Emergency Nursing

PiperLambie, MSN, APRN · Mar 14, 2018

I am a new grad (December) RN that is currently working in the ED directly out of school, but I thought I'd chip in.

1. The ED where I work is almost always busy. We try to have a ratio of 4:1, though the unit goal (when it's not cold and flu season) is to get it down to 3:1. We are a stroke center and a chest pain center, but not rated for trauma. That said, we get the gamut of everything from upset stomach due to eating too many hot wings, stable MVA trauma, strokes, and active codes as the ambulance is pulling in. Because my unit is not specialized in any one area, it's a great chance to see lots of different disease processes.

2. I am on day shift (by some small combination of luck and serendipity), and the standard work week is three days (12x3=36), though there are usually additional hours available. Days worked can vary, and sometimes they are together, while other times, like this week, I am on Monday, Tuesday, and Saturday. Any time at a "desk" is spent quickly charting patients while moving between rooms. I average 4-6 miles of walking per shift, even with my four rooms immediately next to one another. It doesn't bother me because I purposely chose the ED for the combination of not being floated around to other units, as well as being busy enough to make the 12 hours go by quickly. Bottom line is that it is sometimes a grind, but always a hustle.

3. I left a previous career of 13 years in logistics management, attended a 15 month accelerated BSN program, and fully intend to continue my education. I passed my NCLEX last Wednesday and already have started studying resources to take my CEN exam in the near future. My plan has always been advanced practice and possibly teaching, but this was my compromise to medical school. While med school would have been great had I started that path in my 20's, it just seemed like too much to take on in my 30's. Not to mention, with a spouse that is a physician, her loans to become a physician are enough without taking on another $500k for me to also do that.

I enjoy my specialty and being a nurse greatly- otherwise I would not have paid in time, money, and effort to go back to school and do this! I still have tons to learn, but the great thing about nursing and medicine is that there is always something to learn, regardless of how long you've been in the business.

NuGuyNurse2b · Mar 17, 2018

I love ER nursing. There's good days and bad days but overall, but it's been my favorite area as opposed to the other areas I've dipped in. I've always wanted to do ER but as a new grad I couldn't break into it, so I did psych and then med surg for a year. Our area is saturated so getting what you want right out of the gate is not a given. I didn't care for psych, med surg I learned my basics in nursing but the whole system with bedside requirements and customer surveys...it was aggravating me. So ER it's a different story, you treat and either release or admit to inpatient and get them out asap.

CX_EDRN · Mar 19, 2018

1) I work in large (busy!) trauma center and like most EDs, no shift is the same. Which is why I love it so much. I do all the things really, from IVs and EKGs to CPR to managing pressors via ART lines.

2) We do 12s and it's all direct patient care although it does feel like I stare at a screen much more than I would like. It's a hard environment, our acuity is very high and sometimes I feel like I've been hit by a bus when I get home. Not only is it physically demanding, you also have to figure out how to deal with the emotional stuff. Ie, the kid you coded that didn't make it, etc.

3) Never in my life did I want to be a doctor. And I never considered the paramedic route, they don't get paid enough to put up with what they have to do.

There is a stereotype of ED RNs mostly for a reason, you have to have thick skin or you won't make it. And that thick skin is sometimes misinterpreted by other people. I love what I do, I think that those of us that stick around do it because others can't. Or won't. Or don't get it. And that's okay with me.

BassCatchingNurse · Mar 20, 2018

I just had a few quick questions about working as an emergency nurse:
1. What is it like working in emergency? What work do you do?

ER nursing is exciting, frustrating, fun, and exhausting. You never really know from minute to minute what you will get next. You will have gunshots, car collisions, heart attacks, strokes, respiratory distress, DKA, falls, fractures....and drug seekers, colds, flu, "my thumb has been hurting for 6 years," STDs, drug/alcohol abuse, "throwing up for an hour" and any other reason NOT to be in the ER. You get yelled at, cussed at, hit, bit, kicked, and spit on. You will be told "you are the worst nurse" and "you don't care" one minute and told "you are the best nurse" and "thank you for caring for my mom." Sometimes, the only thing separating the two above scenarios is a wall between rooms!!

We do...everything...save lives (and contemplate taking them at times!), CPR, cardiac gtts, insulin gtts, and gtts and gtts. We pass meds, do ekgs, IVs, vital signs, etc. We chart and chart and chart. We clean up urine soaked nursing home patients and clean up BM prn (we are still nurses)!! We triage patients to sort the true emergencies from the 95% that think they are having an emergency!! We laugh, we cry, we shake our heads, and move on.

2. What are your working conditions like? (e.g hours/days, do you work at a desk as well as seeing patients etc.).

12 hour shifts, varying days. We have a desk at the nursing station and we chart, but most my day is spent going room to room!! I rarely sit except at triage.

3. Why did you choose to do nursing over other healthcare jobs like a doctor or a paramedic?

Nursing has a LOT of variety. You can work 3 12 hour shifts and have 4 days off a week. Nursing jobs are everywhere. The money is great. When you clock out, you are done!! Nurses can have a lot of upward mobility, if one so chooses. The biggest for me was the variety of jobs. You can work bedside applying hands-on nursing, at a computer doing research, teaching, or work at home. You can work in an office, cruise ship, helicopter, clinic, hospital, patient's home, your home...the possibilities are endless!!

PeakRN · Mar 21, 2018

1. What is it like working in emergency? What work do you do?

Every day is different, things change constantly. We take care of patients who would have been best treated by their primary during a well visit, as well as those who are either dead or minutes from it. Most fall in between although most patients are on the less sick side.

Some nights I run around like a crazy person, maybe able to cram some food in my mouth while doing the bare minimum of charting; no lunch and I have to stay late an hour or two to finish up the charts on the codes or traumas we ran.

Some nights I get to watch several movies from beginning to end. We walk/lunge laps around the ED. We go up to the helipad or penthouse and admire the city.

I work in both an adult and a pediatric quaternary referral emergency department. When I'm not caring for patients in the ED I'm often resourcing in radiology sedating or emerging cases when PACU staff are busy or have to be called in but we need imaging immediately. I sometimes go up the ICU, PICU, or Peds floor to place lines, or up to OB to assist with massive transfusions.

At least is our system ED (and the ICUs/PICU) nurses get a lot of respect from the medical staff and our opinions hold real value. You have to know your stuff, but when we ask for interventions/meds/tests we get them.

2. What are your working conditions like? (e.g hours/days, do you work at a desk as well as seeing patients etc.).

Typically 12 hour shifts, I work predominantly at the bedside but I do outreach for EMS and our Trauma service. I could never sit in an office so even when I'm doing administrative stuff I do it nurses station so that I can help out the rest of the staff as needed.

3. Why did you choose to do nursing over other healthcare jobs like a doctor or a paramedic?

I used to work in a fire department that also ran our own ALS ambulance service. I wanted an increased scope of practice, increased autonomy, to be more respected as a health care professional, and to have the increased compensation to match it. I want to go advanced practice one day, either CRNA or PNP-AC, both of which require experience as a nurse before hand.

I considered medical school at one point but the length of school, residency, and fellowship for the specialties I would have been interested in would have lasted over a decade and I would have had a huge amount of debt to go with it. I also far prefer pediatrics over adult medicine and the money in peds is atrocious.

Mary3010 · Mar 21, 2018

PiperLambie:

That's great that you can work in ED straight out of your studies!!! Is that the same as the doctors? (The 4:1 ratio).

I didn't realise that different emergencies can specialise in a certain area (you said that you aren't rated for trauma). Additional hours for overtime? How often do you work on weekends?

Wow you would get so much exercise doing 4-6 miles per shift. I suppose working for 12 hours it just adds up. So do other nurses float between one ward to the next? (If they're not in emergency).

Congratulations on passing your exam! I was thinking of maybe doing something like that too. So nursing + teaching people nursing? I suppose you could become a doctor of nursing. Wow that's so expensive!!!!!

Thank you for your reply!!

Mary3010 · Mar 21, 2018

NuGuyNurse2b:

Thank you for your reply! I suppose there's good and bad to every job. Would the bad days mainly consist of patients dying?

What is med surgery like? I didn't realise that there were customer surveys. As far as bedside requirements go do you mean caring for patients for the long term as opposed to treating patients for a shorter time?

Mary3010 · Mar 21, 2018

CX-EdRn:

So do you work at a computer as well then?

It seems like 12 hours shifts as an emergency nurse are the norm then. I suppose you would feel really tired after so long of a shift! Like the stereotype of saving lives?

So do you have to code patients based on how urgent they are? Thank you for sharing!

Mary3010 · Mar 21, 2018

Bass catching nurse:

That would be pretty frustrating when people waste your time in emergency with non-emergency cases. Wow about 95% aren't true emergencies!

Oh wow that's real serious! Getting bitten, kicked at etc. by patients. It seems like it is is the norm for you. Gtts as in IV's? (sorry I don't have a medical background).

Do you mean when you sort patients according to triage you do that at your nursing station?

Wow I didn't even know you could do nursing in your home. So in comparison to a doctor they don't have as many choices because of their specialisations? Thank you so much!!

BassCatchingNurse · Mar 21, 2018

Bass catching nurse:
That would be pretty frustrating when people waste your time in emergency with non-emergency cases. Wow about 95% aren't true emergencies!
Oh wow that's real serious! Getting bitten, kicked at etc. by patients. It seems like it is is the norm for you. Gtts as in IV's? (sorry I don't have a medical background).
Do you mean when you sort patients according to triage you do that at your nursing station?
Wow I didn't even know you could do nursing in your home. So in comparison to a doctor they don't have as many choices because of their specialisations? Thank you so much!!

It's not as much about "wasting my time" since I have to be there whether it is an emergency or not. It is more about...if my time is spent with a non-emergent pt..that might be time away from an emergent patient. Beds are limited. It is not uncommon to have 30-40 patients in the waiting room with wait times up to 9 hours at times. Because people love to sue, doctors will work up that patient with vomiting for one hour...IV, Labs, CT, EKG, IV fluids, phenergan for nausea (because "zofran don't work"), and...since we will be waiting for the CT scan and the results for a couple/few hours...let's go ahead and give them some morphine! And then, the scan comes back negative...the blood work comes back negative...EKG negative...Pt now yelling because they have been there 4 hours and they are "ready to go home now." It's the same patient that doesn't care about the nausea Rx that you are trying to go over with them upon discharge...no...they interrupt you to ask "where's my work note?". Trust me, this is a TYPICAL day where I work!! Due to the sue happy society and the government linking customer satisfaction to reimbursement....the hospital/ER is wasting valuable resources, exposing people to unnecessary radiation, providing unnecessary surgeries, and over prescribing narcotics. Sadly, even if you are one of those that never abuse the system or never get sick, you are still affected because your insurance premiums are increasing due to the above break down in the system...but I digress.

Violence in the ER is real. I have worked with/seen nurses kicked, punched, and spit on. I've worked with nurses with....a black eye, broken arm, and fractured hip (yes by patients)!! I've witnessed patients break walls, doors, and even the ceiling in the ER. I've been threatened bodily harm and even death. I'm still here, but the environment seems to be getting worse.

Yes.."gtt" is "IV drip medications" for blood pressure, heart rate control, rhythm control, etc.

Triage is out front. You sit at a desk in the waiting room, take vital signs, get the reason why the patient is there/signs/symptoms and then assign a number that indicates the "severity" of the patient 1-5.

Mary3010 · Mar 26, 2018

PeakRN:

So in emergency you have less serious cases overall?

So it's not that it's looked down upon for not having breaks...it's that you physically can't. Would that depend on how many staff are put on? Wow charting must take a long time to do. Do you have to do that at your nursing station?

That's good to know that you can have some down-time moments since you must work so hard. The hospital you work at sounds really nice in that you can admire the city from the top of the building. You've got an interesting story, thank you for sharing! So do you frequently change wards to help out other staff?

I suppose you have plenty of time to think about which one you would prefer then if you need experience before advancing in nursing. Wow, I thought that to be a doctor it would be the same amount of pay for pediatrics and adult medicine.