ER vs. Bedside

First off trying to be as unbias as possible, but I am an adrenaline junkie and ER is my love, but I can tell you what my days were like on a med/surg floor vs what they are like in the ER. And not saying any one is better than the other, we all need each other to do our jobs. K here goes:

When I worked med/surg I found I had more structure to my day as far as scheduled meds, scheduled tests and meals for the patients at regular times. Doctors orders written or taken over the phone, unless it happens to be rounds. However that said, there were always the admissions coming to the floor and the discharges to send home that are not on a schedule. There was the unexpected patient that takes a turn for the worse and left me running all day long on no sort of organization. I found that I was able to get to know my patients and families better because the floor I worked on tried to give us the same patients during their admission. There were days when I couldn't have fit a lunch if I tried, and other days where I had an easy patient load and was rather bored.

Now I work ER and the main difference is you just don't know! You don't know who or what is coming through your doors. A variety of patients infant to elderly with a vast aray of complaints. Alot of orders are verbal orders to carry out and get written by the physician later when the patient is sick. I can start orders before the patient is seen by the physician. Pretty much nothing is on a schedule, almost all tests are ordered stat, and meds are given and titrated and changed all in the course of a few hours by talking to the physician face to face. We start almost everything, IV's, O2, Foley's, NG's, etc. However sometimes you are just that busy and unfortunatly some gets left for the floor nurse to do, as bad as I feel not having the patient all set before admission. Some things are done by the paramedics when you receive the patient by ambulance. Alot of the time I don't get time for a full lunch, but sometimes I do and spend the evening twiddling my thumbs because it is an oddly slow evening.

So I hope this may have been somewhat helpful, and like I said we all as nurses need each other from the beginning of arrival to the ER to discharge.

I work at a level 1 trauma center in northeast pa. We have a 43 bed ER split into 4 "pods" where each RN has a 4 bed assignment (1 section has 5). Our ER sees approx 200 pts a day. Each pod has 1 attending and 1 resident. We work very closely with our docs and are on 1st name basis with most. We also have protocols where we enter our own orders based on the pts s/s and our assessment. I work 11a to 11p which is the busiest by far....we are on a 4 week schedule with three 12's and 1 week with four 12's. The ER is considered an ICU and I love the WIDE variety of skills that are needed on a daily basis. As Rita had posted...we utilize every skill we have....ng's, picc's, codes, etc. Our acuities vary greatly. We see newborns with RSV to geriatrics with GI bleeds to 25 y/o's with migraines. Rita is correct is posting that we do not have the "privalege" of frequent breaks that RNs on med/surg have....but the experience is well worth it. I have noticed that RNs that choose the ER are either pre hospital junkies or those with goals to become flight nurses....others like myself are all after the thrill and experience....although there are "dull" times and the occasional demanding patient. Other ICU's have approx 1-2 pts depending on the acuity....I personally cannot titrate pumps and do neuro assessments for a 12 hour shift.....some enjoy the 1 on 1.

I have never "worked" med/surg but did do 3 med/surg clinicals in nursing school and was usually bored out of my mind. I started out in the ER and have not regretted it. The first few months are rough, and there is a huge learning curve, but I love the fact that we can get labs, do our "standing orders" before the doc even sees the patient. We get to learn and use a lot of different skills as was mentioned, and I feel like the unpredictability of the ER keeps things exciting. It is a good place to work if you like to use your critical thinking skills, want to hone your assessment capabilities, and learn how to act quickly in a code without freaking out (as I have seen some med/surg nurses do during codes on the floor, no offense or anything, we just tend to get more codes in the ED). I work twelve hour night shifts. Not a lot of support at night to be honest, you have to be creative and resourceful to get all the work done. I rarely get to take an entire 30 minutes for my lunch. We keep finger foods by the pyxus to snack while we work. We are a tight knit group and I like having the doc there at all times. Sometimes you get burnt out by frequent flyers who just want Narcs, attention, or "3 hots and a cot". That can be hard sometimes, because these people rarely get admitted so on a med/surg floor you really wouldn't have that type of problem. It can make you angry and frustrated to see the same patient come back three nights in a row in a pathetic attempt to get narcs. But then when you do actually have a patient who has a real medical emergency/problem, and you help them, it is that much more refreshing. I love the ER. Try to see if you can shadow a nurse for a day or something to get a better feel for it.

Everyone has already said about everything I could say. I can tell you, ER gives you a good foundation on your nursing skills, because you are doing ALL of them on a consistent basis, and get quite good at them!

If you are looking for an environment where you can establish a meaningful bond with your patients, and get them back to better health, ER is not the place for you. While you are at the beginnings of establishing that nurse-patient relationship, before you know it they are gone. If you like a structured setting and a schedule (when to pass meds/treatments), ER is not for you. If you don't like working under constant pressure, ER is definitely not for you.

But, if you like doing your skills over and over, if you like diversity, working in a fast paced environment, blood and guts, crazy people, critical care, and babies to the most ederly: ER is for you.

My best advice I can give is to is to do what the above post says: Job Shadow. You can see for yourself what you like the best!

Hope that helps some!

Cory

I started out in the ED as a new grad 7 months ago, and I absolutely love it. But my 2 cents, on top of what everyone else has already said, is that we have our doctors immediately available 24/7. As a new grad, sometimes it's hard to decide whether you need to call the MD in the middle of the night. In the ED, it's nice to be able to ask for a different pain med right after reassessing the pts pain or to ask if you can give that toradol IM instead of IV.

In addition, I think ER nurses are definitely more at risk for burning out. Like ILoveTheBeach said, we get a lot of drug addicts and people with toe pain x 1 year who have this sense of entitlement and want to be treated like they are in a hotel - these guys are soul suckers, as we say. Unless you have good coping skills and a great relationship with your coworkers, this could make you very unhappy with your job. Fortunately, I know I can leave those pts and come vent to my coworkers whenever I need to.

On that same note - in our hospital I've noticed the ER nurses are much more tightly knit than floor nurses in general. This might be because, on a daily basis, ER nurses have to rely on eachother to pick up our slack when we get that LOL with a GI bleed and a pressure in the 70s and our other 3 pts are screaming for pain meds. I think on the floors, since things tend to be much more scheduled, this type of problem doesn't happen as often.

Also, on nights, we do a lot of potluck meals that we can all graze on because it really is hard to sit down and have a full 30 minute break (can't say that all EDs do that, but it sure is nice).