Bored in the ER?

sapphire18 · Jan 29, 2012

I hope nobody takes offense to this question, either, obviously I know that you also get very very sick patients, just not really sure what the ratio is (SICK to not so sick), if it depends more on hospital or section of the ER, etc. Thanks! :)

FlyingScot, RN · Jan 29, 2012

Believe me, you won't get bored. You will be running your orifice off taking care of all those non-urgent patients while trying to also care for the ones who are actually sick while being told that there are 70 more sitting in the waiting room waiting for a bed to open up. The last thing that you will be is bored.

VICEDRN, BSN, RN · Jan 30, 2012

It seems there are those that transfer from ICU to Er that get a derisive attitude towards the urgent care/primary care patients and that will depend entirely on how you view these patients and the applicable skills.

For whatever its worth, I too like working with sick people and helping to save lives. When I am asked to work with urgent care patients, I focus on building skills like giving discharge instructions that help patients cut down on re-visits (when to come back?) and helping patients find access to the medications they have been prescribed (Its free at Publix).

I also remind myself that many of these skills are more useful in day to day to life. I can identify a suturable versus gluable laceration, splint a broken limb, speak somewhat intelligently about different cold and flu remedies, identify a pneumonia from a bronchitis from a cough and a few symptoms and offer real advice about stomach bugs and girl problems. In general, its a useful skill. Its just how you choose to look at it.

Its also nice to take a break from the death and dying business and meet some people with problems we can all identify with.

Further, if you spend a minute talking to these folks, you will often learn about the real problems of real people trying to get day to day health care. Its fascinating to me.

And oh! busting your tail feathers will keep you from becoming bored. Trust us; they want those beds turning over!! Sometimes its hard to keep up!

brainkandy87 · Jan 30, 2012

I don't think I could ever be bored in the ER. At the very least, I'll never be as bored as I was on the floor. There's always interesting stuff, even with the primary/urgent care stuff. I'll give you an example:

Had a 27 y/o female pt come in today just complaining of a headache. When we get her in a room and start to assess her, she mentions she has some mild pain that extends from her lady parts to her right flank. Well long story short, she ended up with an intrallady partsl ultrasound and a pelvic exam. During the pelvic exam, she lifted five feet off the table and crying in pain when the doc was checking her cervix. I left before any of the labs from the pelvic or ultrasound report came back, so I never got to find out what exactly was up. However, this shows you that even the "routine" stuff can become wayyy more in a hurry.

akulahawkRN, ADN, RN, EMT-P · Jan 30, 2012

Bored in the ED? I doubt it. You won't have time to be bored. Just remember that the ED isn't the ICU and most of your patients will be of the not-so-sick variety. Accordingly, you'll have more patients than you're used to having at any one time. Right now you're probably doing a 1:1 or 1:2 nurse to patient ratio. Take that and throw in 3 or 4 more Med/Surg care level patients on top of your load...

You won't be using your ICU knowledge as often as you do now (daily), but you probably won't get all that far from it either. Also, comparatively speaking, the ED will probably be a LOT less "organized", but there will be a flow in all that chaos.

Why not try floating to the ED to see what it's like, if the option is available to you?

While I'm not a nurse yet, I do have at least some knowledge of the work load. I defer to the more experienced ED RN's for the specifics of their daily life...

ge104042 · Jan 30, 2012

Boring as opposed to what? hourly I&O, Q 15 min V/S, Vasoactive drug titration? on occasion code a patient? As a former ICU nurse I realized that ICU was to a certain extent was a controled environment, we had standing orders for almost everything. At least thats how it was where I came from. I must admit however, I miss playing with the pulmonary artery catheter, calling the doctor to break the news that the SVR has gotten too high and need to unload the patient, ETC.

ER environment IMHO is controlled chaos, I say controlled because you can control the way you would react and will no way control the potential chaotic environment. And you will sail thru it with your ICU experience.

Esme12, ASN, BSN, RN · Jan 30, 2012

It seems there are those that transfer from ICU to Er that get a derisive attitude towards the urgent care/primary care patients and that will depend entirely on how you view these patients and the applicable skills.

For whatever its worth, I too like working with sick people and helping to save lives. When I am asked to work with urgent care patients, I focus on building skills like giving discharge instructions that help patients cut down on re-visits (when to come back?) and helping patients find access to the medications they have been prescribed (Its free at Publix).

I also remind myself that many of these skills are more useful in day to day to life. I can identify a suturable versus gluable laceration, splint a broken limb, speak somewhat intelligently about different cold and flu remedies, identify a pneumonia from a bronchitis from a cough and a few symptoms and offer real advice about stomach bugs and girl problems. In general, its a useful skill. Its just how you choose to look at it.

Its also nice to take a break from the death and dying business and meet some people with problems we can all identify with.

Further, if you spend a minute talking to these folks, you will often learn about the real problems of real people trying to get day to day health care. Its fascinating to me.

And oh! busting your tail feathers will keep you from becoming bored. Trust us; they want those beds turning over!! Sometimes its hard to keep up![/QUOTE]
As an admitted adrenaline junky who LOVES the sickest of the sick.......VERY WELL SAID! But I am also an AVID people watcher. My favourite part has always been the "New parent syndrome" and the baby "won't stop ". These poor exhausted parents come in overwhelmed and leave with a new found confidence.........and they are VERY thankful for your help.
WELL SAID!!!!!

sapphire18 · Jan 30, 2012

Thanks everyone for all the responses! I have floated to our ER and volunteered, and then worked in one during school. Seems that all the excitement happens either when I'm not there, or a different section of the ER! Lol. So I'm not really sure if I have the most accurate feel for it at this point.

Esme12, ASN, BSN, RN · Jan 30, 2012

Thanks everyone for all the responses! I have floated to our ER and volunteered, and then worked in one during school. Seems that all the excitement happens either when I'm not there, or a different section of the ER! Lol. So I'm not really sure if I have the most accurate feel for it at this point.

You are only as bored as you lyour self to be......

hiddencatRN, BSN, RN · Jan 30, 2012

I think whether you'll find it boring depends on what you find exciting, does that make sense?

I can get pretty sick of the not-sick patients who come in, and nothing makes me question the intelligence and ability to survive a few more generations than a few days in a row in urgent care (seriously, with some of the things people come in for, how do they manage to function in the world??). But what I love about the ER is even when your patients are low acuity, there's a lot of stuff going on, things to do, throat swabs and urine cultures and teaching adults (grown adults) how to use thermometers. There's a constant shifting of priorities and focus even when no one is very sick that works well with my attention span. The times I am bored are the times that our ER is slow (weekends in the summer, early am in the spring and fall, almost never in the winter), not the times I have an assignment of low acuity patients.

If you love having that indepth knowledge of your very sick patient's every inner working, I could see how the ER might not be a great fit for you. The idea of one or two patients all shift that demand all my attention sounds just awful to me. The few times I've had a patient for the entire shift, either due to boarding or because the doctor I'm working with is slower than molasses in winter, have been frustrating experiences. I want them GONE and I want new patients. I think ICU would be boring to me, not because it's a boring unit, but because I do not have the attention span or patience to learn and know everything about a small number of patients.

As far as a balance between truly sick and not sick patients, in my ER a lot of that has to do with your assignment. Sicker patients tend to get put in certain areas, and we have one area reserved for urgent care so if you're in that assignment that is all you see that day. Even if you're working in an area with the sicker patients, most of our patients that get admitted go to a med-surg floor, so even though they are sick enough to stay in the hospital, they might not be as critically sick as you are used to in the ICU. And the patients who are truly sick enough to go to the ICU or a step down unit are rushed out of the ER pretty quickly- sometimes we only have them for 15-30 minutes before they are stable enough to go up to the ICU (with maybe a stop in CT on the way).

Footballnut · Jan 30, 2012

It's not boring when your not-so-sick patient in the fast track area tells the registration clerk their lips are tingling. Your choice? Decide if the patient is a little flakey or investigate further. Turns out this patient was having an allergic reaction and was immediately booted out of the fast track area.

The point is you have a different set of skills to decide how your patients are doing, not just the ones that are obviously crashing. You must stay on your toes even if the patient is "not-so-sick." There's nothing worse than being blindsided with something that you could have picked up on. Never boring, always changing.

I even get a kick out of wondering why someone would show up in a high-priced ED for general care. The answers vary and sometimes make a lot of sense. Inquiring minds are a good thing in the ED.