Bored in the ER?

Dixielee, BSN, RN · Jan 30, 2012

I am a recovering ICU nurse who found her niche in ER years ago! I started my career in a small ED, went to ICU but always worked PRN in ED even while working ICU at a large teaching hospital. There are a lot of differences in the two disciplines and don't let anyone tell you differently! In ICU you are concerned about patient urine output to the cc. In ER you are just happy if your patient has any urine at all :)

If you are a neat freak, you will not survive ER. I knew ICU nurses who would put white tape on a sheet if it had a spot of blood on it, has to label each IV line in 4 places, could not allow any wrinkles in a sheet or hair out of place on a ventilated patient. As others have said ER is controlled chaos, and sometimes not so controlled.

Yes, you will have very sick patients who require a lot of immediate attention, lots of procedures, titration of drips, etc. but the bulk of your patients will not be truly emergent or life threatening cases.

But I will guarantee you will never be bored! All of my good stories come from my ER experiences. Certainly all of my funny ones do! You will learn to shake your head and roll your eyes at some of the things people will say and some of the reasons for coming to the ED. You will learn there are places to put foreign bodies you never considered. You will see the very best and the very worst of society.

You will learn to bite your tongue when people ask you this dumbest question like..."I found a tick on my son's shoe, should I bring him in?" Your first response will be, "The tick??" because the shoe surely can survive a tick!

You will see things that break your heart and things that warm your heart.

Busy? YES!! Crazy and frustrated?? YES!! So dead tired you don't think you can get out of your car once you get home?? YEP!! Bored? NEVER!!

Good luck to you :)

mybrowneyedgirl, BSN, RN · Feb 1, 2012

Also, your ED might allow you to request to be in a certain area. I prefer trauma and am often scheduled there . Other nurses avoid it so if I'm not scheduled there, I can usually trade with them to get the area I prefer... as long as the charge nurse approves the switch.

DebanamRN, MSN, RN · Feb 2, 2012

I have never been bored. I've been a lot of other things, but not bored. I have tried working in other areas but ED is in my blood. Once you get bitten by the ED bug its hard to go back.

Pneumothorax, BSN, RN · Feb 2, 2012

you wont get bored.

there are days u will run your cheeks off and after 12hrs still wide awake because it was a good night, or you will have days where u wish u got more than 4hrs of sleep and had more than 16oz of coffee to drink because call lights, and the flow of patients have been steady and constant.

i can count one night that it wasnt "busy/crazy" as some people say and it was a tuesday night, and snowing heavily outside. coincidence? maybe lol

CrashED · Feb 6, 2012

Believe me you won't get bored! I Went to the ED for the same reason, I was bored, I needed a change of scenery!!! I was working on a physicially busy floor...but it was not mentally stimulating. The patients were all pretty predictable and the post op complications were all the same risks. It was the busiest boring place I had ever worked!LOL We were always short staffed, the nurse patient ratio was unsafe, and I had really stopped learning because there was not very much new going on. A wound dehis is a wound dehis, and a PE is a PE post op! Alot of my coworkers claimed I was jumping from the frying pan into the fire when I told them I was going to emerg!

Now I am a Nurse in a Level1 center. I LOVE IT! A day doesn't go buy that I don't learn something new!The ED is a nice mix of diversity! You can have a Seizure in bed 1, sore throat in bed 2 and a cardiac arrest underway in bed 3! Its controlled chaos. There are some days that you see alot of the same things, its not too busy and then the next day you barely have time to chart, but that is what keeps it interesting! You are a jack of all trade in emerg, and just when you think its a quiet shift, and you are gonna sit down and drink your cup of tea, the ambulance radio patches a call for a Cardiac Arrest 2 min out!! The fun never stops!

NO50FRANNY · Feb 6, 2012

I just had my first day back after some leave and hey sister, you are at triage today- quite possibly the most dynamic, interesting brain excercising spot in the ED for me anyway. Constant use of your skills, knowledge and training- approximately every 90 seconds depending how quickly you can triage a patient. Diagnose from 3-30 feet. The great thing about emergency is that we have an immediate effect on our patients. Immediately ease pain, investigate, reassure, educate, resuscitate. To sum up yesterday, I had cuddles from a patients' mother (in tears) because I actually "listened" to their whole story (I must have been outwardly empathetic), Thanks from dude just discharged from detox for giving him a list of bulk-billing doctors, "Wow, you guys are great!" from the dude with the flu / sore throat who I gave some aspirin/codeine who decided not to wait for a doctor because he felt so much better (sent home with a handwritten list of local pharmacies and how to manage his symptoms), this all amongst triaging a full blown anaphylaxis, 60% burns I+V, A walk in category 1 MI with ecg from his general practitioner (still unsure why doc didn't send him in an ambulance but I don't even ask anymore), a woman whose partner tried to choke her with a rag soaked in battery acid (she walked in too) she ended up intubated, a man who looked terrible who felt (and looked) like he was going to collapse whose local doctor listed a previous unexplained VF arrest just a few months previously, he walked in too although Im not sure how! Not to mention the obligatory choppers and mangled people. I gave my own cuddles too, to the lady who was miscarrying and tearfully attempting to answer my questions while I took her to a nicer nurse than me to look after her, the boy who had a fever but only had his bone marrow transplant 8 weeks ago, who didnt want to tell me anything and could barely get the words out because he knew he was going to have to be admitted to hospital, again, he got a cuddle too. I don't honestly think you could ever be bored. I triaged over a hundred patients yesterday, your ICU knowledge will really, immediately, help literally hundreds of people a week, if you want to......

DebanamRN, MSN, RN · Feb 7, 2012

I agree with NO50Franny - I spent 12 hours in external triage the other day and you have to be able to think on your feet. Its never boring. From the patient with ICP who wound up transferred to the trauma center down to the snaggle-toothed folks who reek so badly of cigarettes you can barely sit there in front of them let alone look into their mouths, and the assorted kids with high temps who didn't get fever reducers ("I wanted you to see the temp" "ok next time give the tylenol, I'll believe you on the temp") where you are medicating in triage, to the patient seizing on the floor in front of you, to the chest pains, TIAs, and some stuff that makes you go huh? you will never have a boring day. Not to mention the patients with medical complaints who wind up going to the psych hospital (psychosomatic c/o anyone?) the ER is never a boring place.

CoolhandHutch, MSN, RN · Feb 7, 2012

The one thing you need to remember that when you get a patient into the ICU the "groundwork" is usually done...line, labs, tubed, drips. Usually. If you are really fortunate, you might even have a patient in a gown. Pants might be on still even though there's a new foley in place.

I digress.

The fun part comes from separating the crap from the crump. Is that routine sore throat a peritonsillar abscess or epiglottis? What about that old lady who just feels "really weak" that has a unhemolyzed K+ of 9.7?

You won't be bored.