Am I a Good Candidate to Work in the ER?

  1. 0
    In a nutshell:

    I am an RN of 23 years who has several years of experience in various types of Med/Surg and Cardiac units and hospice. I am currently employed by a huge healthcare company that owns a number of hospitals in our region as a member of their internal RN float pool where I am currently doing short term assignments on intermediate cardiac units. I am ACLS certified.

    I like my current position, but it is a contingent position, and since my husband recently started a new job that only offers healthcare benefits for him, I have to find a position with benefits for me and our two kids. Due to this, I applied for a full-time position in one of our company's ERs and had an interview last Thursday. The manager seemed very interested and told me that she is going to set up a second peer interview this week.

    This is a suburban 25 bed ER that is currently a Level III trauma center and sees a lot of elderly patients due to its proximity to a lot of ECFs and a relatively good amount of psych patients due to this hospital having three psych units. IOW, no Level I trauma stuff here. I would not apply for a position in one of our Level I's, I don't feel like I'm ready for that yet.

    Here is the crux of my question: I am a very type A person. The good points to that are that I am very organized and get my work done in a timely fashion. I am not lazy, and I can gauge the severity of a situation and respond accordingly. I also have good skills in dealing with families, largely due to my years of working in hospice nursing, and have received good feedback on patient surveys about my people skills and compassion.

    The bad side to being this type A is that I am not super flexible in terms of not being able to complete a task that I am working on at the moment and I like things to run as planned. I can handle it if they don't, but my stress level goes up and I sometimes get frustrated. I like to think that this would be less of an issue in the ER due to patients understanding that there are going to be other patients coming in who trump them in level of triage, but honestly, I do get frustrated more often than I should when my routine gets turned upside down or I can't immediately meet a patient's needs.

    Do you think that the negatives that I pointed out above mean that I would not be a good fit for the ER? Should I look for something more regimented or that runs on a routine? Are these things that I could or would overcome with time? Have any of you experienced the same type of thing within yourself and still been successful in the ER setting?

    I would really appreciate any advice or experiences that you could share. The manager will possibly be calling me today for that second interview and I am sitting on the fence right now!

    Thanks.
    Last edit by westieluv on Apr 22, '13

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  2. 10 Comments...

  3. 1
    It depends on how type A you are.... Being organized is good, but the ER is extremely fast paced and at some point you have to accept that not EVERYTHING is going to get accomplished on every patient. You'll also have to be able to ask for help and then offer your help when you're able to. A lot of floor nurses I've met are very set in the "my patient" mindset and in the ER it's more of an "our patient" mindset. Sure you'll have you're own patients, but everyone has everyone else's back.

    Also, don't assume every patient will be understanding of another patients needs. Some patients will never understand why the new patient who came in with chest pain and needs a stat EKG trumps their chronic back pain. I had a patient today who yelled at me for not heating up her soup when I had a pedi patient with SOB, sats in the high 80's on room air that needed steroids and nebs ASAP.

    I'm a firm believer in trying anything once, your type A personality and ability to handle stress may make you an AWESOME ER nurse! But you never know till you try

    Good luck!
    NO50FRANNY likes this.
  4. 1
    Hi there, you sound like a perfect candidate for the position. I am a fellow type A and when I started working in Emergency my experience was largely in Bone marrow transplant, clinical haematology and radiation / medical oncology. I was used to a very structured and controlled nursing environment, an 8 hour plan if you will and I liked being able to perfectly execute care for my patients and the satisfaction of completing my shift knowing that all my boxes were ticked. However, I had always wanted to work in Emergency and took the leap after 10 years. I thought I would have trouble with the same things you describe, and I did, but working in ER teaches you to let things go. It's a totally different working environment in which you learn to develop a 10 minute plan, instead of an 8 hour one - there is routine, but it applies to assessment, investigations, procedures and so on. ABC PAIN. At first, when critical situations arose, I would experience such a huge adrenaline dump that I would lose my fine motor skills, my hands would shake so much that I couldn't even open a dressing pack. After time, and much support from my senior nurses I learned how to slow down, prioritise, focus and not become stressed or frustrated. I actually do this naturally now without having to think about it- When we do a crash intubation I won't be the person who can't open the ETT pack, I'll be the one speaking quietly and directing the resus while telling the graduate nurse how to do it.

    You mentioned organisation, ability to respond in critical or serious situations and your people skills- such important attributes in Emergency. Patients, their families and friends need to be calmed, patients need Type A assessment and care and the department needs someone who can organise this appropriately. It's a pace thing, a tempo that you get used to over time. Emergency nursing is often stressful and frustrating but the rewards far outweigh this for me. There is an element of teamwork at play in ER that I've not experienced in any other clinical environment, including long stints of agency work abroad and across many specialties. Your co-workers (including if not especially doctors) back you up more than you could imagine, so, for example, if you haven't completed your workup for the little ederly lady who fainted when your patient in the next bay decides to seize, you will miraculously find when you finally get back to her, that someone did her urine spec and a set of vital signs. The great thing about Emergency is that you do immediately meet a patient's needs, and if you can't, someone else will. We have an immediate effect on our patients whether it be pain relief, answer questions, help them breathe... I love the simple stuff. I like talking a 20 year old out of their anxiety attack, because I know they are so frightened they will listen to me and do everything I say, and it works. I enjoy a good verbal de-escalation, and of course a well run resuscitation. Personally, I don't think the things you are concerned about will be a problem at all, just a change of pace and with your years of experience, you will be a great attribute to the new setting. Hope this helps.
    mybrowneyedgirl likes this.
  5. 1
    Wow! Thanks so much for both of your encouraging and informative replies. I really appreciate you taking the time to respond and for encouraging me to try ER. You have no idea how much better I feel now, just having read about your experiences and backgrounds.

    Thanks again, I am still waiting for the manager to call about the second interview only now, I feel like I can go into it with much more confidence.
    NO50FRANNY likes this.
  6. 1
    The transition for you would likely be one of giving up control. There is no routine in the ER. And there is no control over what happens next. You may think you have the next hour planned out with your patients ... and then in a split second ... there goes the radio ... you'll be getting another patient - in your hallway. They're 4 minutes out ... no ... oops ... there they are rolling in the door now.

    And this is the one thing - mindset - that has to come from within the ER nurse. We can suggest umpteen strategies for prioritization, but only you know where your tolerance for "barely controlled chaos" lies.

    Good luck to you.
    NO50FRANNY likes this.
  7. 0
    Thanks, Altra, I can definitely see where this would be a big difference between floor nursing and ER nursing. On the floor, I can usually plan my shift pretty well as long as I don't have a patient crash or more than one admission. Obviously this isn't the case in ER.

    Sounds interesting...
  8. 0
    I think you'll do just fine after adjusting to the differences! I can promise you'll never be bored

    One thing I would suggest is watch some how-to videos on different procedures you'll see often like: intubations, chest tubes, IV starts, EKGs, c-spine stabilization, what to worry about with traumas vs codes, etc. Also, I'm sure you're familiar with most of the drips, but it never hurts to review.

    Ask plenty of questions, and never be afraid to ask for help, EVER! I wish you the best of luck
  9. 0
    Thanks, SweetMelissa, I"ll look up some of those videos and watch them. That's a great idea!
  10. 0
    Not being flexible is the worst thing one can have working in an ER. Remember, things will get done, it's just a matter of when and how you prioritize (the person with a CVA/MI is more important than the person screaming in pain because there is a screwdriver sticking out their hand... you are not ignoring the issue, just prioritizing).

    You will have to sometimes multitask AND help other coworkers with their tasks. The ER is a sink or float environment, getting your tasks turned upside down is a natural occurrence... you will just have to learn how to take the hits and keep rolling.

    FWIW, I have never seen any cardiac nurse [who transfered to the ER] stay longer than a few months simply because the rigor and a set plan does not exist. Routine DOES NOT exist in the ER.
  11. 0
    Quote from NiteQwill
    Not being flexible is the worst thing one can have working in an ER. Remember, things will get done, it's just a matter of when and how you prioritize (the person with a CVA/MI is more important than the person screaming in pain because there is a screwdriver sticking out their hand... you are not ignoring the issue, just prioritizing).

    You will have to sometimes multitask AND help other coworkers with their tasks. The ER is a sink or float environment, getting your tasks turned upside down is a natural occurrence... you will just have to learn how to take the hits and keep rolling.

    FWIW, I have never seen any cardiac nurse [who transfered to the ER] stay longer than a few months simply because the rigor and a set plan does not exist. Routine DOES NOT exist in the ER.
    No need to sound so negative... And their is routine in the ER, but it's mostly how you assess and tackle tasks! And at my very busy level II ER, we just had a tele nurse finish orientation who is doing wonderfully!


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