What's it Like Working in Fast Track ER? Is It Right for You?

If you've ever worked in the emergency department, you realize that it's all about efficiency.  How do you move the somewhat unpredictable number of patients through the emergency department making sure the sickest individuals receive prompt attention.  Most hospitals now devote a small section of the ER, named the "Fast Track", to lower acuity patients in order to increase efficiency.  Usually, the Fast Track is staffed with a nurse practitioner or physician assistant.  What's it like working in Fast Track ER?  Is this the right environment for you?

What's it like working in Fast Track ER? 

As an emergency department nurse practitioner, I work in both the main emergency department, devoted to higher acuity patients, and the Fast Track.  My time is split between the two locations depending on the shift.  The hospital where I work staffs the six Fast Track beds with one nurse practitioner or physician assistant, a nurse and a medical assistant.

A typical day in the Fast Track is busy, busy, busy.  Charts steadily flow back into the "To Be Seen" rack bringing in a never ending cycle of patients.  I fly between beds draining abscesses, diagnosing fractures, reducing displaced fingers, suturing lacerations, ordering nebulizer treatments for asthmatics and diagnosing kids with the flu.  Even though these are for the most part low acuity dealings, the quick pace and always full waiting room keep me on my toes.

On occasion, the triage nurse misjudges a situation landing a patient in the Fast Track who's actually very ill.  This throws off the system a bit while I am forced to slow down my pace and provide a higher level of care.  NP's and PA's in the Fast Track must be vigilant and not assume every patient they see has only a minor illness or injury.  

Positives of Working in Fast Track ER

In contrast to my time in the main emergency department, in the Fast Track I'm in charge.  I delegate to the nurse and medical assistant helping to maintain efficiency.  I don't consult a physician about these patients unless I have a specific question.  My employer trusts that I am capable of handling Fast Track type medical problems appropriately.  I enjoy the responsibility that comes with working in the Fast Track.  It's nice to be the authority, to be trusted and work independently on these shifts (I also get to choose the radio station we listen to which is a big perk).  

Working in the Fast Track is a boost to my confidence.  During my time in the main emergency department I have a lot of questions.  I help treat patients that are very sick often necessitating physician involvement in their care.  At times, this can be waring and a constant reminder that I still have a lot to learn.  In the Fast Track, however, I'm capable of handling almost everything that comes through the door.  It's nice to have shifts that emphasize my strengths and highlight my capabilities as an NP to balance the shifts where I am still constantly questioning and learning.  

Negatives of Working in Fast Track ER

While I now enjoy being the ultimate authority during my shift in the Fast Track, at the beginning of my ER career this was actually a bit overwhelming.  The Fast Track was still a big step up in acuity from the urgent care where I had been working and I had a lot of questions regarding the patients I was seeing.  What kind of splint is needed for this fracture?  This wound is bigger than others I have sutured, what's the best way to repair it?  Does this patient need a CT scan or can they be discharged with strict follow-up head injury precautions?  

It's inconvenient to get help from physicians in the Fast Track where I work becasue it's cloistered away from the main ER.  Also, I just felt stupid constantly asking questions that I knew were of minor importance.  As a new nurse practitioner I still needed supervision, even with lower acuity patients.  I had to be proactive to get it and this caused a lot of stress at first. 

The Fast Track is just that, fast.  Nurse practitioners and physician assistants working in this setting are expected to move patients through the ER quickly managing multiple beds at once.  While I feel that one of my stronger qualities is time management and balancing multiple tasks simultaneously, this can be frustrating for a lot of providers, especially those that enjoy spending a significant amount of time with their patients.  Even for the most efficient provider, this "fast" mentality can be overwhelming at times.

Is Fast Track ER the Right Setting for You?

If you are a newer nurse practitioner or physician assistant looking to work in the emergency department, an ER with a Fast Track is the perfect place to start.  The Fast Track provides a stepping stone for learning about treating higher acuity patients than are seen in an urgent care clinic while still keeping you from being responsible for the sickest patients that show up in the ER. 

If you have been an NP or PA for a while and feel comfortable treating Fast Track type problems, an emergency department offering a mix of main ER and Fast Track shifts is likely a good fit.  Even though you will likely be able to manage the Fast Track with ease, rotating between higher and lower acuity settings is a good balance and helps prevent burnout.

If you've been an NP or PA for many years and have a lot of ER experience, you may get bored working in the Fast Track, especially if you do it exclusively.  Treating only lower acuity patients eventually won't help you improve your skills or provide daily challenges that keep your job interesting.  Consider working for a hospital that offers exclusively main ER shifts.

Questions about working in Fast Track ER?  Looking to share your Fast Track ER opinions and experience?  Comment to share!

 

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Comments

Hello!

Whether you should practice elsewhere before the ER depends on your experience, level of comfort, and the individual emergency department. If you have significant ER experience as a nurse, and work for an employer able to offer support to new grads, you may be just fine starting out in the ER. 

Erin Tolbert

Yes, I have been an ER nurse for 15 years. Ill be a Family NP in the next 3 months. Any ideas or guidance? Recommendations? Or should I practice elsewehere first?

DS

very helpful. starting out as a PA in the ED. thank you for writing!

gitte

Awesome article and answered just about every question I was concerned about as a new NP.

Thank you!

Flo

This is a great blog, thanks for writing it. I'll be a new grad entering ER fast track and am pretty stoked about it.

Ray