changing to ER nursing? give me the low down.

neneRN, BSN, RN · Jan 13, 2003

Absolutely love the ER, wouldn't work anywhere else! Iwork in a very busy Level II trauma center- we see over 110,000 pts/year. Our peds ER is separate-so I never see the sick kids.

PROS:

-More autonomy-don't need an MD order for every little thing (i.e. IV starts, EKGs, Xrays, etc)

-Being able to see immediate results from your efforts with acute cases

-Getting to be very comfortable working codes

-Seeing a little bit of everything, and still seeing something each day that you've never dealt with before /shocks you/makes for a great story

-Good rapport/trust from docs

-Co workers- ER staff in general a little twisted/great sense of humor/very team oriented

-Never knowing what kind of pt you'll get next/ adrenaline rush

-Always getting to use critical thinking/anticipating plan of care

-Learning to be excellent at technical skills, they often need to be done in the blink of an eye (those pts with a BP of 40 and no IV access, etc)

-Going home knowing a pt survived, got better because of your interventions. Going home thinking, I can't believe I handled everything I did today, I kick ass!

CONS:

-myriads of people who use the ER as a walk in clinic or arrive via ambulance for a sore throat, taking time away from the truly sick

-the pace often never slows down, pts keep coming, ambulances keep coming; so sometimes unsafe pt loads resulting in lots of pts being treated in hallways

-My personal biggest pet peeve- trying to get a pt upstairs to their room and the floor nurse can't take report right now, or room isn't clean, or just got another pt,etc. Meanwhile, I've got an ambulance unloading me yet another pt- and I don't have the luxury of telling that ambulance to wait. (I know not all floor nurses are like that, and I'm not slamming anyone-we all work hard. Its just frustrating and happens too often at my hospital.)

-Visitors/pts that don't understand the priorities of the ER. Yes, I know that you are hungry/uncomfortable/need to use the phone, but I can't fix those things right now because I have other pts with active CP, stat orders,dropping BP, changing LOC, etc

-Deaths- remember most codes are unsuccessful, esp the 99y/o contractured, bed sore ridden NH pts with multiple chronic conditions that we routinely code secondary to their full code status. Also, the young healthy traumas that don't make it-those are the worst.

I think with the ER, you either love it or hate it. Welcome!

Indiana ED RN · Jan 13, 2003

I will have to agree with neneRN.... you either love it or hate it.... that was a very nice list of pro's and con's. Another thing you have to find out is how the management in the ED is. As you may find in other posts on this board.... no matter what you do to please the patient/family.... you are always wrong.... Now you do not find that everywhere.... but that can make you change from going home feeling good to going home dreading tomorrow.

KKERRN · Jan 17, 2003

See if your ER has a job shadow program to give you a hands-on view of what to expect in your ER. Also, check out the orientation you will recieve in the ER. Some have a residency program to help ease the transititon.

It is a love/hate area of nursing!

I've been in ER 2 1/2 years now and still not sure if I want to stay, but I know I don't want to return to floor nursing...except maybe mother/baby.

Prior ER my 17 yr. backgroungd was mother/baby, med/surg, and occupational nursing. The first year was overwhelming learning ACLS and EKG's and all the procedures, ect.

Good luck!

Karen

Kim Steinmann · Jan 19, 2003

I worked home health immediately following nursing school, then five years in Cardiac Rehab and then into the ER and I just love it! I enjoy the different people we see with the differing dx's. I took maternity leave and wanted something different and went to the ER and after a year, I still love it. Something new all the time and yes, I have also have had frustration with the people who use us like a doctor's office. Fortunately, our director is very supportive and we also tell all our pts in triage that the MI's, ambulances and Resp. distress, come first, so they expect this and I also tell them in triage, that we are VERY busy, when we are and then, they don't seem as put out when they have to wait. Good Luck!!

Shankster · Jan 22, 2003

I've been an Emergency Nurse for about 7 years now, and i'm still there. We all want something better, but we never leave the ER. Its hard work, but as was discussed before you have the autonomy. I wish you luck. I try to get everyone to give the ER a chance, you will either love it or hate it.

terhay · Feb 2, 2003

Hi AP,

Nene said it well. However...it can be a very stressful job! You can be up to your butt in alligators in an uncontrolled situation, and get several ambulances right on top of everything else, because your co-workers also are probably just as busy, and no one available to help you. It takes a LOT of prioritizing and decision-making, and sometimes this can be most difficult. I had a pt in an asthmatic crisis, and I was really fearing resp arrest, when I got a pt with a long cardiac hx having CP and 3 past MI's, then a brand new CVA with 3 bleeds in her head (confirmed later by CT scan) that was neurologically going downhill, had another that suddenly starting vomiting frank blood (ruptured esophagus). Most of the rest of the staff was on a pedi code. Then in the midst of this, Mrs. Jones (not real name) came screaming out of my CP's room, "I have an emergency!" I dropped everything and went running in there, thinking he was coding, only to hear, "nurse...I need my blankets pulled up". Grrrrrrrr.... Unfortunately, at least for me, this is more typical than not. (Sometimes I feel like I should just wear a French Maid outfit, because often that's how I feel!) It can be totally exhausting. I have had many, MANY shifts of 12.5 hours, where my 1st break was driving home in the morning, 1/2 asleep! ER can be fun, as most ER nurses and docs are rather 'warped' for the most part (don't be offended anyone!!!), and sometimes things happen that are REALLY funny, and it takes everything you have to keep you composer and remain professional. It definately has more independence than most nursing jobs, but MAN!!! it can be unbelievably busy, where you have to make those quick decisions and hope you made the right one! There are also cardinal rules in the ER...Everyone that gets in an MVA, it's always the other person's fault. Anyone that comes in slobbering drunk and obnoxious as hell, has only had "2 beers", 14 yr old pregnancies are caused by immaculate conception, and anyone with anything in an oriface it's not supposed to be in, well...they fell on it, and of course "my doc always prescribes demerol, quaaludes, ETC Sometimes it's real hard not to be nonjudgemental. Then of course remember that anyone that comes in on backboard and spinal precautions will HAVE TO urinate immediately, and no one has food at their house! So of course you have to open the ER deli and find them something...crackers and juice are NOT what they had in mind, because they "haven't eaten" all day! (That's our responsibilty too I guess.) Be prepared for the anger when you don't have a made to order menu! I have been an ER nurse for over 20 yrs, from Level I's to Level IV's, and quite frankly I am getting really burned out! I am seriously considering moving on to some other area. What used to be fun and exciting in my younger days, is now just a lot of work! I'm not sure I want to work this hard anymore. But it will probably be a good experience for you, as long as you are not starting out in a Level I. Good Luck!!!

essarge · Feb 4, 2003

:roll terhay, do you work in our ER????? I had to laugh when you mentioned the ER deli!!! I work 7p-7a and can vouch for that part! I like the patient that has been vomiting all day, comes to the hospital and can't understand why we can't give them anything to eat after we hook up the IV and give them phenergan!!

I work as a tech and can tell you that our nurses have their hands full. Yes, we have frequent flyers, but each time they come in with a complaint, they recieve the same treatment as everyone else (ok...so we are on a first name basis with most of them! )

With the cold weather, we see a continuous stream of homeless coming in for food, warmth and shelter. Our city is a little "full moon" lagged, they wait until three or four days after the full moon and then it hits the fan. Of course there are the NHs that send patients in with a fever of 100 instead of trying FIRST to treat it at the facility (one of my sore points) and then you can't get any info on the patient because the nurse at the NH isn't available...do we code?....what are the pts other problems????

Humor...oh yes....warped is a good word for it!! Anyone who doesn't have an appreciation for the strange and idiotic should not work in an ER! I had one child ring and when I got there, dad was pretending to sleep and the child (who was 4yo) stated"I have been waiting here for two hours! This is ridiculous! I want to see a doctor now!!!" Couldn't help but giggle and smile at that one as I was telling the Doc!

Yes, I love the ER and will be working there when I graduate from school. Shadow a nurse...ask questions...observe. You will know if that's what you want!