Freestanding ER question; unhappy with current job

[turnforthenurse, MSN, NP]

Does anybody here work in a freestanding ER and if so can you share your experiences?

I'm looking into branching out. I love the ER but I feel like at the same time I'm facing severe burnout. I'm no longer excited about work and in fact I just dread going to work on my scheduled days. Some of the doctors are just so unapproachable. We have a lot of holds lately so most of the time I feel like I'm working inpatient vs working the ER and then when I actually have a sick ER patient coming in, my holding patients end up on the back burner and then I feel like a terrible nurse because I have "neglected" them.

I feel like I don't get any support from management and they just all seem to walk around with a smug look on their faces. Some days we are drowning because we are short on staff. The acuity is also pretty high where I mostly have level 2's with maybe a 1 thrown into the mix. This place is just so stressful.

I worked at a level 4 trauma center prior to this where we mostly got level 3's and 2's but usually a nurse would have all level 3's with maybe one level 2. I was honestly much happier there. Better staff, better management, better doctors, everyone worked as a team. No holds.

I was talking to someone who says they work in a freestanding full time and then work PRN at ERs in a hospital through an agency to keep their skills up and to avoid burnout. They were basically in the same situation as me.

Anybody have any advice?

[JBudd, MSN]

By freestanding do you mean an urgent care clinic with no hospital attached? So no admits?

I hear you about all those admitted holds, if I wanted to do med-surg I would still be on the med surg floor! Urgent care clinics rarely see and/or keep the heavy duty ones, the STEMI or GSW adrenaline rush type patients. Would you be happier with all low acuity care?

[turnforthenurse, MSN, NP]

Not an urgent care, a freestanding ER...an ER that isn't attached to a hospital or anything. They probably get a lot of urgent care-type stuff but they can get actual emergencies, too. I'm hoping someone out there on this forum can shed some light on this!

I honestly don't know because I love the ER but I feel like with where I'm at now there are many different factors contributing to why I'm currently unhappy with my position. I'm also trying to avoid complete burnout.

[OBigdog26, MSN, RN, NP]

I work at a freestanding ED. It's not as bad as a regular ED with a hospital attached. You still see the frequent flyers and druggies You still get medic calls, trauma pt's, stroke, STEMIs....it's not a place for new RNs. It's definitely a little more challenging being in this setting because it feels like you are in an island. What I mean by that is you don't have the resources like you would in a regular ED. It's just 3-5 RNs, 1 provider, and ancillary staff. Our ED doesn't have any CNAs or respiratory. So, basically as a RN you do it all.

Patients that need to be admitted get transferred to the hospital. We still have psych holds. Sexual assault cases are still seen by a SANE RN. We have CT, XR, US, and lab in the ED.

What really irks me is when medics send us inappropriate patients who end up being admitted. Also, it can get really frustrating when patients go to the FSED treating it like an Urgent Care.

Edit: we do have good teamwork at my FSED. Everyone looks out for one another and helps out. For the most part, most of the doctors are approachable and will listen to you.

Sent from my iPhone using allnurses. Pardon for any misspelled words, I blame it on auto-correct.