Curious About ER Nursing

ChristineN, BSN, RN · Sep 30, 2013

ER is vastly different from med-surg, as you stated. What appeals to you about ER? I would suggest you see if you can see if you can spend a day observing in an ER and see what you think. Try to go into an observation day with an open mind

rnblack4 · Sep 30, 2013

I think the variety and excitement of it. It's a different pace. I feel like the floor gets to be monotonous. I want to explore other options. We have a float pool nurse that comes up to GSU a lot and she loves ER over the floors because it's that different pace. We are the #1 Trauma Center for our area, so we see a vast range of patients. My uncle is a paramedic in Colorado and all of the stories that he tells me sound so exciting. I can be a bit of an adrenaline junkie. :)

I'm just afraid that I don't have enough experience for them to offer me the job. I have been a nurse for only 1 year and 3 months. Plus, I don't know if I'm as marketable as I don't have ACLS or PALS yet. We can work on that after accepting the position, but I know it would look better. It's not as though I'm transferring from a tele unit or ICU. At least I would be coming from GSU....we see so much there. We are the only floor the trauma docs want there patients on, so we do see our share of trauma patients.

I haven't asked if they would do an observation day. I could definitely find out. I wanted other nurses' perspectives though. I know every place in the hospital has there pros and cons, I just was wondering what other people thoughts were about there own ER.

DavidDudley · Oct 14, 2013

Every ER is different but as far as my ER goes, here are my pros and cons:

Pros:

1. Fast pace 2. something brand new and fresh all the time 3. knowing that even though u may have the worst patient ever, their gunna be sent up to the floor soon, 4. able to utilize so many great and fun nursing skills, 5. no need to call MD cuz MD is always there, 6. no need for tedious long narcotic counts before and after shifts, 7. having the team of ER nurses to reinforce you if you get a critical patient

Cons:

1. morbidly obese patient whos in a-fib, sob with minimal exertion, and refuses a catheter and MD has ordered IV lasix = NIGHTMARE. 2. patients who have a constant need for something and never is happy, especially the ones that ask for 10 different things at the same time and expect u to provide it all at once, 3. no cna support, 4. MD always present (while I quoted this as a positive, it is ALSO a negative because if the MD on shift makes you miserable then your shift will be miserable), 5. when ER is impacted and charge and triage nurses are filling up your beds IMMEDIATELY upon any of your discharges

Overall I love my job, I've only had 2 days where I absolutely hated it and wanted to quit. Aside from that, it's been my best nursing job.

maverickemt · Oct 18, 2013

Dear ED/ER nurses,

My name is Sachin. I am currently an Active Duty RN (BSN) working in San Antonio, Texas. I plan to separate within the next year. I would love to step inside an ER/ED after I separate. However, I have no formal ER/ED training. I welcome any suggestions for me to get into an ER/ED. Thank you. Sincerely, Sachin

TrevyRN, BSN, RN · Oct 18, 2013

I am very happy in the ER and I knew I would. I'm thick-skinned, an adrenaline junkie, a people watcher. I also love surprises. Helps to have a sense of humor, too.

I have only worked in the ER in a semi-rural Level 3 trauma center since graduating, so I might not have the most legit perspective :-) . I'm going on 8 months of work in the ED now. I don't think I'd want to do any other kind of nursing!

Some things could be pros or cons depending on what you personally find annoying or exciting. For instance, I love the variety of patients we get (psych, geriatric, infants, peds, gyn, medical, post surgical, traumas, prisoners, etc). Some people wouldn't like that and would want to specialize (i.e. L and D, neonatal, whatever population they feel passionate about or drawn to).

Like one of the previous posters mentioned, having the MD there can be great or horrible, depending on the doc. We're blessed at our hospital to have awesome, team-oriented docs. But, wow, if one of them is in a mood - gonna be a tough night. I think it's a tremendous advantage to have them then and there because docs can be a-holes or angels over the phone when you call them. I'd rather have someone look me in the eye and be an a-hole, LOL.

I generally like to be kept busy and like a fast paced environment. Occasionally, around 4 to 5 in the morning, things can get a little slow on our unit. That makes me a lot more frustrated than when things are going fast-out of control. When I'm busy, the shift goes by fast. Sometimes I don't pee or eat. That's probably a bad thing, but again, I like to be kept busy!

One thing that some of the floor nursing and home health nurses have told me they struggled with is getting a patient that you don't know a baseline for. You have no rapport with them and sometimes no history or info and are expected to assess them and fast. Is this geriatric altered LOC pt always alert to self only, or did this just happen? Sometimes, you don't know. Is this patient that's unconscious a DNR or not? I personally don't mind this, and love that I don't have patients for long periods of time. My favorite is when an L and D pt comes in and the triage nurse wheels them down the hall to the L and D department. THANK.... GOD. But, like I said, if that's your cup of tea, you're missing out on the messy miracle of life... .

One person from surgery came to work in the ER and was quite skilled and performed really well, got along with everyone, then quit. Said he didn't like "the unknown". Missed being able to look at a schedule, a history and physical, and a more controlled environment. You never know what will roll or walk through the ED door. Then again, sometimes you do :-)

There is always that drug seeker that comes in by ambulance every other day with "chest pain" at 3 am... both a relief because you know they won't die, and a curse because you're tired of their lies and them taking up beds for pt's with kidney stones suffering in the waiting room.

Shadowing a few different ED nurses would be a great idea. And if possible, maybe in different hospitals since every ED is different. Does your ED have trauma, neuro, cardiac, is it level 1 or level 4...? They'll all have different feels.

Someone listed no CNA support as a negative, but we have excellent ER techs that work on our unit. The other nurses are always willing to lend a hand if they can spare a moment - we have each other's backs. Really nice where I'm at. There are frequently CT techs, x ray, respiratory, lab, and even family members to help out at times as well. It's mostly on you though.

You get critical patients, but at least they are on monitors!

All the people on drugs can be annoying or dangerous but they make for great stories and sources of entertainment. I have had people spit on me and hit me though. Not cool. Then again, some people work psych or prisons or in Alzheimer homes every day.

Some pretty smelly people come in. I've had patients with maggots on them, cockroaches in the purse, and ... fleas. But you get to send that smelly person home, to the floor, the ICU, or sometimes even in a helicopter to go somewhere else. YAY! 12 hours of the same smelly person - not for me.

Those are my pros and cons :-p

hope it helps and good luck!

PS. if you like variety or get bored, you could always be a float nurse or something later.

DavidDudley · Oct 18, 2013

Someone listed no CNA support as a negative, but we have excellent ER techs that work on our unit. The other nurses are always willing to lend a hand if they can spare a moment - we have each other's backs. Really nice where I'm at. There are frequently CT techs, x ray, respiratory, lab, and even family members to help out at times as well. It's mostly on you though.

Yes we have ER techs to help but in most cases they are mainly doing EKG's, transporting patient's upstairs, updating vitals, or answering the telephone. When your really busy then it helps to have someone help with the little things that can hold you down like having most of the patient's on your run frequently asking to be walked to the bathroom or commode, frequently asking for food, having you make calls for them, as well as the total care patient that defecates on himself every 20 minutes. It all adds up and puts you behind in your run.

TrevyRN, BSN, RN · Oct 18, 2013

AGHH those vagal-out poop themselves diarrhea patients! would they quit feeding grammy so many laxatives at the home and then shippin them to us? LOL

It's true it mostly falls back on us as RNs, but I'm mostly saying that at least there is someone at all. If I have to, I can delegate to them and they'll help out with code browns, so long as we make sure one of us is manning the phones and ordering stuff for physicians at the station while we chart. It is usually us doing most of the pt care but they really are awesome techs.

It all comes down to your ER's flow, staffing, scopes of practice of different staff, etc.

And bedpans and lots of blue pads under people's butts... very important. They're a poor substitute for a CNA LOL... but they're something.

hhmmm.... *getting too ADD to post effectively*

AvaRN22, MSN, RN · Jul 20, 2014

I am currently a perinatal RN, but I've always been drawn to ER. I love the knowledge and skill-set that may come with ER experience; broad enough to be useful in almost every environment throughout the world. At least that's the impression I get.

I got half-way through TrevyRN's post, then I just stopped in my tracks when I read that he/she doesn't pee or eat during the shift. And then my heart dropped. I remember that there were ER nurses back in nursing school who would say things like "sometimes you don't have time to chew" so she would have meal shakes instead of real food.

I went into nursing to support the health, wellness, and safety of my patients and my community....not to set myself up to be a future patient due to radically unhealthy working conditions where you can't even address fundamental physiological needs. I understand that ER is fast-paced, but I hope that I can still be good to my body if I do decide to which to this specality this year.

I am very happy in the ER and I knew I would. I'm thick-skinned, an adrenaline junkie, a people watcher. I also love surprises. Helps to have a sense of humor, too.
I have only worked in the ER in a semi-rural Level 3 trauma center since graduating, so I might not have the most legit perspective :-) . I'm going on 8 months of work in the ED now. I don't think I'd want to do any other kind of nursing!
Some things could be pros or cons depending on what you personally find annoying or exciting. For instance, I love the variety of patients we get (psych, geriatric, infants, peds, gyn, medical, post surgical, traumas, prisoners, etc). Some people wouldn't like that and would want to specialize (i.e. L and D, neonatal, whatever population they feel passionate about or drawn to).
Like one of the previous posters mentioned, having the MD there can be great or horrible, depending on the doc. We're blessed at our hospital to have awesome, team-oriented docs. But, wow, if one of them is in a mood - gonna be a tough night. I think it's a tremendous advantage to have them then and there because docs can be a-holes or angels over the phone when you call them. I'd rather have someone look me in the eye and be an a-hole, LOL.
I generally like to be kept busy and like a fast paced environment. Occasionally, around 4 to 5 in the morning, things can get a little slow on our unit. That makes me a lot more frustrated than when things are going fast-out of control. When I'm busy, the shift goes by fast. Sometimes I don't pee or eat. That's probably a bad thing, but again, I like to be kept busy!
One thing that some of the floor nursing and home health nurses have told me they struggled with is getting a patient that you don't know a baseline for. You have no rapport with them and sometimes no history or info and are expected to assess them and fast. Is this geriatric altered LOC pt always alert to self only, or did this just happen? Sometimes, you don't know. Is this patient that's unconscious a DNR or not? I personally don't mind this, and love that I don't have patients for long periods of time. My favorite is when an L and D pt comes in and the triage nurse wheels them down the hall to the L and D department. THANK.... GOD. But, like I said, if that's your cup of tea, you're missing out on the messy miracle of life... .
One person from surgery came to work in the ER and was quite skilled and performed really well, got along with everyone, then quit. Said he didn't like "the unknown". Missed being able to look at a schedule, a history and physical, and a more controlled environment. You never know what will roll or walk through the ED door. Then again, sometimes you do :-)
There is always that drug seeker that comes in by ambulance every other day with "chest pain" at 3 am... both a relief because you know they won't die, and a curse because you're tired of their lies and them taking up beds for pt's with kidney stones suffering in the waiting room.
Shadowing a few different ED nurses would be a great idea. And if possible, maybe in different hospitals since every ED is different. Does your ED have trauma, neuro, cardiac, is it level 1 or level 4...? They'll all have different feels.
Someone listed no CNA support as a negative, but we have excellent ER techs that work on our unit. The other nurses are always willing to lend a hand if they can spare a moment - we have each other's backs. Really nice where I'm at. There are frequently CT techs, x ray, respiratory, lab, and even family members to help out at times as well. It's mostly on you though.
You get critical patients, but at least they are on monitors!
All the people on drugs can be annoying or dangerous but they make for great stories and sources of entertainment. I have had people spit on me and hit me though. Not cool. Then again, some people work psych or prisons or in Alzheimer homes every day.
Some pretty smelly people come in. I've had patients with maggots on them, cockroaches in the purse, and ... fleas. But you get to send that smelly person home, to the floor, the ICU, or sometimes even in a helicopter to go somewhere else. YAY! 12 hours of the same smelly person - not for me.
Those are my pros and cons :-p
hope it helps and good luck!
PS. if you like variety or get bored, you could always be a float nurse or something later.

ChristineN, BSN, RN · Jul 20, 2014

I am currently a perinatal RN, but I've always been drawn to ER. I love the knowledge and skill-set that may come with ER experience; broad enough to be useful in almost every environment throughout the world. At least that's the impression I get.
I got half-way through TrevyRN's post, then I just stopped in my tracks when I read that he/she doesn't pee or eat during the shift. And then my heart dropped. I remember that there were ER nurses back in nursing school who would say things like "sometimes you don't have time to chew" so she would have meal shakes instead of real food.
I went into nursing to support the health, wellness, and safety of my patients and my community....not to set myself up to be a future patient due to radically unhealthy working conditions where you can't even address fundamental physiological needs. I understand that ER is fast-paced, but I hope that I can still be good to my body if I do decide to which to this specality this year.

I work in an ER and I eat every day. It is practically an expectation that everyone gets their break. Some of our nurses are also breastfeeding and they find time to pump 2-3 times a shift. And these things don't work because we have lots of downtime, we keep our unit full most days

laKrugRN · Jul 20, 2014

During my internship, I was on Med/Surg but when it was dead I would float to ER. Loved it! Fast paced at times and you never knew what was coming in. I really enjoyed it.

Guests · Jul 20, 2014

I was wondering what people find are pros and cons to working in ER? Are you happy there? I know ER nursing is VASTLY different from floor nursing. I guess I'm still trying to find my niche in nursing. One where I'll be happier to be at work.

Pros:

1) Time-limited encounters... The structure of the ED is geared toward disposition... up or out... either way, they're not mine anymore.

2) No primary nursing... OMG, having to work with the same patient(s) day after day would drive me batty... and I'm certain my schtick would wear thin after awhile.

3) Skills... You'll never get better with a needle than in the ED... lines for everyone... Foleys, NGs... often... wound care, check... ventilators, check... drips, check... central lines and arterial lines, check... A little bit of everything and a whole lot of some things...

4) Proximity... My rooms are all with about 30 feet of my workstation...

5) Back-up... If need be, I can have 3 nurses and 3 docs at my side within less than a minute... (though in my earlier positions, it was just me... rural EDs can be lonely, scary places... but you learn self-sufficiency)

6) Lots 'o cops... Cops around regularly... makes it a bit safer and can get you out of tix...

7) Interesting... There's a reason why TV shows center on the ED... it can be an action-packed place with lots of interesting characters... patients and staff...

8) Docs... we work closely with our docs and develop collegial relationships... learn a lot and get to know some very interesting folks

9) Job security / career security... Not too many people like the ED or can hang in the ED... turnover is regular so you build seniority quickly... and we staff to potential, not census... no call-offs... Look at any hospital... the most regular job openings are in the ED...

10) OT... they can always use the help... if you're into OT, the ED is the place you'll find it...

11) Prepared... Pretty well equipped with the knowledge to handle most anything that can befall a person...

12) No bedbaths... rare oral care... and even the pericare is somewhat limited compared to the floor...

Cons:

1) Violence... ED can be a pretty sketchy place... most of us have stories of threats and assaults of various types...

2) Burn out... if you're a gentle soul, the ED can eat you alive... lots of drama, lots of tragedy... if you can't laugh at it or slough it off, it can tear you up

3) Death and destruction... More than our share of grieving families... that were intact just hours before and are now torn asunder... often the first ones to tell someone that they're paralyzed or that their kid's brain has been severely damaged...

4) Exposure... in the midst of trauma codes and CPR, bodily fluids can be flying and sharps are out on all sides... I've seen a few sticks and had a couple of close calls...

5) Staff... some pretty aggressive types tend to congregate in the ED... can be intimidating

6) ICUs... for some reason, a subset of the ICU nurses are regularly and predictably rude to the ED nurses... can be tiresome delivering a patient into their midst... now that said, some of the nurses on the units are fantastic to interact with.

7) Psych holds and intoxicated patients can be very trying... and dangerous...

8) Can be difficult when boarding patients because we're not equipped and supplied as are the floors and units.

9) Tweakers and drunks...

+++++

I dig ED nursing... it's a kick in the pants, the hours fly by, the money's good, and you end up with enough stories to hold your own with the cops / firefighters / medics at the barbeques...

And you develop a bomb-proof gut that can swill coffee and chow on chili in the midst of some sights/sounds/smells that would have left you retching before.

And you get to know the back stories that you don't read in the newspaper...

ED nursing rocks...