WHY are ER nurses like "that"

  1. l had my yearly eval today...went very well. Ended up getting into a discussion with my NM about new ER nurses from different areas of nursing and some new grads aclimating(sp) to the ER culture.
    Does anyone else out there think ER is a unique subculture of the hospital and nursing?...l definately do, andl am fascinated by this topic.

    l lecture in our ER residency program that we hold bi-annually, many are ER nurse wannabe's, or new nurses in local ER's. l have seen several with tremendous potential that do not make it, not because they were incapable or screwed up, but because ER veterans are not very good at identifying the problems these nurses are having and simply write it off as "not ER material".

    For the most part, the veterans are not of the "nurse eating mentality"....although it seems like it to the newbes sometimes.

    l am interested in other's perceptions of ER nurses and the sub culture. l don't want this to be an us vs them, but some honest perceptions that are held and why. l am hoping to use the info to mentor new RN's in the ER. lt is hard to be new anywhere, but for me, ER was the hardest place l have ever had to prove myself.


    One of my perceptions after having worked ER a few yrs now is that the nurses have a "lead, follow or get out of my way mentality" l can feel when l am slipping into this and honestly sometimes it is absolutely nec. when pt's crash and the ER is crazy. ER nurses are REQUIRED to make snap decisions...again necessary ....and , any ER nurse that denies being a bit of an adrenalin junkie is in denial

    Your thoughts experiences appreciated..........LR
    •  
  2. 20 Comments

  3. by   baseline
    I agree that ED nurses have a certain mentality. But I have to add that I think all nuses who work in one area over a period of time tend to develop personality traits that identify them to that specialty. I can differentiate CCU nurses from SICU nurses from OB nurses etc etc during one lunch talking about Seinfeld.

    For the ED specifically, it is the unknown, snap assessments with minimal if any hx and flying by the seat of your pants. No such thing as we don't have a clean room, no beds etc. It just gets better or worse. Sometime your shift ends, and you crawl home.
  4. by   l.rae
    Originally posted by baseline
    I agree that ED nurses have a certain mentality. But I have to add that I think all nuses who work in one area over a period of time tend to develop personality traits that identify them to that specialty. I can differentiate CCU nurses from SICU nurses from OB nurses etc etc during one lunch talking about Seinfeld.

    For the ED specifically, it is the unknown, snap assessments with minimal if any hx and flying by the seat of your pants. No such thing as we don't have a clean room, no beds etc. It just gets better or worse. Sometime your shift ends, and you crawl home.
    you know what baseline....that crawling home statement is too close to the truth....thanks for replying. l am hoping to generate enough response to use in mentoring.
  5. by   kaycee
    I crawled home tonght for sure.
    I think organizational skills and knowing your priorities are essential skills in ER nursing. Knowing what's important to do now and what can wait. Knowing what to worry about and what can sit for a while. Making what seems like an impossible situation possible.
    It's hard to teach these things, you just have to live it. I try my best to teach newbies but some just don't get it. If you ever figure out how to do it with out years of experience let me know. I'm all ears and tired feet!
  6. by   AngelGirl
    Baseline, you said it.........RE: crawling home. I keep a file of quotes I see, particularly at the lower edges of these entries. Yours is a definite keeper. Thanks.

    Re: the topic at hand. Newbies are in for a great deal of learning no matter where they go. ER is truly a tough place to learn. The outcomes of snap decisions can be SO crucial. Long timers are often afraid to allow a new person to "try" in a situation where, as Yoda says, "Do or do not...there is no try."

    The ER is usually not staffed with Nurse Instructor Wannabees, such as myself. I love to teach and will walk anybody through whatever I'm doing, if time permits. I find that it helps me to relax, sort of like thinking outloud. But, I find that am the exception.

    I believe that many ER people have a mental list with items they are ticking off as they go. This keeps them centered. Having to stop and review it with someone interrupts their train of thought, and they feel vulnerable to making mistakes. They prefer to simply get the job done and talk about it later. This, however, does little in allowing the new nurse any hands on experiences.

    New nurses who can follow and watch and perceive, usually do well. If they then make observations of their own, and treat patients accordingly, they can review these with a "seasoned" nurse. Hopefully, they will then receive both correction and affirmations.

    Smart nurses, no matter how set they are in their ways, will hopefully wake up and realize....... the critical staffing situations will be assuaged ONLY if they are willing to work with those willing to take the plunge in joining the ER staff! :kiss
  7. by   AngelGirl
    l.rae:
    Please see the ER Thread entitled, "Need Encouragement." It addresses the issue you've posed here, and I didn't see your name in it. :wink2:

    :angel2:
  8. by   CCL"Babe"
    Definately a subculture.

    For the ED specifically, it is the unknown, snap assessments with minimal if any hx and flying by the seat of your pants. No such thing as we don't have a clean room, no beds etc. It just gets better or worse. Sometime your shift ends, and you crawl home.
    The autonomy, the ability to "diagnose" and work up a patient based on your assessment skills. Some places - physicians give you more autonomy than others. The confidence in your assessment skills to be able to act on your evaluations.

    The ability to pare down the crap to get to the heart of the matter.

    The ability to cope with seeing all facets of life-the worst, the good, the bad and the down right ugly. The totally warped sense of humor that you develop to get by.

    People in the ED have to be able to depend on their co-workers to "get their back" in any situation. When some people don't "get it" They can effect the entire department. The ED tends to see more anger, violence than any form of nursing. During my stint in the ED I was assaulted many times by impaired patients. Nurses in other parts of the hospital don't get to see what goes on in the ED, and often wouldn't believe the stories of what you see. What ED staff sees and does "bonds" them much like firefighters and police, which is probably why so many ED nurses marry within those subcultures.
  9. by   l.rae
    Thanks for the replies, definately no formula to teach here, l am hoping other nurses from other specialties will give their views...it always helps to know how you are perceived. and AngelGirl, l will do a search and chk out that thread, l must have missed it.
  10. by   l.rae
    angelgirl, l did a search and didn't see any recent threads...there were several older ones. was there one in particular you were referring to?
  11. by   baseline
    I need to add one more thing. In my experience in orienting new ED nurses, I have found that the experienced med-surg nurse tends to be more successful than the critical unit nurses. Now, before anyone takes offense, I think the reason is the multiple patients and triage that a busy med-surg nurse has to do routinely.

    As a CCU nurse, I had one patient, maybe two. Sick? Uh huh. But I knew what was going on most of the time....at least some really good clues! The room was clean, neat and orderly, and the traffic was minimal. I was in a controlled environment.

    In the ED I always felt I was in control, but of a three ring circus and the elephants had dysentery. :-)

    Y'all are making me miss it .... STOP IT!!!! I am a burn out victim!!!
  12. by   oramar
    No matter what the speciality I think it would help if everyone just had less to do. The "eat your young" stuff comes from over work no matter where you are.
  13. by   momoftriplets
    This is a great discussion. I have geriatric, medsurg, critical care experience as well as case mgmt before I came to Er. I definately agree that organization is where it is at. I quickly felt comfortable in the Er. but I will admit I would rather take care of a bad trauma or a full code any day than a kid with a broken arm. post molds ain't my thing. lol
    Another Er nurse that I work with stated that Er is like juggling a lot of different balls, when one bounces, you have to pick up another one, and so on, and so on. You are constantly juggling many things at once and I do believe that some people can adapt well in that environment, and some people can't.
    Also said, I think it takes a good year or two before someone can really feel comfortable.
  14. by   blue280
    I worked in the ER for 3 yrs, 2 of them as a HUC then as a nurse intern and then as a GN. I left the ER to work on a med-surg floor because the pace was so hectic. As a HUC(ward clerk), I loved it asn was quite good at what I did. But as a nurse, I still need work on my time management skills and I wanted to be more familar with disease processes. Many people connot believe I gave up the "glamour of ER" for the boredom of mes-surg. I don't believe that a new nurse, unless they are very exceptional (and I graduated with honors) can work that kind of pace without some kind of burn-out. Many kudos to all you Er nurses, you are definately a special breed!

close