And as you get the reports on the four patients, first thing I did was I went around, I introduced
myself to my patients and I got my vitals, my first vitals, first thing.
(05:42):
And I kind of looked over, did an assessment as you kind of doing your vitals, you want
to do your, you just kind of make sure that everything's good.
One thing about the ED, you have an ED nursing assessment and you just kind of keeping an
eye on things that's going to cause a change in condition.
So after I did my vitals, introduced myself, I immediately went into the chart to see if
(06:08):
they had any medications due or to see if I needed to prep them for any type of procedures
like CT x-ray or are they going to be moving to a different apartment?
Like are they going to be going up to the floor?
Are they going to be, have they been admitted inpatient or are they going to have surgery?
What time is the surgery?
(06:29):
And also I want to see what labs have already, what we call resulted.
I mean, what labs have already came in, then that way I can look at the labs and see if
they low on potassium, if they low calcium, if they low sodium, I can kind of already
predict what medications need to be given.
Or I can go ahead and give my provider heads up and say, Hey, look, this sodium is really,
(06:52):
really low.
Do you want me to go ahead and hang a bag of saline or something like that?
And also once I, and that's kind of like the rotating thing throughout the whole day.
As I get patients in, as I discharge patients, it's kind of the same flow.
And if I get to the point to where I'm not busy, like if I have four patients and they're
(07:14):
all waiting to go to CT or something, know all the meds have been given, then I would
float around and help my colleagues.
Because some colleagues may be drowning.
Some colleagues may have two patients, may discharge two patients and all automatically
get two people from EMS at the same time.
So I go and take one of those patients and they'll go and take the other.
That's kind of, you know, how the ED flow is.
(07:39):
The benefit to the ED is it's fast all day.
It's constant, constant discharging and constant intake.
And depending on what I'm sorry.
Yeah.
It really depends on the time of day too.
Like normally some EDs, if you come in in the morning, typically the morning is a lot
slower and then it starts to pick up.
(08:01):
Where if you come in mid shift from like 11 to 11, you're hammered all day.
Or if you're on night shift, it starts to slow down about two to three o'clock in the
morning.
So those are some of the, that's how my flow was in the ED.
Preop was a totally different vibe and flow.
(08:21):
So preop starts early in the morning because your first surgical cases are usually around
7.30.
So I would get in, I could look at the board and usually I have two patients to get started
that morning.
I go introduce myself to the patient.
I get to make sure the patient, you know, get dressed in a gown.
(08:41):
Sometimes they will have pre-medications, maybe some Tylenol, or maybe you have to run
some antibiotics.
So I would get an IV started.
I would get them to sign a consent.
I will wait for anesthesiologist to come sign their consent and do their briefing.
Sometimes they may have to have a nerve block done.
(09:02):
I would assist with the nerve block.
Then the surgeon would come in and do his briefing.
After his briefing, then pretty much now they're ready to go.
The circulator nurse and the CRNA will come, basically get the patient and they're gone.
Then I would get another one.
(09:24):
So the total time with the patient is usually about, usually it takes me about 20 to 30
minutes to prep a patient, but usually they have to show up for surgery about two hours
prior.
So usually I'm stuck with the patient for about an hour, but most of the time they don't
need anything.
They need to go to the bathroom.
They would just let me know.
(09:44):
We'll walk them to the bathroom.
They can use the bathroom and come back.
Usually have about two patients at a time.
So how my medic assessment, how was as a medic?
Number one, I had excellent medic skills.
So doing things like a 12-ly was easy.
Doing things like the IV was easy if they needed any pre-procedure.
(10:08):
Sometimes the harder IV sticks, I got trained to do ultrasound IVs.
So I would do an ultrasound IV for the ones that were really, really hard to stick.
But for the flow and also my medic assessments, I remember sometimes when we would get some
patients that are inpatient coming for surgery, they may be a renal patient, but I've had
(10:30):
them come down with tall peak T waves and looking at their labs and knowing I need to
get an updated potassium and a potassium too high.
Little things like that you can recognize from just being a medic.
But my medic assessment was still the same, just keeping an eye on the patient, anticipating
if a patient is going to crash or if they become altered.
(10:53):
I was able to pick up on that quickly.
The workflow really was really early in the mornings and it gets real busy early in the
mornings, but by the afternoon it slacks off and it's little to nothing.
So I feel like it was easier, pre-op was easier than the ED, but it was just a different role
in the healthcare system.
(11:14):
So those two were totally night and day.
One while I felt comfortable, the other one I kind of had to learn.
ED I felt comfortable from day one.
Pre-op, I kind of had to learn my flow.
So hopefully I was able to give you a little bit of insight in those two areas.
I'm going to hit some more areas like the ICU, endoscopy, step down the floor and also
(11:38):
case management to let you see how my experience of how my day was in those areas too.
So thank you for joining me.
You guys have a nice day.
I'll see you guys next time.
For me, the hardest thing was trying to figure out my fit.
(00:08):
And what I mean by my fit, I mean where I feel comfortable.
Because in nursing, you have a lot of different areas and it's like being a kid in a candy
store, but you may not fit in every area you practice.
I remember when I first became a nurse, my very first area was a cardiac step down unit.
(00:29):
And I left because I literally walked in my manager's office and told her that I wasn't
a fit for you.
I didn't feel comfortable.
I didn't really like the workflow.
So I left and I wound up going to the emergency department.
So again, when I say fit, it's going to be where you feel comfortable.
(00:52):
And honest with you, you may not find it for a bit.
You may have to go around from unit to unit until you find it.
I got a couple of friends of mine that are both in nursing school and they're struggling
with that right now.
And I told them, look, I'll be honest with you.
You're not going to know what you want to do until you actually get in it.
(01:17):
Because I had my own visions.
So I'm going to give you an insight on what it's like, what my day was in two areas.
And as I go on further into podcasts and I'm going to talk about the other areas, but these
two areas I want to talk about is what my day like in the ED and what my day like in
pre-op.
So welcome to my podcast.
(01:40):
So as a medic, I felt drawn to the ED.
And it was probably because that was the most interactions I had with an RN.
And that's why I took my patients.
And for some reason in my mind, I felt that EDRN and medics were kind of like the same
except higher pay.
(02:01):
And so that's probably what I want to be.
I would just want to be in an EDRN.
Now understanding, I had a lot of misconceptions about nursing before I started that now, like,
oh my God, I was just so far off.
For example, keep in mind, like I said, in my other podcasts, I wanted to be a PA.
(02:23):
And that kind of led me to nursing only because for the advanced practice.
And in my mind, I thought being in the ED would give me the experience that I need and
the knowledge I need to be a nurse practitioner.
And now I'm kind of looking like, what was I thinking?
First of all, which type of nurse practitioner, which type of advanced practice, you know,
(02:45):
you got neonatal nurse practitioners, pediatric nurse practitioners, you have certified midwives,
you have acute care, adult gerontology, clinical nurse specialist, CRNA.
I mean, I was like, had no idea, but that was just my thought process because that's
all I knew.
(03:06):
So don't beat me up on that.
I didn't know any better either.
But here's what I found out is that there's a lot more to being an RN than just the ED
because there are so many areas.
And the benefit that I had was as a paramedic, I was able to use my medic skills in all of
these areas.
(03:27):
And so just want to kind of give you what, tell you what my day was, especially in the
ED.
First, like I mentioned earlier, I felt drawn to the ED because I felt that it was an extension
of being a medic because that's why I brought my patients.
And to be honest with you, the transition from a medic to the ED is probably one of
(03:50):
the more easier ones.
I was able to have a short orientation because I already knew how to manage my patients.
So in the ED, I was able to use my paramedic assessment skills.
I was able to use my excellent IV skills.
I knew how to do a 12 lead.
I could read a 12 lead.
I can hang a drip faster than anyone can.
(04:11):
I already knew the basics of charting.
I mean, really the basic basics of doing patient care, you already know.
And so all you just really needed to know really was how to chart on the different narrators.
What's the procedures when you get into trauma?
What's the procedures when you get into cold stroke and things of that nature?
(04:37):
And also how to call a critical lab and how to do blood cultures and all that type of
stuff and a lot of compliance things, which you'll learn that during your orientation.
But the average day was really you had about huddle with the charge nurse about 15 minutes
before your shift starts.
(04:59):
So when you get there, you kind of sit around in a certain area or break area and then charge
nurse come in, kind of give you the patient assignments that you have and really it's
the rooms that you have or the bay or you may be in triage room or you may do fast track.
It just depending on where they send you.
(05:20):
And you go out and you meet those nurses and you get a report from each nurse.
Usually most EDs you're going to have about four patients.
So you get the reports on four patients.
And as you get the reports on the four patients, first thing I did was I went around, I introduced
myself to my patients and I got my vitals, my first vitals, first thing.
(05:42):
And I kind of looked over, did an assessment as you kind of doing your vitals, you want
to do your, you just kind of make sure that everything's good.
One thing about the ED, you have an ED nursing assessment and you just kind of keeping an
eye on things that's going to cause a change in condition.
So after I did my vitals, introduced myself, I immediately went into the chart to see if
(06:08):
they had any medications due or to see if I needed to prep them for any type of procedures
like CT x-ray or are they going to be moving to a different apartment?
Like are they going to be going up to the floor?
Are they going to be, have they been admitted inpatient or are they going to have surgery?
What time is the surgery?
(06:29):
And also I want to see what labs have already, what we call resulted.
I mean, what labs have already came in, then that way I can look at the labs and see if
they low on potassium, if they low calcium, if they low sodium, I can kind of already
predict what medications need to be given.
Or I can go ahead and give my provider heads up and say, Hey, look, this sodium is really,
(06:52):
really low.
Do you want me to go ahead and hang a bag of saline or something like that?
And also once I, and that's kind of like the rotating thing throughout the whole day.
As I get patients in, as I discharge patients, it's kind of the same flow.
And if I get to the point to where I'm not busy, like if I have four patients and they're
(07:14):
all waiting to go to CT or something, know all the meds have been given, then I would
float around and help my colleagues.
Because some colleagues may be drowning.
Some colleagues may have two patients, may discharge two patients and all automatically
get two people from EMS at the same time.
So I go and take one of those patients and they'll go and take the other.
That's kind of, you know, how the ED flow is.
(07:39):
The benefit to the ED is it's fast all day.
It's constant, constant discharging and constant intake.
And depending on what I'm sorry.
Yeah.
It really depends on the time of day too.
Like normally some EDs, if you come in in the morning, typically the morning is a lot
slower and then it starts to pick up.
(08:01):
Where if you come in mid shift from like 11 to 11, you're hammered all day.
Or if you're on night shift, it starts to slow down about two to three o'clock in the
morning.
So those are some of the, that's how my flow was in the ED.
Preop was a totally different vibe and flow.
(08:21):
So preop starts early in the morning because your first surgical cases are usually around
7.30.
So I would get in, I could look at the board and usually I have two patients to get started
that morning.
I go introduce myself to the patient.
I get to make sure the patient, you know, get dressed in a gown.
(08:41):
Sometimes they will have pre-medications, maybe some Tylenol, or maybe you have to run
some antibiotics.
So I would get an IV started.
I would get them to sign a consent.
I will wait for anesthesiologist to come sign their consent and do their briefing.
Sometimes they may have to have a nerve block done.
(09:02):
I would assist with the nerve block.
Then the surgeon would come in and do his briefing.
After his briefing, then pretty much now they're ready to go.
The circulator nurse and the CRNA will come, basically get the patient and they're gone.
Then I would get another one.
(09:24):
So the total time with the patient is usually about, usually it takes me about 20 to 30
minutes to prep a patient, but usually they have to show up for surgery about two hours
prior.
So usually I'm stuck with the patient for about an hour, but most of the time they don't
need anything.
They need to go to the bathroom.
They would just let me know.
(09:44):
We'll walk them to the bathroom.
They can use the bathroom and come back.
Usually have about two patients at a time.
So how my medic assessment, how was as a medic?
Number one, I had excellent medic skills.
So doing things like a 12-ly was easy.
Doing things like the IV was easy if they needed any pre-procedure.
(10:08):
Sometimes the harder IV sticks, I got trained to do ultrasound IVs.
So I would do an ultrasound IV for the ones that were really, really hard to stick.
But for the flow and also my medic assessments, I remember sometimes when we would get some
patients that are inpatient coming for surgery, they may be a renal patient, but I've had
(10:30):
them come down with tall peak T waves and looking at their labs and knowing I need to
get an updated potassium and a potassium too high.
Little things like that you can recognize from just being a medic.
But my medic assessment was still the same, just keeping an eye on the patient, anticipating
if a patient is going to crash or if they become altered.
(10:53):
I was able to pick up on that quickly.
The workflow really was really early in the mornings and it gets real busy early in the
mornings, but by the afternoon it slacks off and it's little to nothing.
So I feel like it was easier, pre-op was easier than the ED, but it was just a different role
in the healthcare system.
(11:14):
So those two were totally night and day.
One while I felt comfortable, the other one I kind of had to learn.
ED I felt comfortable from day one.
Pre-op, I kind of had to learn my flow.
So hopefully I was able to give you a little bit of insight in those two areas.
I'm going to hit some more areas like the ICU, endoscopy, step down the floor and also
(11:38):
case management to let you see how my experience of how my day was in those areas too.
So thank you for joining me.
You guys have a nice day.
I'll see you guys next time.
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