Do you have to be tough to work in ED?

JuLeSx7d7 · Jun 28, 2012

I caught this post as I was searching for something else, LoL!! I've been in emergency medicine for the greater part of my adult career. EMT -> Medic -> RN.

(and even though I don't have the 30-99 years + in ER like some people on here) I can very much give you an unbiased and non-burned out opinion on ER and emergency medicine...

Yes it is fast paced, yes multiple patients will need you at once and you'll need to say no to some while attending others. Different EDs will have their different pt populations. Some super acute, most simply primary care and fast track. Contrary to what you may have heard you do not have to be bossy but assertive. You do have to be mean and rude but do stand your ground. This is a field where a team approach is more common than "island nursing" if you get my drift.

This is coming from a guy while super introverted outside of work (like the kind that sits next to a cute girl in school but doesn't say a word the whole semester) to one that is super assertive at work and delegates what he needs to be done by resources available to him.

If you have the drive and heart to deal with the overwhelming feelings of anxiety and drowning from patient load then you will fly with flying colors. Trust me...if I can be an ER nurse AND love my job after years and years in the field than you can too.

Cheers!!

al7139, ASN, RN · Jun 28, 2012

We have all kinds in my ED, from outspoken to quiet. I dont think it really matters if the Doctors respect you, BUT you better be able to be loud if a patient needs to be seen immediately or if a patient is "heading south". NICU will help with peds, but I got a good cardiac background before I went to ED.

happyinillinois · Jun 28, 2012

Yes. If you are not assertive, you will be run over by those who are. It is so fast paced, that no one will notice you drowning, you need to speak up! If you are polite and wait your turn,it will never happen. You must advocate for yourself and patients.

whichone'spink, BSN, RN · Jun 28, 2012

Yes, and be prepared to get stabbed in the back by those who perceive you as "weak". They'll kill you. It's not worth it to get a job in the ED unless you feel confident you can be as vicious as the top alpha nurses in the ED.

sujikalai75 · Jun 28, 2012

esp with seniors....they are the persons who dig our mistakes & turn it into a golden pathway.really its hard to adjust but there s no way...

shoegalRN, RN · Jun 28, 2012

You have to be assertive if working the ED. You have to be able to speak up when you are drowning and when you feel your patient is crumping.

You can be assertive and be cordial at the same time. You don't have to bossy, but you have to know when to stand your ground, either with co-workers, patients, or family members.

brainkandy87 · Jun 28, 2012

The ED doesn't require you to be "mean," but you certainly can't be passive. If you are passive, you will have patients, nurses, and doctors walk all over you. You can't be afraid to stand up to anyone, whether it's the 6'5" 400 lbs drunk guy or the 4'8" 80 lbs, 30 year experienced ER nurse that likes to chew up young nurses. Be confident in what you do, but know what you're doing. If you don't know, go ask. :)

CherylRNBSN · Jun 28, 2012

You need to be at least somewhat assertive, and capable of being just plain assertive, to work in ANY intense, fast paced environment where lives are at stake. But you have been working in NICU, so I assume you already have that capacity to some degree.

While I have logged many bedside hours caring for very sick and dying and coding pts., I know the following about ME:

I don't like sick/dying children! I simply get way too emotional. Adults don't bother me nearly as much. But a sick kid....Oy. I just might cry. (Not good to do very often. That's just my weakness. So I AVOID that population! I would never work in ER b/c of that. Or peds.)

Also, I don't particularly like fresh trauma! Some people L.O.V.E. love that, thrive on it. We are all different. I personally love adult critical care. Function very well there, love the fast paced environment and challenges. I like sick patients, except as outlined above.

I think the only was you'll know is to dip your toe in. It will soon become apparent! Could you ask to float or shadow in the ER?

It sounds like the interest is there, so I am thinking you might LIKE it.

Maybe the only thing you would need is a good preceptorship to build your confidence. Good luck! And remember, if it's not a good fit, you can always return to NICU. Don't be afraid to try. You just might find "your spot."

NO50FRANNY · Jul 1, 2012

I don't necessarily think you need to be tough to work in the Emergency department, but you have to have the capacity to develop a healthy backbone, and know when to stick up for yourself or your pt., and VERY often, your fellow nurses/doctors. I was a relative doormat when I started and have developed a reasonably impenetrable spine over the years. I think working in Emergency has done wonders for my personality, taught me to speak up, engage and diffuse rather than avoid confrontation, taught me what a real team environment is like, helped me have faith in my (and others') skills and how to deal with my propensity to panic. I remember a colleague giggling at me when I told a patient's relative to back off or I would have him removed from the premises for obstructing care. She said that I was this lovely, sweet little oncology nurse 6 months before and had officially evolved. You will surprise yourself. When I think about it, the Emergency physicians who command the most respect are very softly spoken, extremely calm and very diplomatic, they let their obvious brains do the talking. The ED is no different from any other area in terms of BIG personalities, but critical care tends to attract a few more I guess. I am never bossy, my requests always end with "please", and I never raise my voice. If you focus on providing excellent care for your patients, work hard and play well with others the rest will just come naturally.

sauconyrunner · Jul 1, 2012

I worked with a super quiet nurse. She had a hard time and people felt that she was ineffective. She was a good nurse, but she was completely unable to handle patients when they were upset, angry or aggressive (which happens, you know, more than once a day in an ED.) It was not that she was quiet, it was that she just could not deal with the types of patients personalities that litter our area. Lots of less noisy people can handle those conflicts extremely well...but she did not and it made her job somewhat unpleasant.

But here's the thing, you should go down to your ED and shadow for a day or two. You'll get an eyeful and have a great idea if this is something you want to try or not. It is, like the NICU (I think), really a different type of nursing from the reast of the hospital. And very good luck to you!