ER Cliques and better assignments

[amzyRN]

I've noticed that the night shift crew seems to be kind of cliquish and that if you're not in, you more often than not get a crappy assignment. How do you address this without ruffling feathers. Another night nurse confided to me that they are looking for a new job because of this and that they were afraid to say anything cuz they'd get fired. Any ideas?

[Nalon1 RN/EMT-P, BSN, RN]

A crappy assignment is only a crappy assignment if you let it be one.

Who makes the assignment? Charge? Manager?

Just ask before everyone else gets there if you can try a different area that you are not normally assigned to. Just something like "hey, I have had rooms xxx for a few shifts in a row, can I have another assignment next shift to try something different".

Not accusing anyone of anything, not saying you want a "better" area, just a different one than where you have been.

[Medic/Nurse, BSN, RN]

As someone who as worked every assignment in the ED (and worked in well over a dozen ED's as staff, contractor, PRN and travel) — there is some kernel of truth to the "frequency" of which staff gets *which* type of assignments.

Regardless of the patient I encountered I always assessed that patient and tried to learn something I could take on to the next patient. I looked at every patient as an opportunity to learn and enhance my clinical practice. It totally defined the way I practiced.

Most ED's do not put *newer* nurses in triage, in as the primary trauma or as the rprimary in resus rooms. Not sure if that's what you mean by crappy assignment or not? Also, be careful what you wish for —really. The last time I ever worked in a hospital my assignment had me primary with 4 resus rooms in 4 of my last 6 shifts. Never again.

Some ED's will require a certain amount of experience for certain nurses to take certain areas

Also, have you taken TNCC and ENPC? And if you are committed to staying in the ED consider looking into joining ENA and sitting for your CEN, CPEN or TCRN certifications after you have practiced long enough to feel masterful? Do you have all the alphabet soup classes of ALCS, PALS, NRP — if not consider getting those and repeating them in 6 months after you take them. Do all these things, tho quietly. Your practice and professionalism should speak for itself. If, after many practice improvements, you're still turfed to the, general illness, non-monitored beds and gyne/abdominal pain side of the ED routinely without fail or break for months and months on end, it might be time for a frank discussion with your educator or manager about what you can do to improve your clinical practice areas. Or maybe it's time to move on.

Some ED's are bit cliquish. I've seen some antics. If your in the club, you get lighter assignments or your rooms fill last or with easier/more "desirable" patients. I've seen this is to be true for any unit. Units that do this long tend to reach critical mass and eventually become toxic as change is usually inevitable. People leave, staffing gets tough, budget gets reviewed, satisfaction drops and so on.

The bottom line for me? Satisfaction. If you really aren't satisfied, look around. I found no shortage of options with a strong medic background and a willingness to get the job done and try to do my best everyday.

I believe in nurses that support other nurses. I believe in encouragement. I believe we are better when everyone is at their best, when everyone learns, grows and meets their goals —we are a stronger department, hospital, profession.

I left junior high a long time ago.

Good luck.

[amzyRN]

Most ED's do not put *newer* nurses in triage, in as the primary trauma or as the rprimary in resus rooms. Not sure if that's what you mean by crappy assignment or not? Also, be careful what you wish for —really. The last time I ever worked in a hospital my assignment had me primary with 4 resus rooms in 4 of my last 6 shifts. Never again.

Some ED's will require a certain amount of experience for certain nurses to take certain areas

Also, have you taken TNCC and ENPC? And if you are committed to staying in the ED consider looking into joining ENA and sitting for your CEN, CPEN or TCRN certifications after you have practiced long enough to feel masterful? Do you have all the alphabet soup classes of ALCS, PALS, NRP — if not consider getting those and repeating them in 6 months after you take them. Do all these things, tho quietly. Your practice and professionalism should speak for itself. If, after many practice improvements, you're still turfed to the, general illness, non-monitored beds and gyne/abdominal pain side of the ED routinely without fail or break for months and months on end, it might be time for a frank discussion with your educator or manager about what you can do to improve your clinical practice areas. Or maybe it's time to move on.

Some ED's are bit cliquish. I've seen some antics. If your in the club, you get lighter assignments or your rooms fill last or with easier/more "desirable" patients.

Good luck.

At my ED they are putting new grads in high acuity assignments to "train them" I've been told. But these newbies are in with the "in crowd". Meanwhile a few of the more experienced nurses, albeit new to the ED. I have a lot of cardiac care experience and have actually worked codes before coming to the ED. I have all the necessary requirements, ACLS, PALS, TNCC and will be working on my CEN at some point.

I would like experience in the resus rooms, and with more critical patients. I wanted to move up the acuity not down. And if they are putting new grads in codes, I want the same experience. How else am I going to improve and grow. I don't mind the minor stuff, the abdominal pains, pediatric fevers, SNF patients who pulled out G tubes, but I need to be challenged. I was more challenged when I was on orientation.

I am going to ask for a different assignment first and see what happens. Then the nurse educator. Overall, I really like my ED and want to stay for a while, I just don't want to always get boring assignemtns.

[DayDreamin ER CRNP]

If it were me, I would ask the person making assignments if there is something I am not doing or doing wrong to not get placed on the other assignments. I always have a "big bed" assignment but I love those patients. The sicker, the better. If I were not being assigned those beds, I would want to know what I had not done, or done wrong, to not get those tougher assignments. We have several "pods" in our department and two of our 8 pods are "high acuity" and it is staffed with the stronger nurses with maybe one or two less experienced nurses that are there to learn and gain more exposure to the sicker patients. We have some folks in the "lower" acuity pods that never leave those areas and they are fine with that. They excel in that environment and could not care less about working the traumas and resus rooms. It takes all kinds to run an ER.

If you want more exposure, you just might have to ask for it.

[Nalon1 RN/EMT-P, BSN, RN]

...

If you want more exposure, you just might have to ask for it.

Just be careful what you ask for...

BTW amzyRN, what do you consider a "crappy assignment"? What you consider crappy may be what another loves.

[EDRN1]

You can bring it up to charge nurse or manager, but as you are already aware it might backfire. My advice bring it up only when you are ready to switch hospitals or departments. Some ER just suck and it is best to just run away from them.

[PG2018]

I thought the ER had the worst cliques internally among any nursing unit I've been in. As a grad student, psych guy, I was ALWAYS given the rooms farthest away with a caseload of old folks trying to crawl out of bed, GI bleeds, gyneo bleeds, and anything else that sucked time or stunk. Frequently, I kid you not, they were intrigued and literally rolled in and dumped. I was very very glad to quit. It was too bad. I went there to experience the breadth of human illness and injury.