ER nursing education

[mrvlegov]

Hi,

Before I ask my question, I'll give you a little history so you can help me!

I have been an RN for about 4 years now. I floated mainly Med/Surg and Tele/step-down in a 100 bed hospital for the first 2 years. Then I started working in the ER for about 9 months. I really loved the ER but there were a lot of politics and changes in management and I was having a hard time with the schedule (I'm a single Mom) and got a great job offer at an Orthopedic Same Day surgery Center. Great pay, great hours etc. I worked there for a year doing PACU and Same day the hours were amazing but found I was incredibly bored and didn't feel I was learning anything; I was just plain unhappy there! Throughout this time, I also worked per diem at a small community ER (25 bed hospital) I just picked up a shift here and there. I loved the people there and the environment so I quit at the surgery center and now work only at this small ER. I also work in PACU and Same day surgery at the same hospital when they need me (usually only 4-6 shifts a month) just to mix things up.

This ER usually staffs only one nurse and one Dr. except between the hours of 3-11pm there is either a second RN or a Paramedic/tech to help. We have 8 rooms in our ER. The Doctors are very helpful and will give Meds or collect labs etc. if we are busy and the Respiratory and Radiology techs will also help with making beds and taking vitals sometimes also.

Any big trauma will go to the larger hospital nearby so in theory, we aren't supposed to get anything major at our hospital. We do get a lot of the "urgent care" type visits but we get a lot of cases we end up transferring to the bigger hospital. We stabilize and transfer etc.

So my question is, although I feel comfortable and confident working there and my colleagues seem to respect my nursing skills/knowledge. I have this nagging feeling that one day something will come through the door and I won't have a clue or that I'm just faking it, like I don't really know what I'm doing! In some ways this is kinda silly because there is a lot of support there with the Dr being right there and the house supervisor etc. and there have been times that I wasn't sure and I asked questions and learned and always had the support I need. But I feel like I'm to the point where I'm not learning much anymore. I have taken ENPC, PALS, TNCC, ACLS etc. but we see trauma and even codes so rarely that I am not getting much regular hands-on experience. My only experience with this stuff was the 9 months I worked at the other ER (which is still a smaller ER). I feel like I'm always just caring for people with toothaches and occasional SOB or CP or the chronic COPD etc. I know all ER's get these cases and there's much to be learned from them but I'm just rushing around...I do ask questions when I can to try and understand things but I just don't feel right! In the winter, we get a lot of fractures because of the ski hill but...I just feel frustrated and am not sure where to go with my career! Does this make any sense to anyone?

I have been thinking of trying to get some books to read just to keep learning and keep my knowledge current or increase my knowledge. I've also thought of doing a travel assignment too...I don't know which books would be the most helpful for me.

Sometimes I wonder if nursing is what I really want to do or if I just haven't found the right fit? I just feel dissatisfied.

Does anyone have any suggestions for me? Either books or education I could read or attend? I've thought about going to school and getting my NP but would I really be happy with that either?

When I work in PACU/Sameday I'm incredibly bored...I do it for a change a pace and was hoping to learn more but I usually just end up feeling bored even if its busy and counting the hours til the day ends.

Anyone have any ideas for me??

Thank you!

[loricatus]

Check out the ENA's (Emergency Nurse's Association) website

http://www.ena.org

You'll find a wealth of information there, more information and discounts if you join.

[Medic09, BSN, RN, EMT-P]

Well, you've already taken the basic ENA sponsored courses, so not much left that way. And you clearly see yourself the problem isn't 'courses' or 'certs'; it is experience.

I know you're a single mom, but the only things that come to mind are working occasional shifts somewhere busier if possible, and volunteering with your local EMS squad. It sounds like you must be in a pretty rural area (an ER that can be staffed by one doc and one nurse), so I wouldn't think you have a lot of options.

I would say also look for some workshops that have serious simulation as a component.

[Larry77, RN]

I agree that exposure is what you are looking for...how about getting a relief position at the local "bigger" hospital's ED? Sounds like you have all the certs they will ask for, and enough experience for them to hire you. You could do the travel or agency thing but in my experience you tend to be thrown to the wolves and if you don't feel real confident you could sink easily.

As far as books Sheehy's Manual of Emergency Care is a great book for reference also I would recommend some conferences there is usually trauma conferences and critical care/emergency nursing conferences both have been informative in my experience. You could study and take your CEN as well but I think experience will help more than studying for that exam.

Hope some of this helps,

Larry

[CARLINAYLSWORTH]

Hi,

If you are willing to try something really different, then i would suggest Doctors Without Borders. They are an amazing, well managed organization that gives emergency and long-term aid to those most in need in this world. They are highly in need of ER nurses right now and you will still receive a salary. This is extremely rewarding work and might be the change you're looking for. Hope this helps. Good luck, Carlin

http://www.doctorswithoutborders.org/work/field/?ref=main-menu

[AndyLyn]

I hear ya. I work in a similar situation, although we do get our fair share of critically ill patients. I joined ENA and have been studying to take the CEN exam. It's given me lots to think about, and I try to work in what I've been learning with my real life patients.