Emergency Nursing

Specialties Emergency

Published

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?

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

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

Thanks...looking forward to hearing your thoughts!!

PeakRN:

Do you have a lower acuity level compared to the rest of the hospital because you work in quaternary emergency?

200% of your average daily census...do you mean when you go over the normal amount of patients you treat?

Not only would you be able to concentrate better at the nursing station, I guess it would also be better to sit down and rest for like 5 min or so.

That makes perfect sense!! So some nurses see patients from other wards if they specialise in delivering that treatment e.g an obstetric nurse who is more knowledgeable in checking fetal tones. They just do it for that treatment but don't have a whole shift there. Is that only where you work? I only ask because I've heard of a paediatric nurse who said they wouldn't go to the ER. I'm guessing maybe it's only if nurses specialise.

Wow, see I thought it would actually be harder to treat a baby for instance over an adult because they can't show you their pain and they're so small etc. Thank you for your reply!

Smonty1025:

Thank you for your comments!! So are there different types/areas of emergency? E.g traumatic injuries like car crashes, more first aid work like giving stitches to a patient, patients who are in a life of death situation etc. That's great that you started in emergency as soon as you graduated!!

I suppose you have to be flexible in knowing and dealing with patient's who require different treatment. So where you work they don't give you the lunch/break schedule or you just choose not to have it?

I saw on TV once a nurse who I think was a nurse practitioner who was showing their patient in a room results on the computer. I think it was an x-ray result. It wasn't acting and it was in the emergency ward. I wasn't sure if nurses commonly work there as well. I know nurses have a nurse station where you chart procedures/medicines given for each patient but I wasn't sure about that. They're private rooms. I've been in some before with one nurse being a clinical and nurse specialist and a doctor was in there at one point too.

A 3:1 ratio sounds good!! I agree the hospital isn't a hotel!! I suppose when the ratings are low, it would probably be because of patient's waiting. Thank you once again for your comments!!

Bass catching nurse:

That does make sense. It must be somewhat nerving to think that any of your patients whilst they may seem perfectly 'normal' may in fact actually be the ones to lash out. Is there a reason for them to be violent? Is it because of impatience or the fact that they are just violent people?

I'm assuming that it would be both females and males who can be violent against male/female nurses. I guess there's nothing you can do to avoid this....unless you keep your distance which is impossible when you're treating them. It sounds like it is a very common occurrence in the ER and probably something that happens not only in America but elsewhere as well.

For sure!!! Some patient's won't trust you once they are restrained. I'd imagine some nurses finding it hard to restrain patient's by themselves as well. I feel like I would.

I'm guessing people would actually die just from waiting to be treated esp. because you said that you can have more than three level 2's. So am I right to say that as each patient arrives, you give them a number and then look at them more thoroughly in the triage room in the ordering of their given number? (You said that you don't triage everyone first). Thanks for your comment!!!

Pixie RN: Thank you for your comment!! I never knew there were pre-hospital nurses. I guess that makes sense though that there would be flight nurses. I can't think of any other pre-hospital nurses though apart from if there are any on cruises.

So paramedics can work in hospitals or is it only if you are deployed? (You said that some ED's have paramedics whose scope in the ED is not too far from the RN scope). How have the ED's been different for you over the years?

Pixie RN and Peak RN:

Thank you for your comments!! My understandings of the differences between the professions are (correct me if I am wrong because I may very well be):

*Paramedics take patients to the hospital to have further treatment etc. They provide first aid work only. They do not have as large of a scope of practice as a nurse/doctor and therefore do not have as much knowledge in medicine. Unlike doctors/nurses they do not use as many machines and perform less duties that nurses/doctors do. They also obviously don't see x-rays, MRI's and they also don't see/perform I'm guessing an ultrasound.

*A doctor prescribes medications to the patients, diagnoses the patient's problems, can read results such as x-rays, ultrasounds, MRI's etc. and does more technical procedures. They are the ones who gives orders like asking pathology or radiology to do tests or nurses to do various things. A doctor specialises in a particular area such as emergency, paediatrics, maternity etc. If they want to change specialisations then they need to do more study. This is all my understanding by the way, I might be wrong. They can also do further study to become a surgeon. They are also the one's to check if a patient is still alive and reports to families/friends etc. how the patient is and if they have died.

*A nurse however performs the duties that the doctor gives them e.g giving patients medications, performs first aid work like gives stitches, checks vital signs, does a lot of IV drips, cleans patients, performs an ECG to check heart rates and other duties depending on where they specialise e.g delivering babies if they work in maternity.

The only thing is that a nurse practitioner I have heard can prescribe medication, diagnose (checking with a doctor), can read results such as x-rays so I'm not too sure. Maybe they are a doctor of nursing. I'm guessing that there is more flexibility in nursing than a doctor because sometimes they can move wards to perform their specialisation and there are so many options in nursing (though medicine does too so I'm not too sure). Also I don't think you need to do more study to swap from one ward to another. I've been told that the television sometimes portrays doctors doing tasks that nurses also do.

Thank you so much I really appreciate it!!!!

Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

Mary, are you in the US? Some of your terminology makes me think that you are in the UK or Australia, where things might be very different! I have a friend in Australia who is starting Uni in a nurse/paramedicine program, which sounds awesome because it combines them.

Pixie RN:

Yes I'm not American, you're right!! What terminology is different? I didn't even know that you could combine nursing and paramedics. Where would those nurses work?

Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
Pixie RN:

Yes I'm not American, you're right!! What terminology is different? I didn't even know that you could combine nursing and paramedics. Where would those nurses work?

I think it was the use of the word "whilst." :) Here is the program: MONASH Bachelor Of Nursing And Bachelor Of Emergency Health (paramedic) in Melbourne / Victoria Monash University | AustralianUniversities.com.au

I am not sure where such a person would work, maybe critical care transport?

Bass catching nurse:

That does make sense. It must be somewhat nerving to think that any of your patients whilst they may seem perfectly 'normal' may in fact actually be the ones to lash out. Is there a reason for them to be violent? Is it because of impatience or the fact that they are just violent people?

I'm assuming that it would be both females and males who can be violent against male/female nurses. I guess there's nothing you can do to avoid this....unless you keep your distance which is impossible when you're treating them. It sounds like it is a very common occurrence in the ER and probably something that happens not only in America but elsewhere as well.

For sure!!! Some patient's won't trust you once they are restrained. I'd imagine some nurses finding it hard to restrain patient's by themselves as well. I feel like I would.

I'm guessing people would actually die just from waiting to be treated esp. because you said that you can have more than three level 2's. So am I right to say that as each patient arrives, you give them a number and then look at them more thoroughly in the triage room in the ordering of their given number? (You said that you don't triage everyone first). Thanks for your comment!!!

Some people are just violent...some are just jerks that were never taught how to act in public or control themselves.

I'm sure it happens in other countries...but with America's push for "customer service" in healthcare along with the decay of social graces...this is what you get!

We do triage everyone as they come in; however, if 6 people walk in at the same time, then we can only triage one at a time. Also, they first "sign in" with registration. I can see the complaint that they sign in with registration for; and then, I get the person that I think should be triaged next.

Specializes in Adult and pediatric emergency and critical care.
PeakRN:

Do you have a lower acuity level compared to the rest of the hospital because you work in quaternary emergency?

200% of your average daily census...do you mean when you go over the normal amount of patients you treat?

Not only would you be able to concentrate better at the nursing station, I guess it would also be better to sit down and rest for like 5 min or so.

That makes perfect sense!! So some nurses see patients from other wards if they specialise in delivering that treatment e.g an obstetric nurse who is more knowledgeable in checking fetal tones. They just do it for that treatment but don't have a whole shift there. Is that only where you work? I only ask because I've heard of a paediatric nurse who said they wouldn't go to the ER. I'm guessing maybe it's only if nurses specialise.

Wow, see I thought it would actually be harder to treat a baby for instance over an adult because they can't show you their pain and they're so small etc. Thank you for your reply!

We actually have a higher acuity than most EDs, but the reality is that 3/4 of our patients are healthy enough to go home, unlike the patients who are all admitted (and in theory 'sick enough' to be admitted). We tend to see more specialty oriented patients so high risk OB, Heme/Onc, Transplant, and complex kids are our daily routine.

Yeah, we can easily double our average daily census some days, especially during the winter. We get all of the normal peds respiratory season stuff in the Peds ED, and all of our neutropenic patients are showing up with the same stuff in the adult ED.

Helping other units is not unique to our facility, but ours probably does so more than most. Often the nurses that come down to help in the ED are performing treatments that either we are not trained in or are less familiar with. In more general EDs this means that the Heme/Onc nurses may come down to the ED to access ports, NICU may come down to start difficult IVs in infants, OB may come down for continuous monitoring. We have trained all of our ED staff in access all central access devices including ports and we have multiple nurses who are trained in ultrasound guided IV access so we don't tend to call people much, but OB is always the thing we are happy to have someone come down and help with.

We have separate pediatric and adult EDs and hospitals on our campus and our Peds ED has pediatric emergency physicians and pediatric emergency nurses that are distinct from the adult ED. Most peds nurses are not comfortable in the ED, finding good pediatric nurses who are also critical care minded is a continuous struggle, and most prefer to stay up in the PICU; there is also a lot of tough love in the ED and I think it can be hard for a lot of peds nurses to get accustomed to.

We definitely also have nurses who specialize in multiple different disciplines. I am one of the few nurses who work in our adult and pediatric ED and I still work in the field as a EMS prehospital nurse. We have a couple of nurses who work in the PICU and Peds ED, a couple that work in the adult ICUs and adult ED, and a couple who work in both the adult ICUs and PICU. There are other nurses who work on other various floors, but to be honest I'm not that familiar with the non-critical care nurses. The vast majority of our staff throughout the hosptial only work on their primary unit though.

I actually prefer to work with kids than adults, they have not adapted a disease-oriented mindset and just want to be kids. Physical exam isn't that much harder in kids, and in many ways is easier, but much of what you are looking for is more subtle. History either comes from the parent or both the parent and the patient, the way we ask questions just changes a bit.

Pixie RN and Peak RN:

Thank you for your comments!! My understandings of the differences between the professions are (correct me if I am wrong because I may very well be):

*Paramedics take patients to the hospital to have further treatment etc. They provide first aid work only. They do not have as large of a scope of practice as a nurse/doctor and therefore do not have as much knowledge in medicine. Unlike doctors/nurses they do not use as many machines and perform less duties that nurses/doctors do. They also obviously don't see x-rays, MRI's and they also don't see/perform I'm guessing an ultrasound.

*A doctor prescribes medications to the patients, diagnoses the patient's problems, can read results such as x-rays, ultrasounds, MRI's etc. and does more technical procedures. They are the ones who gives orders like asking pathology or radiology to do tests or nurses to do various things. A doctor specialises in a particular area such as emergency, paediatrics, maternity etc. If they want to change specialisations then they need to do more study. This is all my understanding by the way, I might be wrong. They can also do further study to become a surgeon. They are also the one's to check if a patient is still alive and reports to families/friends etc. how the patient is and if they have died.

*A nurse however performs the duties that the doctor gives them e.g giving patients medications, performs first aid work like gives stitches, checks vital signs, does a lot of IV drips, cleans patients, performs an ECG to check heart rates and other duties depending on where they specialise e.g delivering babies if they work in maternity.

The only thing is that a nurse practitioner I have heard can prescribe medication, diagnose (checking with a doctor), can read results such as x-rays so I'm not too sure. Maybe they are a doctor of nursing. I'm guessing that there is more flexibility in nursing than a doctor because sometimes they can move wards to perform their specialisation and there are so many options in nursing (though medicine does too so I'm not too sure). Also I don't think you need to do more study to swap from one ward to another. I've been told that the television sometimes portrays doctors doing tasks that nurses also do.

Thank you so much I really appreciate it!!!!

In the US there has been a push to use EMTs and Paramedics more in the EDs since they can perform some of the same skills as nurses but are paid substantially less. Their training is focused on the management of the most emergent patient conditions (airway management, STEMI treatment, ACLS/PALS algorithms, basic trauma resusitation, et cetera). In most systems EMTs are considered to be the minimum to staff an ambulance, and paramedics are the majority of the advanced life support providers on the ambulance. There are some other EMS levels like EMRs who have less training than EMTs, AEMTs who are between EMTs and paramedics, and additional certifications for paramedics in critical care, flight, or community care. EMTs generally have a couple of weeks, possibly a couple of months, of training. Paramedics generally have one year of additional training, some will have an associates degree and most have some addition college coursework like anatomy and physiology and basic biology.

The US military also has different level of EMS care, Pixie would be better at explaining the minutia but generally they are more trauma oriented and may be able to perform some trauma skills that would be beyond the scope of their civilian counterparts. There are also some specialties like SF medics, pararescue jumpers, and independent duty corpsmen who have much more advanced training and are probably much more akin to the paramedics or advanced paramedics in the UK.

Physicians like you said or oriented to the medical management of the patient. Physican's assistants work under the physician's license, and will typically see lower acuity patients or do followup or evaluations for the physician that they work with.

Nurses have very different roles depending on their specialty and their scope changes greatly based on their state that they practice in. For example in my state I can place central access, arterial lines, intubate, perform basic radiology interpretations like EFAST, chest xrays for cardiac/pulmonary evaluation and line placement, KUBs for line placement, pelvis xrays for fracture, and non-con head CTs for bleeds and fractures (these are all still read by a physician but we can make treatment decisions based on their initial interpretation); all of these are either very limited or prohibited by other states' boards of nursing. Much of my role is expanded because I work in critical care and in the 911 system. I also have protocol orders in the field for the management of those patients. We have a ton of standing orders in the ED and are always discussing the plan of care with our medical providers so that if a condition changes we can immediately treat the patient rather than have to find the provider first.

Nurses in other environments will have other roles, for example ICU nurses will be much more adept to managing ventilators, ECMO, CRRT without needing to immediately consult the medical provider. Nurses on the floors, in schools, or doing home care certainly have a much more 'traditional role' similar to what you have described.

Advanced practice nurses will have varying role based on their state, in some they are independently licensed and in others they may need physician supervision. CRNAs provide anesthesia care in the hospital/surgery center enviorments, Nurse midwives treat women's health and pregnancy. Nurse practitioners will have different roles based on their specialty, some are primary care trained and others are acute care trained. Nurse practitioners may be trained in family care (the most general/wide scope training), pediatrics, adult care, neonatal care, or women's health.

Physicians rarely perform bedside care, though ED and anesthesia providers certainly will provider more than most (but still less than TV would portray). A couple of our physicians and PAs are former paramedics and are more comfortable with helping with bedside care when we have critical patients and need help.

Pixie Rn:

I would never have guessed that the word 'whilst' is not commonly used by Americans (as you say). Thank you so much for the website link!!!! I'm going to have to look into that further.

These are the different types of registered nurses that we have (there are also enrolled nurses but I think they're not as high so it's probably better to be an RN):

How to become a Nurse - Registered | The Good Universities Guide

And Doctors:

How to become a Medical Practitioner | The Good Universities Guide

Paramedics (I don't think we call them EMT's, though I could be wrong. We just call them paramedics or the ambulance...unless people in the medical field do):

How to become a Paramedic | The Good Universities Guide

You don't have to look, it's just if you are interested in how it is different. You're so lucky you live in America, it sounds so fantastic!!

Bass catching Nurse:

I'm guessing then that some people couldn't work in the ER if they were older or pregnant because of this violence. I agree people are violent/jerks everywhere!!!

It never struck me that this violence was this bad in the ER esp. because whenever I have been, I have never seen it. Paramedics where I live are now refusing to treat people if they are violent. I've heard aggressive patients in hospitals but not as you have described. Thank you for sharing that information!!! I'd rather know the facts.

Oh right ok that makes sense as far as triaging goes. It sounds really good triaging people as a nurse...I'd love to see this in action!!! I sort of saw it last time I was in emergency but I actually understand more about it now. Also, I know now that the rooms the nurse took the patients in where for triaging.

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