Emergency Nursing -- What's it like?

[RedhairedNurse]

Hi all,

I would please like to hear some feedback as to what you like most about being an ER nurse. I originally applied in the ER but they put me on an oncology floor instead. I'm a new grad and really trying to find my place in nursing. I like working at a fast paced environment and can multi task. I'm worried about staying depressed on a floor like I'm currently working on.....I like stay busy and working night shift on this floor is making me wonder if I'm going to get bored, or not challenged enough.

[RNcDreams]

I went straight into ER, but it's a community ER that gets an abundance of SICK medical patients-- it's a non trauma facility.

I had this in mind when I took the job. I didn't want to get thrown to the wolves--- I wanted a hands on, manageable experience to get me started in the specialty I knew I loved.

I happen to be a Type-A, must-know-everything-and-do-everything kinda gal.... and I thoroughly enjoyed my ER preceptorship.... nothing else in school jumped out at me, and I wanted a job that made me happy.

If I get a "change in MS" nursing home patient, who surely has urosepsis and a gigantic cardiac history, who is diabetic and blind and has COPD and HTN , etc ,etc,............. you bet your butt I am doing a head to toe!!

Neuro exam to establish baseline, listen to heart, lung, and bowel sounds, peripheral pulses, and a good set of vitals with a PO temp.

My hope is that I am establishing a new norm, and giving a better report to the floor to facilitate a smoother transition. Many ER nurses, new AND seasoned, do not assess their patients well.

(It's your choice, whether you are in Med Surg or the CCU-- am I going to be thorough, diligent, and detail oriented, or am I going to skimp?)

However, you can be sure if someone comes in who sliced their thumb off with a hacksaw.... I am not going to say "Please sit forward so that I can listen to your lungs." Very often, a focused assessment is quite appropriate.

That being said.... these are nursing judgments..... which ya don't learn until you dive in and try!

** Also, someone had said they have issues starting IV's that aren't in the AC..... the facility I work at places a lot of emphasis on starting from the hand up, using an appropriately sized angio, and not just "throwing an 18 in everyone." I have, as a result, gotten really good at placing lines in hands, forearms, even thumbs when necessary.

My main point is:

If you are a self directed learner, you might be fine.

These are my "criteria" for new grads in the ED:

-Must be able to accept constructive criticism

- Must not be too cocky/proud/confident

- Must know their limitations

-Must be willing to start small

-Must continue aggressively learning and being inquisitive

-Must seek out and stick with one or two supportive, smart preceptors

Hope that helps!

[RedhairedNurse, BSN, RN]

I happen to be a Type-A, must-know-everything-and-do-everything kinda gal.... and I thoroughly enjoyed my ER preceptorship.... nothing else in school jumped out at me, and I wanted a job that made me happy.

I agree with you. I'm also a type-A. I like to be thorough in my assessments.....I just like to be busy beyond imagination. I'm not happy where I am currently working as a student nurse. I start my internship here soon as well. I want the ER so badly, but I don't want to seem whiney to my recuiter and already start to request a change from my current dept. I was just happy to get my foot in the door. I guess I'll just have to take what I can get and listen to some of the advice in the previous replies to my original post. Thanks. I know I messed up the quote from above by copying and pasting just certain parts, so sorry.

[RN1982]

I went straight into ER, but it's a community ER that gets an abundance of SICK medical patients-- it's a non trauma facility.

I had this in mind when I took the job. I didn't want to get thrown to the wolves--- I wanted a hands on, manageable experience to get me started in the specialty I knew I loved.

I happen to be a Type-A, must-know-everything-and-do-everything kinda gal.... and I thoroughly enjoyed my ER preceptorship.... nothing else in school jumped out at me, and I wanted a job that made me happy.

If I get a "change in MS" nursing home patient, who surely has urosepsis and a gigantic cardiac history, who is diabetic and blind and has COPD and HTN , etc ,etc,............. you bet your butt I am doing a head to toe!!

Neuro exam to establish baseline, listen to heart, lung, and bowel sounds, peripheral pulses, and a good set of vitals with a PO temp.

My hope is that I am establishing a new norm, and giving a better report to the floor to facilitate a smoother transition. Many ER nurses, new AND seasoned, do not assess their patients well.

(It's your choice, whether you are in Med Surg or the CCU-- am I going to be thorough, diligent, and detail oriented, or am I going to skimp?)

However, you can be sure if someone comes in who sliced their thumb off with a hacksaw.... I am not going to say "Please sit forward so that I can listen to your lungs." Very often, a focused assessment is quite appropriate.

That being said.... these are nursing judgments..... which ya don't learn until you dive in and try!

** Also, someone had said they have issues starting IV's that aren't in the AC..... the facility I work at places a lot of emphasis on starting from the hand up, using an appropriately sized angio, and not just "throwing an 18 in everyone." I have, as a result, gotten really good at placing lines in hands, forearms, even thumbs when necessary.

My main point is:

If you are a self directed learner, you might be fine.

These are my "criteria" for new grads in the ED:

-Must be able to accept constructive criticism

- Must not be too cocky/proud/confident

- Must know their limitations

-Must be willing to start small

-Must continue aggressively learning and being inquisitive

-Must seek out and stick with one or two supportive, smart preceptors

Hope that helps!

Too often I have received patients from ER who needed immediate intubation upon arrival to the unit. I think if ER had enough staffing, RNs in the ER would be able to assess their patients more often. Last year, I received at patient from ER with Exacerbation COPD. Three sets of ABGs were done on the patient while he was on 4 liters nasal cannula. He was alert, according to the ER RN. The patient arrived with a 100% nonrebreather and was unresponsive. I was very upset with the ER nurse because she felt the patient "needed more oxygen" even though his abgs were good, not perfect on 4liters. Too much O2 is toxic for COPD patients. However she failed to assess that the patient had a "major" mental status change. Within 5 minutes we had anesthesia intubate the patient. She didn't accompany the patient to the unit, another RN did, but she found out about the patient being intubated as soon as they arrived. I received a call from her and she was asking me if it was her fault. I had to tell her that I must file an incident report by policy and I'm not the one that determines its her fault but I was pretty steamed at her and the ER doc.

The ER doc rushed to the unit after we called stat intubation and in a very cocky manner "we don't send patients like that from the ER"... Me "Well, you just did, genius".

Anyhow, my point is, if the ER you are going to is going to offer a great and very thorough orientation with a preceptor or two, thats great. But don't go into the ER without the necessary assessment skills. You need to be on your toes in the ER at all times because a patient's condition can change within a matter of seconds/minutes.

The hospital where I used to work stopped hiring new grads because proper assessments were not being done and patients were dying. I know of two new grad RNs who worked in the ER and were told to transfer to a med/surg unit and come back to ER in a year. I know of a couple more who were terminated. Be careful, it's your license.

[RNcDreams]

Too often I have received patients from ER who needed immediate intubation upon arrival to the unit. I think if ER had enough staffing, RNs in the ER would be able to assess their patients more often. Last year, I received at patient from ER with Exacerbation COPD. Three sets of ABGs were done on the patient while he was on 4 liters nasal cannula. He was alert, according to the ER RN. The patient arrived with a 100% nonrebreather and was unresponsive. I was very upset with the ER nurse because she felt the patient "needed more oxygen" even though his abgs were good, not perfect on 4liters. Too much O2 is toxic for COPD patients. However she failed to assess that the patient had a "major" mental status change. Within 5 minutes we had anesthesia intubate the patient. She didn't accompany the patient to the unit, another RN did, but she found out about the patient being intubated as soon as they arrived. I received a call from her and she was asking me if it was her fault. I had to tell her that I must file an incident report by policy and I'm not the one that determines its her fault but I was pretty steamed at her and the ER doc.

The ER doc rushed to the unit after we called stat intubation and in a very cocky manner "we don't send patients like that from the ER"... Me "Well, you just did, genius".

Anyhow, my point is, if the ER you are going to is going to offer a great and very thorough orientation with a preceptor or two, thats great. But don't go into the ER without the necessary assessment skills. You need to be on your toes in the ER at all times because a patient's condition can change within a matter of seconds/minutes.

The hospital where I used to work stopped hiring new grads because proper assessments were not being done and patients were dying. I know of two new grad RNs who worked in the ER and were told to transfer to a med/surg unit and come back to ER in a year. I know of a couple more who were terminated. Be careful, it's your license.

It is a shame that these patients did not receive proper care.

Recently, a COPD patient in my ED crashed on arrival on the floor.... and the nurses who sent the patient up had been there for 25 years.....

I was taught how to titrate 02 based on the patients history of retention vs. non-retention, I have researched and studied COPD, and I have consulted the respiratory therapist for guidance when I am unsure.

A new graduate can make the same mistake of using a non-rebreather on a COPD patient who is laying in a med-surg bed just as easily as they can on a patient lying in a stretcher in the ER.

If a new grad is not taught how to assess, that new grad must take an assessment of themselves and decide whether they are going to seek out that guidance, or if they are going to practice in a dangerous way.

Not all new grads are careless/dangerous :uhoh21:

[RN1982]

It is a shame that these patients did not receive proper care.

Recently, a COPD patient in my ED crashed on arrival on the floor.... and the nurses who sent the patient up had been there for 25 years.....

I was taught how to titrate 02 based on the patients history of retention vs. non-retention, I have researched and studied COPD, and I have consulted the respiratory therapist for guidance when I am unsure.

A new graduate can make the same mistake of using a non-rebreather on a COPD patient who is laying in a med-surg bed just as easily as they can on a patient lying in a stretcher in the ER.

If a new grad is not taught how to assess, that new grad must take an assessment of themselves and decide whether they are going to seek out that guidance, or if they are going to practice in a dangerous way.

Not all new grads are careless/dangerous :uhoh21:

I never said nor implied nor do I think that new graduates are careless and dangerous. I never even said that the ER nurse was a new grad. I'm just saying that you need to have assessment skills and you need to be diligent in the care that you provide your patients.

[RNcDreams]

Okydoky... point taken! :)

[RN1982]

Okydoky... point taken! :)

Listen, I could never be an ER nurse, I readily admit that. But I always tell my friends that decide to go to ER that they are the FIRST to see the patient. They must be diligent and must be vocal and not to be afraid to tell the docs what your gut instinct tells you about your patient. But they also must assess, assess, assess and report changes to the doc immediately. The nurse that sent me that patient was not a new grad and God only knows how long he was unresponsive. His ABGS on the unit were to say the least, not compatible with life..Ph 6.88 PCO2 200.

[MIA-RN]

I started in the ED after about a year and a half of being a staff nurse. I love it. I don't do trauma cases. I see lots of stuff though. My assessments are very focused. If the patient is in w/ asthma exacerbation, I am going to listen to the lungs. I might not however listen to bowel sounds etc. THere just isn't the time to do that when you have several other patients who are that sick.

I am really glad I got the M/S experience first. I learned so much more by doing that and I was way better prepared. Plus, the ED pays better and by coming in with experience, I started at a nicer pay rate!

[RN1982]

I started in the ED after about a year and a half of being a staff nurse. I love it. I don't do trauma cases. I see lots of stuff though. My assessments are very focused. If the patient is in w/ asthma exacerbation, I am going to listen to the lungs. I might not however listen to bowel sounds etc. THere just isn't the time to do that when you have several other patients who are that sick.

I am really glad I got the M/S experience first. I learned so much more by doing that and I was way better prepared. Plus, the ED pays better and by coming in with experience, I started at a nicer pay rate!

If I need to just do a quick bowel sound assessment, I check the lower right quadrant. But yeah, when you have patients coming in for something like COPD exac and asthma, a more focused assessment is appropriate.