As a traveler I do not have to take call or rotate shifts. All of this is decided beforehand and written into your contract. One nice thing about ER is you are rarely if ever floated to another unit. ER's must staff for the inevidability of disaster, so even if you have a lull for a few hours, it can turn on a dime.
The other night at 0230 (I usually work till 0330), we only had about 10 patients in the ER and I was asked if I wanted to go home early. Being that it was my third 12 hour shift, I was ready! Anyway....I had emptied my pockets, put up all my stuff and was walking toward the door when we got 2 EMS calls. Both were respiratory distress due to arrive any minute. When they rolled thru the door, one was already intubated (a 46 yr old with COPD), the other had a trach button and was having decreased LOC and periods of apnea. So much for leaving early and having a quite night!
As far as work overload being worth the money....I don't know that the ER is overworked anymore than any other unit, it is just different. On a floor and sometimes ICU, you can sort of pace yourself based on the number of beds you have and the number of patients in them. When you are full, you can't take anymore patients. NOT so with the ER. The doors are revolving and we never close. There are nights when we never even get close to emptying the waiting room. Other times, you just stay even, and we rarely keep a bed empty very long.
One of the big problems in a lot of hosptals especially during the winter months, is a lack of available hospital beds. We routinely hold patients in the ER who need to be admitted to the hospital, sometimes 24-48 hours. One day last week at 3 pm we were already holding 11 patients (52 bed ER). We are constantly trying to shift the "holds" into a hospital bed for comfort and move them into the "back" part of the ER. Usually staffing is able to send us a float who takes care of the "floor" patients, but we never get extra help to care for the ICU patients.
I can't even begin to describe what a typical day in the ER is, because it would be a book! I will hit the highlights though....
If you are assigned to the general ER and not the ALS section, you will see everything in the book. If you are in ALS, you will get the significant chest pains, respiratory distress/arrest, overdoses, trauma, etc.
In the general ER you will see kids with beads up their noses, pregnant vag bleeders, lacerations, sprains and fractures, drunks and druggies either there because they are a danger to themselves or others, or they are seeking detox (after last drinking, snorting, injecting 2 hours PTA). There are lots of back pains, toothaches, headaches as well. Multiple "wreck checks"...people involved in minor MVC's who think their insurance company wants them to "get checked out". They all get sent home with Rx for vicodin, flexiril and motrin, 2 days off work and and ice bag.
You will see an abundance of belly pains. I hate them the worst! Well, almost (GI bleeders get that prize). They all get IV fluids, labs, meds, CT scans, ultrasounds and or pelvic exams. They are usually whiny females who have nothing better to do but hang out in the ER. 90% of the time everything is negative and we send them home 6 hours later with a Rx for vicodin and a referral to their PCP. I recently had a young woman with a 10/10 on the pain scale who had her mom bring her a salad before we even got her labwork done. Then she ate an entire fried chicken dinner between glasses of contrast prior to her CT scan. Oh yeah, she was really sick. NPO means nothing to these people! I had a woman walk into triage complaining of nausea and vomiting while eating a big box of fried rice. I told her she really needed to stop eating if she was nauseated....she said, "I was hungry, and besides, I just bought this". How can you argue with that logic. I can't tell you how many people who are complaining of nausea/vomiting who are eating and drinking because they want to have something to throw up. DUH!!
You will get your share of coughs, runny nose, upper airway congestion, kids with fever (whose parents did not give Tylenol because they wanted you to see how high the fever was
). Lots of asthma and respiratory complaints during season changes and high pollen counts (like now).
I don't want to leave out the multiple UTI's, simple ones and those with urosepsis who are VERY sick. You get your share of diabetic related problems, high blood pressure and chest pain that turns out to be non cardiac. Lots of belly pain/chest pain that turns out to be a gall bladder problem (had a guy complain of GB pain after eating ONE POUND of bacon for breakfast (who could have known??
In a nutshell....if a human being can suffer from something, you will see it in the ER. If they have no real problems, they will invent one! Or do something stupid enough to buy them a bed in the ER. Summer brings lots of problems related to being outdoors. Drowings or water related problems, sunburn, diving accidents and such. I had one guy who tried to dive into the pool from his hotel balcony. He almost made it! Many of the summertime activities are related to the infamous "2 beers". If it is not the 2 beers then it is related to the "2 dudes" who caused the problems. I guess bad things happen in "twos" instead of threes!
ER is a new adventure every shift. Just when I think I have seen it all, heard it all, smelled it all.....someone proves that I have not!
My new mantra is.....if it were not for stupid people, I would be unemployed!:chuckle