A day in the life of an ER nurse...

mamalle · Apr 14, 2007

What is a day usually like in the ER?

I work 7a-7p. depending on what the night was depends on how many patients I have to take over and how many are waiting to come back. yesterday I started out with 3- by 9am I had 9 until the next nurse came on. Its busy all day normally but around 4-5p it really hits the fan. esp on fridays.

What all diagnoses's do you see? CHF, Pneumonia, AIDS, UTI's, Renal issues, STDs, Psych, Sickle Cell, GI bleeds, MI, Asthma, TB, Ectopics, Diabetes, HTN, Threaten ABs, all types of ortho fractures, Cellulitis, Urosepsis and Altered Mental Status is big, Etoh abuse, Substance abuse, ODs, I could go on and on... we are also a Level II trauma center so that is a large portion of our patients at times.

How many patients do you see? (pt./nurse ratio)

It all depends on the day, acuity and staff. yesterday I had about 6 pts to the other nurses 2 pts on the medical side. On the cardiac side- we normally take turns and can have up to three monitored pts. If there is a one on one. it may be different.

How long was your orientation? 3 months if I recall correctly.

What qualities/skills do you feel are important? being able to prioritize, multitask and good assessment skills. always go with your gutt AND do not ever feel like you cannot ask a question. No question is a dumb question. Being able to adapt to the constant changes and flow of the ER, along with being able to work with so many different personalities..

ritarunningfeet · Apr 15, 2007

Definatly no typical day, it varies soooo much but in the ER I work in I have any where from 2 patients if I am Trauma to 5 patients if I am in the less acuity section, we still end up with the high acutity patients. sometimes more patients if you are floating in the hall. In a night we see alot of different diagnosis, from hurt limbs, to abdominal pain, to chest pain, to trauma, to neuro, to just about anything you can think of. Example last night my assignment was 3 rooms, in my 12 hours I sent 2 pts to cath lab, one to ICU tubed, a kid with temp 105, a pt with HR of 170, a vomiting child that wasn't vomiting anymore, a r/o sepsis admit, a pediatric r/o sepsis admit, a cornial abrasion, a fall with headache( that another nurse watched and sent home for me while I was with my cath lab pt), and just before going home an abdominal pain. granted the assignment was full when I came in, so 3 of the patients were already started and the one just before going home I didn't have to do much with, but all in all it was a busy night for me. Some nights I will hold on to the same patients for most of the shift other nights people get moved through super quick.

I was on orientation for 3 1/2 months, I had never worked in er before, some who come in with previous experiance are on only for like 1 month.

You definatly never know what to expect in er. Some nights are rather slow and boring and some you don't have a chance to even pee, and sometimes you get that weird case that leaves you baffled.:monkeydance:

RedERRN · Apr 15, 2007

What is a day usually like in the ER?

I work 7a-7p in a Level 1 trauma center at a 700+ bed hospital. Our EC has 52 beds that are divided into Quick Care (Urgent Care), Pediatrics, Fast Track, Level 2 (main EC beds), Level 1 (ICU/critical pts), Trauma, and Chest Pain Center. Upon arriving to work we are given our assignment which consists of 3-4 rooms in chronological order in a specific zone. Ideally the nurses in Level 1 and Trauma only have 2 pts but we are so short staffed that this rarely happens. Each nurse sees an average of 6 new patients a day. This is in addition to the 3 or 4 patients that are already in the rooms when coming onto shift. Each patient is in different phases of care. Some are just in from EMS, some are waiting on disposition, some are admitted and waiting on hospital room assignment (which can literally take days). In our EC, the nurses do most everything because our techs are not held accountable for any of their assignments - :angryfire: this is a really big issue contributing to our high turnover of RNs.

What all diagnoses do you see?

If it is a diagnosis, or even a symptom, we see it. :uhoh3: Our hospital is also a Neuro Center, a Heart Hospital, a Childrens' Hospital, and a Trauma Center in addition to being a teaching hospital and the only indigent care facility in our area.

How many patients do you see?

Each nurse usually has 3-4 patients (most of the time 4 pts since staffing is sooo bad). The nurses in Level 1 should have only 2 patients based on the hospital's Critical Care standards of practice...yeah, right. Sometimes the nurses in Level 1 will have 4 patients - but rarely more than 3 are actually critically ill. In one day each nurse sees a total of 9-13 patients each day on average.

How long was your orientation?

12 weeks - it included 3 12 hour shifts per week in addition to 3-6hours lecture per week on Emergency Critical Care and ACLS, PALS, and TNCC certification.

What qualities/skills do you feel are important?

Honestly, the most important quality/skill I possess is the ability to compartmentalize. Quick thinking, excellent rapid assessment, very good communication, and patience are the most important nursing qualities/skills.

TazziRN, RN · Apr 15, 2007

"typical day" and "ER" are not synonymous!!!

I work 7a-7p also. I am in a rural ER, so our pt census is a lot lower than most....if we see more than 15 pts in a shift it's busy.

My orientation at my current facility was 3 days, because I was experienced. When I graduated and accepted an ER position, I had a 12-week critical care preceptorship.

kmoonshine, RN · Apr 15, 2007

What is a day usually like in the ER?

I work 2nd shift, so when I come into work it is usually busy. There will be times when we are slow, and then all hell breaks loose! Things change in a heartbeat. When I come into work I get report and try to stock my supply carts. I also make sure there's an ambu bag and working suction in my major trauma rooms. I double-check any infusions that are running, assess my patients, look at their labs, take report from EMT/paramedics, and so on...

What all diagnoses's do you see?

Tonight I cared for a patient who broke their pelvis in an MVA, a 2-year old involved in an MVA, and patients with chest pain, generalized weakness, abdominal pain, and so on. Then, 1 hour before my shift was to end we had a PNB come in so I got in on that. I've also seen hepatic encephalopathy, GI bleed, asthma, abdominal pain, miscarriage, heart attack, chest pain, pneumonia, angioedema (just saw it last night), CHF exaccerbation, high blood pressure, pancreatitis, bowel obstruction, seizure disorder, alcohol intoxication, overdose, hypoglycemia...lots of interesting stuff.

How many patients do you see? (pt./nurse ratio)

3-4 patients per nurse. But, we have a flow nurse who picks up rooms if the primary nurse is busy (if I'm with an acute MI patient and they need to go up to the cath lab, I'm pretty much in that room the entire time and other nurses pick up my rooms- there's so much to do in such a short period of time for MI patients). If the patients are non-critical, usually 3-4 patients isn't a problem. But, when we start having to hold people down in the ED because there's no beds on the floor, or if we have ICU holds, things get a bit crazy.

How long was your orientation?

3-4 months

What qualities/skills do you feel are important?

Ability to be calm, interest in learning something new each day, excellent communication skills, assertive, someone who's not afraid to ask lots of questions, prioritization, excellent critical thinking skills, and someone who is a real team-player. Confidence is very important also.

mamalle · Apr 15, 2007

wow I amazed on the ratios seems lower than what we have. Granted Im lucky enough NOT to have to do peds- we have a pediatric ER that sees pts up to the age 17. our rooms are divided by monitored and medical. we do have 4 monitored rooms on the trauma side that we can use for overflow or the trauma dept uses them. we have 3 trauma nurses around the clock that are funded through the health care district so they really are not employed in the ER. I would be happy with 4 pts on the medical side but it never works out that way. we also use our 1 monitored bed on the medical side for overflow if need be if the cardiac side is busy or filled. on friday I had 6 admits- one including a CP in that room. along with 2 other patients I had started in the hallway. Its unreal... I guess that is why I am happy to be perdiem and work a few times a month- if I had to go back to fulltime- I would surely be burned out quick..

ernurse16 · Apr 15, 2007

Typical day in the ER... organized chaos! Expect the unexpected. Always be on your toes, you never know what will walk, roll, or be carried in at any given moment. Plan to see everything and things you never imagined that you would see. Staffing is generally between 3 and 5 pts depending on the type of facility. Higher acuity (trauma centers) generally staff better, but then there are the nights where you are shortstaffed and have more or... pts are pulled to the hall and you still have them.

Most important in my opinion... learn to prioritize, trust your gut instinct, and never never never think you know it all. Ask questions. When you think you know it all... You are dangerous... no matter how long you've been a nurse. I learn something new everyday.

Lastly I guess... is learn to laugh. I think humor is our coping mechanism :trout:

EmerNurse, BSN, RN · Apr 22, 2007

I'll agree with the humor thing - have a very good (if twisted) sense of humor!

Typical day? Sure come in at 1900, zone's full, mostly patients waiting on beds except one room with a new patient through ambulance (that I saw pull in while I was sitting in my car waiting for my shift to start). Probably at least one vented or bipap'd patient. 4-5 rooms in my zone. Get these all up to the floors (check patients, check charts, do what needs to be done that wasn't, call report, off they go) and then start all over. Some nights will fill all my beds back to back with chest pains and SOBs from rescue. Do this a few times, pee when you get home.

Lately, this IS the norm. As for what we see? Lots of acute exacerbations of chronic problems. Past month has been dialysis folks who didn't get dialysis today and are also CHF'ers and come in SOB but we can't diurese 'em cause they're dialysis... these things come in runs. Also the abdominal pains (20% will actually be something major) and the rest are gastritis or FOS. At least 3 babies with fevers at home who are normothermic at triage but mom "wants to make sure". At least 3 or 4 "hurt all over x 4 weeks" that just "couldn't take it anymore" at 2am. A Bunch of chest pains, most under age 24 + for cocaine, others are admitted for 23hr obs "just in case". Oh and don't forget the 4 90+ year olds from LTC with hx of dementia and alzheimer's who come in with AMS. Full work up there and a guarenteed admit, as well as full skin assessment, total care, etc. Oh and always at least one high sugar >500 and one low sugar

No good answer to your question, as you can see - ya just never know.

Dallas_RN, BSN, EMT-P · Apr 22, 2007

I work in a Level I trauma center 7p-7a and see EVERYTHING under the sun. In the past 3 days we had 6 stabbings and 8 GSW's (shootings), NUMEROUS MVC's (lost count but around 12-15), several CVA's, endocarditis, 3 subdural hematoms, and 4 codes... This is just what I saw on my side of the E.R...

AmandaBrittainy · Apr 23, 2007

important qualities - you cannot be a lazy er nurse, this is my biggest hate in life. Where I work, no one completes charting, half of the nurses don't even bother checking temperatures - there are more busy brownnosing the doctor to try to get a chance to suture a patient later in the night (out of our scope in NM). I dont know how many patients I walk in on weekly that don't even have thier basic needs met let alone critical ones - am I alone, why doesn't my employer punish these people and how come when I write up deadly mistakes, it is pointed out at every meeting that I am the town cryer - god forbid I wrote an incident report on a nurse that left a tourniquet on a patient for 4 hours.

teeituptom, BSN, RN · Apr 27, 2007

They are different days depending on what happens

Welcome to the wonderfull world of ER nursing

hahahahahahahahahahahahahahaha