Are there nurse shortages in the ER?

rjflyn, ASN, RN · Apr 8, 2005

Considering I am working in the ED as a travel nurse and the hospital im currently assigned has 9 or 10 of us, I would say so. Along with that they are not having much trouble finding me assignments in the region of the country I live. Most places I have independantly looked in to from time to time all have a few postions from per deim to full time. Most of the full time shifts fall on nights though. Come on down see how the other side lives and saves lives.

rj:rolleyes:

Dixielee, BSN, RN · Apr 8, 2005

I agree...as an ER travel nurse, I have not had too much trouble finding work where and when I need it. I am currently in Tucson, and they use travelers year round, not just seasonally. I think most of Arizona is this way. California also has LOTS of ER travel jobs available.

There are lots of things to consider to determine if you would fit into the ER, and several threads on this forum you might find interesting in this regard. As for me, until I can get my farm up and making money, I will be working ER somewhere!

imastudent · Apr 8, 2005

I agree...as an ER travel nurse, I have not had too much trouble finding work where and when I need it. I am currently in Tucson, and they use travelers year round, not just seasonally. I think most of Arizona is this way. California also has LOTS of ER travel jobs available.
There are lots of things to consider to determine if you would fit into the ER, and several threads on this forum you might find interesting in this regard. As for me, until I can get my farm up and making money, I will be working ER somewhere!

do you think the overload of works in the ER is worth the money? also are you often on call and are your hours irregular or not flexible? can you tell me what your typical day at an ER is like? (i don't think there would be a "typical" day since you can never expect what will happen in the ER but I want to have a basic idea..) thank youuuuu!

suzanne4, RN · Apr 8, 2005

The workload isn't any different.............and it will vary with the hospital that you are working at.

And to your original statement. You do not see a CNS or NP working in the OR on a normal basis. They are normally seen on the nursing units. It is the RNFA that you will see in the OR in the role that you have been previously talking about in other threads. The training is completely different.

If you are interested in the OR, why would you want to work in the ER?

imastudent · Apr 8, 2005

The workload isn't any different.............and it will vary with the hospital that you are working at.
And to your original statement. You do not see a CNS or NP working in the OR on a normal basis. They are normally seen on the nursing units. It is the RNFA that you will see in the OR in the role that you have been previously talking about in other threads. The training is completely different.
If you are interested in the OR, why would you want to work in the ER?

actually im trying to decide from ER, OR and MEG/SURG. im leaning more towards ER though..im trying to get a basic idea of everything..i know experience is the best way to find out but i like to collect some info before i start things...there are sooo many types of nurses/areas that they work in it takes a lot of research time to learn a bit about everything :uhoh3:

Dixielee, BSN, RN · Apr 9, 2005

As a traveler I do not have to take call or rotate shifts. All of this is decided beforehand and written into your contract. One nice thing about ER is you are rarely if ever floated to another unit. ER's must staff for the inevidability of disaster, so even if you have a lull for a few hours, it can turn on a dime.

The other night at 0230 (I usually work till 0330), we only had about 10 patients in the ER and I was asked if I wanted to go home early. Being that it was my third 12 hour shift, I was ready! Anyway....I had emptied my pockets, put up all my stuff and was walking toward the door when we got 2 EMS calls. Both were respiratory distress due to arrive any minute. When they rolled thru the door, one was already intubated (a 46 yr old with COPD), the other had a trach button and was having decreased LOC and periods of apnea. So much for leaving early and having a quite night!

As far as work overload being worth the money....I don't know that the ER is overworked anymore than any other unit, it is just different. On a floor and sometimes ICU, you can sort of pace yourself based on the number of beds you have and the number of patients in them. When you are full, you can't take anymore patients. NOT so with the ER. The doors are revolving and we never close. There are nights when we never even get close to emptying the waiting room. Other times, you just stay even, and we rarely keep a bed empty very long.

One of the big problems in a lot of hosptals especially during the winter months, is a lack of available hospital beds. We routinely hold patients in the ER who need to be admitted to the hospital, sometimes 24-48 hours. One day last week at 3 pm we were already holding 11 patients (52 bed ER). We are constantly trying to shift the "holds" into a hospital bed for comfort and move them into the "back" part of the ER. Usually staffing is able to send us a float who takes care of the "floor" patients, but we never get extra help to care for the ICU patients.

I can't even begin to describe what a typical day in the ER is, because it would be a book! I will hit the highlights though....

If you are assigned to the general ER and not the ALS section, you will see everything in the book. If you are in ALS, you will get the significant chest pains, respiratory distress/arrest, overdoses, trauma, etc.

In the general ER you will see kids with beads up their noses, pregnant vag bleeders, lacerations, sprains and fractures, drunks and druggies either there because they are a danger to themselves or others, or they are seeking detox (after last drinking, snorting, injecting 2 hours PTA). There are lots of back pains, toothaches, headaches as well. Multiple "wreck checks"...people involved in minor MVC's who think their insurance company wants them to "get checked out". They all get sent home with Rx for vicodin, flexiril and motrin, 2 days off work and and ice bag.

You will see an abundance of belly pains. I hate them the worst! Well, almost (GI bleeders get that prize). They all get IV fluids, labs, meds, CT scans, ultrasounds and or pelvic exams. They are usually whiny females who have nothing better to do but hang out in the ER. 90% of the time everything is negative and we send them home 6 hours later with a Rx for vicodin and a referral to their PCP. I recently had a young woman with a 10/10 on the pain scale who had her mom bring her a salad before we even got her labwork done. Then she ate an entire fried chicken dinner between glasses of contrast prior to her CT scan. Oh yeah, she was really sick. NPO means nothing to these people! I had a woman walk into triage complaining of nausea and vomiting while eating a big box of fried rice. I told her she really needed to stop eating if she was nauseated....she said, "I was hungry, and besides, I just bought this". How can you argue with that logic. I can't tell you how many people who are complaining of nausea/vomiting who are eating and drinking because they want to have something to throw up. DUH!!

You will get your share of coughs, runny nose, upper airway congestion, kids with fever (whose parents did not give Tylenol because they wanted you to see how high the fever was:uhoh3: ). Lots of asthma and respiratory complaints during season changes and high pollen counts (like now).

I don't want to leave out the multiple UTI's, simple ones and those with urosepsis who are VERY sick. You get your share of diabetic related problems, high blood pressure and chest pain that turns out to be non cardiac. Lots of belly pain/chest pain that turns out to be a gall bladder problem (had a guy complain of GB pain after eating ONE POUND of bacon for breakfast (who could have known??:rotfl: )

In a nutshell....if a human being can suffer from something, you will see it in the ER. If they have no real problems, they will invent one! Or do something stupid enough to buy them a bed in the ER. Summer brings lots of problems related to being outdoors. Drowings or water related problems, sunburn, diving accidents and such. I had one guy who tried to dive into the pool from his hotel balcony. He almost made it! Many of the summertime activities are related to the infamous "2 beers". If it is not the 2 beers then it is related to the "2 dudes" who caused the problems. I guess bad things happen in "twos" instead of threes!

ER is a new adventure every shift. Just when I think I have seen it all, heard it all, smelled it all.....someone proves that I have not!

My new mantra is.....if it were not for stupid people, I would be unemployed!:chuckle

imastudent · Apr 9, 2005

The workload isn't any different.............and it will vary with the hospital that you are working at.
And to your original statement. You do not see a CNS or NP working in the OR on a normal basis. They are normally seen on the nursing units. It is the RNFA that you will see in the OR in the role that you have been previously talking about in other threads. The training is completely different.
If you are interested in the OR, why would you want to work in the ER?

what is a RNFA? and what are physician assistants compared to? NPs?

also what is a per diem nurse?

imastudent · Apr 9, 2005

As a traveler I do not have to take call or rotate shifts. All of this is decided beforehand and written into your contract. One nice thing about ER is you are rarely if ever floated to another unit. ER's must staff for the inevidability of disaster, so even if you have a lull for a few hours, it can turn on a dime.
The other night at 0230 (I usually work till 0330), we only had about 10 patients in the ER and I was asked if I wanted to go home early. Being that it was my third 12 hour shift, I was ready! Anyway....I had emptied my pockets, put up all my stuff and was walking toward the door when we got 2 EMS calls. Both were respiratory distress due to arrive any minute. When they rolled thru the door, one was already intubated (a 46 yr old with COPD), the other had a trach button and was having decreased LOC and periods of apnea. So much for leaving early and having a quite night!
As far as work overload being worth the money....I don't know that the ER is overworked anymore than any other unit, it is just different. On a floor and sometimes ICU, you can sort of pace yourself based on the number of beds you have and the number of patients in them. When you are full, you can't take anymore patients. NOT so with the ER. The doors are revolving and we never close. There are nights when we never even get close to emptying the waiting room. Other times, you just stay even, and we rarely keep a bed empty very long.
One of the big problems in a lot of hosptals especially during the winter months, is a lack of available hospital beds. We routinely hold patients in the ER who need to be admitted to the hospital, sometimes 24-48 hours. One day last week at 3 pm we were already holding 11 patients (52 bed ER). We are constantly trying to shift the "holds" into a hospital bed for comfort and move them into the "back" part of the ER. Usually staffing is able to send us a float who takes care of the "floor" patients, but we never get extra help to care for the ICU patients.
I can't even begin to describe what a typical day in the ER is, because it would be a book! I will hit the highlights though....
If you are assigned to the general ER and not the ALS section, you will see everything in the book. If you are in ALS, you will get the significant chest pains, respiratory distress/arrest, overdoses, trauma, etc.
In the general ER you will see kids with beads up their noses, pregnant vag bleeders, lacerations, sprains and fractures, drunks and druggies either there because they are a danger to themselves or others, or they are seeking detox (after last drinking, snorting, injecting 2 hours PTA). There are lots of back pains, toothaches, headaches as well. Multiple "wreck checks"...people involved in minor MVC's who think their insurance company wants them to "get checked out". They all get sent home with Rx for vicodin, flexiril and motrin, 2 days off work and and ice bag.
You will see an abundance of belly pains. I hate them the worst! Well, almost (GI bleeders get that prize). They all get IV fluids, labs, meds, CT scans, ultrasounds and or pelvic exams. They are usually whiny females who have nothing better to do but hang out in the ER. 90% of the time everything is negative and we send them home 6 hours later with a Rx for vicodin and a referral to their PCP. I recently had a young woman with a 10/10 on the pain scale who had her mom bring her a salad before we even got her labwork done. Then she ate an entire fried chicken dinner between glasses of contrast prior to her CT scan. Oh yeah, she was really sick. NPO means nothing to these people! I had a woman walk into triage complaining of nausea and vomiting while eating a big box of fried rice. I told her she really needed to stop eating if she was nauseated....she said, "I was hungry, and besides, I just bought this". How can you argue with that logic. I can't tell you how many people who are complaining of nausea/vomiting who are eating and drinking because they want to have something to throw up. DUH!!
You will get your share of coughs, runny nose, upper airway congestion, kids with fever (whose parents did not give Tylenol because they wanted you to see how high the fever was:uhoh3: ). Lots of asthma and respiratory complaints during season changes and high pollen counts (like now).
I don't want to leave out the multiple UTI's, simple ones and those with urosepsis who are VERY sick. You get your share of diabetic related problems, high blood pressure and chest pain that turns out to be non cardiac. Lots of belly pain/chest pain that turns out to be a gall bladder problem (had a guy complain of GB pain after eating ONE POUND of bacon for breakfast (who could have known??:rotfl: )
In a nutshell....if a human being can suffer from something, you will see it in the ER. If they have no real problems, they will invent one! Or do something stupid enough to buy them a bed in the ER. Summer brings lots of problems related to being outdoors. Drowings or water related problems, sunburn, diving accidents and such. I had one guy who tried to dive into the pool from his hotel balcony. He almost made it! Many of the summertime activities are related to the infamous "2 beers". If it is not the 2 beers then it is related to the "2 dudes" who caused the problems. I guess bad things happen in "twos" instead of threes!
ER is a new adventure every shift. Just when I think I have seen it all, heard it all, smelled it all.....someone proves that I have not!
My new mantra is.....if it were not for stupid people, I would be unemployed!:chuckle

:rotfl: thank you for your post! it was very interesting to read =D

this is why im interested in working in the ER..i think the diversity (whether it's serious or completely DUMB) of the cases that you see make it impossible for your work to feel dull. im sure that time goes really fast when you work in the ER. im just worried that maybe i wont be able to take all the "gross" part of ER..like seeing how a serious accident affect a person's body, blood, etc.

is it rare to find morning shifts to work in the ER?

im hoping that i can work at the st. jude hospital because it's in my city and i know that they have a great reputation in serving their community

imastudent · Apr 9, 2005

Dixielee have you ever considered working somewhere else other than ER?

suzanne4, RN · Apr 9, 2005

what is a RNFA? and what are physician assistants compared to? NPs?
also what is a per diem nurse?

Registered Nurse First Assistant...........I answered your other post the other night completely about this. It stands for Registered Nurse First Assisitant.

Physician's Assistant functions under the license of a physician. There are certified, not licensed. A Nurse Practitioner functions under her/his own license. Their responsibilities can be similar in some states, in others different. In some, an NP can actually open their own office and have their own patients.

I don't mean to sound harsh, but you need to try different things to see what you like, not what others prefer. You will only be happy doing what you prefer. Each person has different likes and dislikes. If you prefer, try shadowing a nurse in a couple fo different areas, but you may change where you end up working several times. Only experience will make the difference for you. But don't try to decide now what you want to do when you finish, things can change drastically. Just keep your ears and eyes open to everything.

Per diem nurse, just means that means an nurse that works when they want to, they may not have a set schedule. Usually get paid more because their shifts are not guaranteed, can get cancelled that day, and they do not get benefits. Again, this is something that you need experience for. You would just work in the area where you have experience. Similar to a "daily" travel nurse but without the travel perks.

imastudent · Apr 9, 2005

Registered Nurse First Assistant...........I answered your other post the other night completely about this. It stands for Registered Nurse First Assisitant.
Physician's Assistant functions under the license of a physician. There are certified, not licensed. A Nurse Practitioner functions under her/his own license. Their responsibilities can be similar in some states, in others different. In some, an NP can actually open their own office and have their own patients.
I don't mean to sound harsh, but you need to try different things to see what you like, not what others prefer. You will only be happy doing what you prefer. Each person has different likes and dislikes. If you prefer, try shadowing a nurse in a couple fo different areas, but you may change where you end up working several times. Only experience will make the difference for you. But don't try to decide now what you want to do when you finish, things can change drastically. Just keep your ears and eyes open to everything.
Per diem nurse, just means that means an nurse that works when they want to, they may not have a set schedule. Usually get paid more because their shifts are not guaranteed, can get cancelled that day, and they do not get benefits. Again, this is something that you need experience for. You would just work in the area where you have experience. Similar to a "daily" travel nurse but without the travel perks.

why would a person choose to be a PA over a NP and vice versa? ive often read that physicians are looking for a "physician assistant OR a nurse practitioner" to offer them jobs. this makes me think that they are very similar to each other. im not interested in setting my own practice at all so i wouldnt care if i dont have my own license. what's important to me is what differenciates them from each other in what they do and how they assist their physicians. i also want to know if both PAs and NPs work in the same settings. PAs are NOT NURSES right? and they have separate educational systems?