A simple question for ER Nurses

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Could someone please list the day to day functions of an ER Nurse?

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Specializes in Er/ICU/Med-Surg/Home health.

The whole idea of the ER is to get pts stabilized then get them to where they need to go (admitted to the floor or discharged). The routine "usually" goes like this: a pt comes in (by self or ambulance), gets triaged to determine where they fall in the long line of pts waiting (usually done by triage nurse or MD input), once the pt is in the back - the nurse gets VS, brief medical history, nursing assessment, and complaint then reports to MD. Once you've become familiar with the Docs - the nurse pretty much knows what he is going to want - you can have the bloodwork drawn, catheter in place, etc, etc to speed things along.Depending on the MD, he will go see the pt and or just write orders. Its the nurses job to see that every order gets done and results are back as quickly as possible. MD makes diagnosis and the nurse either discharges pt or they are admitted.

Now, that is a very simplified version. Problem with the Er is that you will have to deal with the crazy pts who dont belong there and want to start some drama when the pt next to them is in the middle of a code. I personally love the Er because it is very unpredictable, fast paced (every order is a NOW order kind of thing) and its challenging.

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ER nursing is very diverse. Simply to assess whatever situation comes in the door and act. Sometimes it is a sore throat, sometimes it is a cardiac arrest or trauma. Some of the mundane clients who use the ER instead of their doctor's office can be very exasperating, but it is a part of life in the ER. Just about the time you are so disgusted with runny noses and sore throats, a patient will come through the doors that you CAN and DO make a difference. The ER nurse triages, assesses, provides treatment and sends the client to the appropriate place inpatient or home. It is a crazy place at times, but can also be very rewarding.

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Specializes in Trauma, Teaching.

The whole reason so many of us do ER is that there isn't a routine day to day function. But, I'll try :wink2:

Get report, assess the patients you're taking over. Inspect, palpate, percuss, auscultate all systems.

Start IVs, place catheters, set up for invasive procedures, do consicious sedation on pediatric or adult patients.

Assess some more, intervene for what you find: pain, nausea, anxiety. Nursing measures for comfort. Grab a doc and get an order for pain med, anti nausea med, BP med (up or down). Monitor response to meds and measures.

Grab a chart and bring the next patient back from triage. Do more assessments/interventions/re-evaluations.

Grab the drunk wandering down the hall and get him back onto his stretcher. Assist with a pelvic exam. Peek under the sheet and find the "constipated" teen just delivered a baby. Resuscitate the baby. Comfort the elderly lady in the hall whose husband in dying in the cardiac room because his heart is just too weak for any interventions to keep it beating much longer. Assess all your patients again. Answer the radio, notify the cath lab an acute MI is coming in. Answer the radio and holler at the charge nurse there's a truama stat coming in, and we'd better move that sore throat out into the hall and get the trauma bay ready. Deal with angry mom that her kid's sore throat got pushed into the hall and isn't considered as important as the woman who's been shot in the chest by her angry boyfriend whom the cops are still chasing and just might end up coming in to finish the job. Do the admission paperwork and finally get that lady to a room after being in the ER for 36 hours. Discharge 3 patients, do all the teaching about their casts, splints, slings, medications, crutches, home care and need to follow up. Get 4 more patients to replace them. Assess them all, yell at the doc which one in crashing and he'd better get in here now! CPR and full code, get the guy to the ICU. Restock the crash cart. Go reassess your patients and see if anything you did made a difference yet or do you need to get the doc to order something else. Restart the IV in room 22 that took 4 sticks to get in in the first place but boyfriend pulled it out "'cause you put it in the wrong place". Call security to escort intoxicated boyfriend out. Calm the patient down and restart the IV, again.

Answer the radio again. Triage (assess!) the new ambulance patient. Give a shot of Ativan to the suicidal screamer in the locked room who is determined to hang herself with the gown you put her in. Get security and your techs and any nurse you can find to hold her down and put restraints on while you wait for the Ativan to work. Give a detailed history of the incident to the crisis counselor who isn't sure if she needs to be admitted. Go reassess your patients. Explain to the doc why that enema order from "an HOUR ago!" hasn't been given!!! Do the narcotic count (who cares if you have a Pyxis, that 20 year old policy says count the drugs! every day!). Hunt for that piece of paper that has your vital signs written on it.

Oh, and by the way, WRITE DOWN everything you saw, heard, did, didn't do, the patient's response to it, clearly and in detail as you go along because God forbid your charting is not up to date when some suit decides to check up on your work.

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Specializes in ED, Flight.

Whew!

JBudd, I think you left out:

Manage an ICU patient on vent and drips who will be in the ER for the night.

or just

Manage two or three admitted patients who are now HFTN/Here For The Night.

Don't forget:

precept student or new grad nurse.

generally answer questions and help out overwhelmed colleagues. (something JBudd does well. :bow:)

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Specializes in ED, Flight.

Honestly, ER nurses do some of every kind of nursing there is. The ultimate 'handyman' or 'odd jobs person'.

The ER can never say 'we can't take the patient, no beds/no nurses.'

The ER can never say 'we can't take that patient, they need specialty care.'

The ER can never say 'we can't take that patient, they're too acute.'

At some time in the shift the ER nurse handles peds, psych, geriatric, trauma, med-surg, icu, cardiac, ob, or ortho patients.

Whatever comes, the ER staff just take care of it; at least initially. And when the other units can't take the patient due to lack of resources, then they stay in the ER and the ER staff take care of them until they can be moved. Often the whole shift or longer.

In the smaller cities where there is one ER, there is no 'going on diversion'. As long as they keep coming, the ER has to look for a way to take them in.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

It's not such a simple question, is it? Or rather, no simple answer. :D

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Specializes in Trauma, Teaching.

C'mon Medic, you know I never manage the ICU patient on drips, I DELEGATE! :yeah:

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Specializes in OR, ER, TRAVEL, SURGICARE, WOMENS HOSP.

Oh! and JBudd, Don't forget rural ER nurses also, clean up "upchuck", mop floor, clean up urine, feces or anyother fluid that is excreted by patients. Put own orders into computer, help radiology to sit up unresponsive pt for cxr. Take labs down to laboratory. First start IV, collect blood, take to lab, do 12 lead EKG, gather meds, dispense meds, mop floor some more. Help suture pt's. Drop nasal gastric tube. Order meal for IDDM pt. who has been in ER too long and needs to eat. If cafateria closed, grab tv dinner and nuke it. Feed pt if no family member present. All those niceties you get in the big city we have to also do in a small hospital.Sometimes even have to salt driveway for ambulances!!

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Specializes in Emergency, Trauma, Flight.

it's easy.... get up... take a shower and brush my teeth.... drive to work..

and stomp out disease and save lives!!!

:cool:

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
Oh! and JBudd, Don't forget rural ER nurses also, clean up "upchuck", mop floor, clean up urine, feces or anyother fluid that is excreted by patients. Put own orders into computer, help radiology to sit up unresponsive pt for cxr. Take labs down to laboratory. First start IV, collect blood, take to lab, do 12 lead EKG, gather meds, dispense meds, mop floor some more. Help suture pt's. Drop nasal gastric tube. Order meal for IDDM pt. who has been in ER too long and needs to eat. If cafateria closed, grab tv dinner and nuke it. Feed pt if no family member present. All those niceties you get in the big city we have to also do in a small hospital.Sometimes even have to salt driveway for ambulances!!

You must work with me! LOL!! We're not especially rural (but just enough to get the occasional legs-vs.-tractor patient), but we are a freestanding ER with fewer resources, including a cafeteria that closes in the evenings and lack of housekeeping staff at times. We often do just about everything!

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Specializes in Emergency Dept, ICU.

"Order meal for IDDM pt. who has been in ER too long and needs to eat. "

That's funny usually at my ERs it's all the other patient's that NEED TO EAT becuase they are starving and haven't "eatin all day" but before they even get to an ER room they are hitting us up for food and drink!

The DM patients usually just don't ask for food... they just slowly lapse into unresponsiveness while we are running around catering to the non-sick. And then we shoot em up with dextrose and then get them a tray.

***SORRY VENT***

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