ER nurse advice

[baej]

Hi..so this is my first post on here. I've been an ER nurse now for about 1.5 years and I have been questioning what I want to do with my life lately. This is all I wanted to do in nursing school but now that I'm doing it I'm not so sure. I worked in two hospitals on the east coast with no ratios, barely any breaks, and was extremely understaffed so I thought that those were my problems. I recently moved to California and work at a great hospital with a 1:3 ratio. I've been here since March. I love my coworkers and the company, but I still dread going to work. I constantly feel like I still don't know anything at all and am always anxious about what kind of patients are going to come through the door. We get a lot of really sick patients from Mexico that don't speak English and are noncompliant or have no access to their meds. I am wondering if I should go into a different field or stick it out? I know that 1.5 years is not a long time. I would just really appreciate any advice anyone has, like a kind of job that is similar but not so stressful or maybe someone's story as to how they got over this anxiety. I do love the thrill of the ER and saving lives and making people feel better but I also just can't handle it sometimes.. I also love travel and have been thinking about doing travel nursing but am worried I won't be able to handle it because I felt so thrown off starting this new job, I feel like I didn't know anything.. thank you for anyone's input!

Also, just adding, I've tried searching things ER nurses should know and things like that to learn more and have had trouble finding much. If anyone knows any resources that would be great!

[Kuriin, BSN, RN]

1:3 ratio in the ER? What the hell hospital system do you work for? I want that, lol.

[amzyRN]

I have a little over 1.5 years in the ED, I worked around 7 months at one place, a year at the other and from what I can tell it takes at least 2 solid years for most people to know what they are doing and to be able to do it well probably more time. One of my old co workers said that it's not good to leave before getting 2 solid years at one facility because you won't be exposed consistently to the high acuity assignments which is where the real challenge lies (in my opinion).

If you want to stay in the ER, I'd stay for 2 years where you work now so you can get experience with critical patients and triage too. I left the ED briefly and worked in another department (went back to inpatient nursing where I came from) and I was very bored. Having worked in ER, I don't think I could every go back to monotony and routine. But I'm not sure what kind of things you like, so maybe taling to people who work in other departments.

Maybe if you tried to get into the ICU, that would be more your thing, or pediatrics or something else. Find what inspires you and do that. I like the critical care part of the ER, it's challenging and I know that I have a lot to learn. I like to learn and grow and be challenged, which is one of the reasons I like the ER.

[baej]

Yeah, it sounded amazing in theory until I realized its basically having three ICU patients half the time with an insane amount of documentation and none of them speak english, and you have to put pretty much all of the doctors orders in for them..its extremely time consuming and frustrating.

[baej]

and thank you for your input amzyRN. I have been told that it's good to wait it out and I will get more used to it eventually. I do enjoy a more fast paced environment. I've never worked on the floor but I always hated it in school. It is definitely the more critical care patients that I struggle with now, and with the acuity being so high here it's super stressing me out! Today I had a rapid afib with RVR back to back with a STEMI, then I was given three patients within an hour of each other being a blood transfusion, heparin drip, and ICU sepsis on levophed which I think is kind of ridiculous its just so overwhelming! I'm just used to getting a bunch of abdominal pains, chest pain, sob, etc pretty straightforward stuff. I probably will just try to keep pushing through though..

[Kuriin, BSN, RN]

Ah...yeah. Erm. Levophed generally is a 1:1 because you titrate every 5 minutes. I'm going to rescind my previous statement about wanting to be in that ER, lol.

[Pheebz777, BSN, RN]

Go for E.D. Certifications. CEN, CPEN, TCRN, etc.. That will broaden your knowledge and improve your skills which is majority of the reason why nurses feel anxious in going into work. Watch a lot of YouTube videos on disease pathophysiology, trauma surveys, vassopressors, vent management, etc. Watch Larry Mellick MD videos on YouTube he documents realtime E.D. situations. You can't just go to work and go home and relax. You have to constantly absorb all the knowledge and skills you can until you are confident enough to go into work. You will not improve effectively by just learning on the go.

I come from 15 years working in the CVICU dept. Already have CCRN-CMC-CSC certifications and am currently working on getting my CEN. While studying, there is so much I have to learn while working the ED.

[HM-8404, BSN, RN]

You are seeing why the burn-out rate is so high it the ER. I have been an ER nurse for several years, from level 1 trauma center to a third world type hospital in the US. The problem I see with ER's is administration does not want anyone sitting in the "waiting room" when there is an empty bed in the back. Even if the nurse for that empty bed already has three critical patients that will be going to an ICU. ER's are chronically understaffed, but that has no bearing on the quality of care administration expects. They are more concerned about your charting so they can bill for everything than they are if the patient is safe. I have had jobs where the nurse transports their own patients upstairs along with doing total care. I am at the point where I am looking around to see what else is out there. The stress starts taking a toll on your health as well as your family after a while. Beware taking travel assignments. Most places that bring travelers in it is because the place is so crappy to work in they cannot get local nurses to work there.

[TheSquire, DNP, APRN, NP]

The problem I see with ER's is administration does not want anyone sitting in the "waiting room" when there is an empty bed in the back. Even if the nurse for that empty bed already has three critical patients that will be going to an ICU. ER's are chronically understaffed, but that has no bearing on the quality of care administration expects.

As an occasional Charge RN, there are ways around this - while I may load up the rooms of a nurse with an ICU-bound pt, it'll be with patients who can be safely ignored for some time, and/or with patients that someone else has already started line/labs/fluids on.