I agree with the prior posts. You have to be able to think on your feet and take things into your own hands sometimes when the doctor just cannot be there at the bedside at that moment. I had a patient recently who went into vfib on my zoll (he was off the hardline monitor because we were preparing to transport him). We started ACLS-did a quick shock, and he regained rhythm and pulse with the shock before the doctor made it in- Since shocking someone should be done ASAP in witnessed cardiac arrest, you need to be on your toes and confident-that you know your rhthms, your equipment, how to assess responsiveness, your shock energy, and your cpr/airway management. You have to be confident in yourself and in your assessment skills. You have to be able to prioritize correctly. You have to be okay with knowing you're not always providing the most personalized BEST care to all patients. This was hard for me. Sometimes patients feel ignored when you cannot get them a cup of water when you are helping someone in respiratory distress who just came through the door--which can sometimes take a while to get them settled down-heck you might have to assist with getting them tubed. Sometimes you can't clean someone up right that second after they've soiled themselves or you can't get the pain medicine for someone that second. Or maybe you come off rough when you're trying to dress a patient quickly. You might get complaints lodged against you from these patients-which can be stressful-not being able to please everyone. -not that I get many complaints-but it happens. I guess this just depends on how well staffed your ER is. A lot of times patients understand that you have a load of patients you're balancing and if they understand that, they will be more patient waiting for you. And, about the thinking on your feet and confidence, it comes in time. I know our ER keeps new ER nurses in less acute areas for about a year to help them develop their prioritization and speed skills and become familiar with policies and procedures. This has its drawbacks, though, because then when a "less acute" patient goes south, the nurse isn't as experienced to recognize the downhill turns (we can move the patient to the higher acuity section, but this down turn has to be recognized). Good luck!