Why I'm sick of the ED

86toronado, BSN, RN · Apr 13, 2011

1. When I try to delegate things to an ED tech because I'm busy medicating, assessing, triaging, or discharging patients, I get attitude, or "I'll get to it" while they're chatting someone up. That's if I can find the tech.
2. I have to fight to use my nursing knowledge and skills, my "job" consists of nursing "tasks", aka "tasks" that a tech "can't do": medicating, triaging, discharging, etc. My triage of the patient also doesn't seem to matter, the docs often interrupt me to ask the same questions I'm asking. Nurses don't seem to have a place in the ER, I feel like a medication monkey who starts IVs and reads preprinted discharge instructions to people, because there's not really time for anything else. The only time I feel like Im worth my pay is when I catch mistakes: wrong dose or wrong route for a med order, etc, or actually teach someone something: keep a list of the medication you're taking in your wallet. There seems to be very little time actually assessing patients, there's not enough time, more focus on CT scans, lab work and Xrays.
3. When I triage and prioritize patients according to urgency, I get flack about some non-urgent task that needs to be "done" so the patient can get discharged, aka tylenol for a "fever" of 99.4, etc...
4. I'm becoming sloppy, because "there's no time", some days I'll say "f***" it and take my time to do what I consider a good job, these are the days I get yelled at the most.
5. I get no to very little report on patients that I'm responsible for, if I ask questions, I get an attitude like I'm being difficult. If I act "nice" and joke around like everyone else, I get treated well. This furthers the feeling that we're all just med and task monkeys.
The last couple of months have been rough, to say the least :)

Wow! I'm pretty new to the ED, I've been there for 6 months, but I have to say I agree with everything you said there. But to make matters more interesting, every time someone (ie: management) asks me how I'm liking it so far, and I'm honest with them I get the idea that they think I'm an "ICU snob" who only wants to see and treat critical patients. I finally learned that the way to deal with it is to lie through my teeth and say I love it, because I want to keep my job...

RunnerNurse09, BSN, RN · Apr 13, 2011

Personally, some of the reasons you are sick of the ED are the reasons I left a med/surg floor and went to the ED (and absolutely love it).

On the floor, I felt like all I was doing was passing out meds and that I couldnt think for myself. No one gave a crap if you were having a bad day. I had to call a Dr for every and any little thing. In the ED, I can order blood work, CTs or Xrays if needed based on my nursing judgement, and the MDs are great and really respect the nurses assessments. We have a few bad techs, but most are great. Also, its all about team work. The other night I got slammed with 2 medic pts and a rsp ditress at the same time, and the charge nurse and two other nurses came to start working up my pts for me. We all care about each other and help.

On the floor was where I felt like a monkey, not using nursing assessment skills.

Its probably YOUR ED. If you loved the ED to begin with, maybe try a new one.

I wish you the best of luck. The ER isnt for everyone, and eventually I will have to move on, but right now I love it.

allstudentnurses, ASN, RN · Apr 16, 2011

I have to agree with Runner, I don't feel like I'm restricted in my E.D., I order a lot of things based on my nursing judgment and that is why I love the E.D. and will never work anywhere else unless I'm unable.

E.D. is completely different from any other dept. in the hospital. I moved from med/surg to the E.D. as a tech and it took me a while to catch on with how things "worked" down there, but once I understood how things worked, I was hooked. Now that I'm a R.N. now, I love it even more.

The E.D. is very stressful, you have to be able to keep your cool and manage stress well, otherwise you will not last. I admit, I get crabby at times when at work, but outside of work I'm usually extremely happy because compared to E.D. life, regular life is relatively stress-free.

:-)

Michele1377 · May 4, 2011

The last couple of months have been rough, to say the least :)

I hear ya! I have been an ER nurse for 18 years and I have seen nursing (in my dept) be reduced to the task monkey environment that you quote.

Don't have an answer for you, personally I think it is pitiful, and I am just about ready to throw in the towel myself!

Michele

BackpackingRN · May 4, 2011

As a new grad this is the field in which I am desperate to get a residency... :/ I hope my future hospital post lives up to what I hope it will be.

emtb2rn, BSN, RN, EMT-B · May 4, 2011

Sounds like it's time for a scenery change. Not every ER is like yours, there are good one out there. Try to find a new one with a better culture.

Good luck.

WonderRN · May 8, 2011

I have felt the same way.......

I just moved to a new ED. The docs i worked with at the old ED learned to trust my judgement/assessment, with some exceptions (some docs just don't care what nurses have to say). At this new facility, the docs don't know me yet and I can tell. And it bothers me a lot. I had to argue with a doc the other day about a nursing home patient that should be NPO because she didn't pass the swallow test. She very clearly aspirated the small amount of water I gave her......eventually he gave in. But he made a big deal about it and tried to embarrass me in the work area. Doesn't matter. But I digress......

I don't want to be just a work horse. I want my assessment to matter. Sometimes I don't think they appreciate it what it takes to PULL information out of patients to get it on the triage sheet. Or make a med list. And even if the doctor does do his/her own triage after you, you have helped to pull out important information in the patients mind and the information flows easier for the doc when they get in there.

But there are other times, I don't get in the room until after the doc does. And I am just chasing after him/her and trying to keep up.

In those times, I tell myself that my role as an RN is to keep the patient safe, keep the patient comfortable, educate them, translate, and fill in the gaps for the MD/notify them for any change in pt condition. While I am getting my orders done.

I am sick of the tech issue as well. There are some really good ones and I let them know how much i love them. The others, well, I tell the charge nurse about when I have a problem. And hope that eventually, with enough complaints, they will leave or be fired. Because in the end, the suits do care about productivity, and when productivity is halted by lazy techs, well, they'll do something about it.

In the end, I believe ED nurses have more independence than floor nurses. I know my critical thinking skills remain sharp because of the revolving door and varying levels of patient acuity and my technical skills are pretty good too, because of the frequency in which I use them. Those things are important to me, and that is why I stay.

Also, I work PRN at an urgent care. I love it, it helps me not burn out because there I can actually talk to my patients, educate them, not feel slammed. And generally, patients love you because you help them feel better fast. I also have learned a lot there, like how to take a fishhook out with a string, how to reduce a nursemaids elbow, the tricks to irrigating an ear, etc.

Like the others said, maybe go part time and work part time somewhere else too, to change it up?

Keep the faith. Keep doing whats right for the patient and you'll be able to sleep at night.

Michele1377 · May 8, 2011

Sounds like it's time for a scenery change. Not every ER is like yours, there are good one out there. Try to find a new one with a better culture.
Good luck.

I just did that - left my position after 18 years to take a PRN postion and a facility I wanted to "try on". In the end, if it feels right, I will certainly consider a staff postion, but I will never again allow myself to work for a toxic manager!

(Still shaking my head that I dealt with it for 18 yrs!)

cadency · May 10, 2011

I can totally relate to this post right now. I've been in the ER environment for a year and a half. This being my second ER since I've been in a new state. I don't know if it's the state out here, but the ER environments have been very difficult compared to my other experiences in hospitals back in Arizona.

I find, more than anything, a lot of burnout and roughness in the ER. Yes, the populations we see are the worst. Yes, occasionally some of the patients appreciate the care and not spit on it. Sure, the work is hard... but the staff is so burned out and miserable. Even in jest, the staff members are cussing each other, cussing in front of patients, being rude, saying things I cannot even imagine saying within ear shot of the patients' rooms. I find this wearing me out...

Not all of the techs I know have been like that. I was a tech for 3 years and EMT trained... so I understand the stress they are under better as a nurse. I've run into some that are very... arrogant about their skills and find certain tech requirements beneath them and so won't do them. You learn who to ask, who not to ask, and what to just do on your own cause it's quicker.

My ER has "goal" times for discharge of an hour and 20 minutes. Now they're cutting back on staff, 4 people have left and they've only replaced one of them... and putting on more charting/pt demands. Things that should be done quickly and take precedent are being ignored, delayed, or getting done inappropriately. Like you, I feel like I've had to make choices on what I can do well and take time to do and what needs to get shorted on. It can feel like an unsafe environment for my license.

Maybe a new ER is in order? A new PRN job for a new challenge? Or a good vacation...

Keep your head up; you aren't alone!

edmia, BSN, RN · May 12, 2011

I know exactly what you're feeling. And could add the colleagues who are passive-aggressive, backstabbing, jealous freaks that make me want to call in sick often...

But then, there's that moment in a shift where you connect with a patient and have the opportunity to get a glimpse of their life outside the madness of the ED. Or, you have a really cool code that works out perfect and you smile because all the knowledge you have shines through and it wasn't just a "task".

I live for those moments and it keeps me sane. But, I know that I will make a change as soon as I become bitter because I don't ever want to turn into that passive-aggressive, backstabbing, jealous freak

Footballnut · May 14, 2011

True, this is one of the most difficult areas you can work in, and there's little thanks in addition to everything else. If you choose to stay in Emergency Nursing keep track of the good people/things that come your way as the result of having practiced your profession in the ED. It might help carry you through some of the difficult times.