Growing Thick Skin.

RheatherN, ASN, RN, EMT-P · May 4, 2008

i dont know if it was the fact that it was ER, or if it is just the staff where ever you work. i have thicker skin from being where i am now d/t certain staff than any past job. medic; er...ect.

TraumaNurseRN · May 4, 2008

Do you think working in the ER has helped thicken your skin? Or is that something that's a pre-req for being in such a high intensity place?

I personally think it takes a special kind of person to work in the ER. You do need a tough skin at times. It's a tough job. But there has been nurses who some have thought they would never make in the ER setting, and do just fine.

fireshifter · May 4, 2008

I'm not an RN yet, but I was an EMT in an ER for 3 years. It totally toughened me. I agree with another poster that it had to do with the staff sometimes, rather than the job. Of course, I didn't work trauma so I'm not sure if that would have changed anything.

I think the perception from outsiders was hardest for me to deal with. I was pretty young working there and my friends were all in college. They would ask for funny stories or crazy things I'd seen. Sometimes, I really just wanted to tell them the sad story I'd dealt with, though. I didn't have anyone to help me deal with some of the stress and I didn't realize I needed to handle it better. I'm eager to go back to the ER as a nurse with an adult mind and handle it a little more maturely.

Jen D.

flightnurse2b, LPN · May 4, 2008

i had thick skin before i went to work in the ER, from being a field medic. but when i started as a field medic, i questioned myself all the time about how i would survive in that kind of job because there were so many cases that broke my heart. it doesnt get easier, but after time you learn to focus on the task at hand and not get really upset about the actual patient. i know it sounds really callous, but distancing myself is the only way i can prevent a burn out. the ER is not anywhere you can have a come apart. but it is also the most rewarding job i can ever think of having and i can't wait to go back once i graduate in october.

mesixfuture · May 4, 2008

I don't think working in the ER has anything to do with growing a thick skin. I work on a WIC floor and we have some of the thickest skinned nurses you'll ever see. But then again we code babies, kids, deal with fetal demises....traumas aren'ts the only way to callous your hide. I'm very interested in the ER and I've pulled a few shifts down there just to see what it was like...my first trauma was a drug overdose/attempted suicide who was paralyzed from his waist down due to previous bullet wound injuries. He was only twenty-six, but it was a heck of a lot easier than coding a twenty-six week, 1 lb baby who had to be c/sectioned early because her twin died in the womb and was making her septic. My thick skin might also be due to the fact that I'm a medical examiner on the side, but never let it be said that ER is the only breeding ground for a second epidermis.

akvarmit · May 7, 2008

Interesting topic.......I was thinking about this at work recently.

I always thought I got "thick skinned" from my ER experience, but I view it differently now. I work managing 7 staff in a D&A rehab right now and I"ve never seen so much unjustified attitude and entitlement - -okay - -except maybe from those 3am patient's with cold sx that used to come in via EMS, and then want food for their 3 kids they brought with them. :banghead:

When they spend a ton of energy debating ridiculous things with me, I want to remind them that where we work, no one is coding! I feel like saying "You want to talk like that, someone had better be trying to die!"

Unfortunately, I would be cracking myself up, and they wouldn't get it. If you call that thick skin, then I guess I"m guilty. I'd take the camraderie of working a trauma over this staff's drama. I think "thick skin" is just a survival skill of focusing on what's important and letting the other stuff slide off.

Headed back to the ER in (countdown) 17 days :yeah:

fireshifter · May 7, 2008

Reading through some replies, I guess some of it is what constitutes a thick skin. Is being jaded about society because of your experiences in the ER "thick skin" or is it just being disillusioned that there is good in all people or is it the sick humor we develop or is it being able to handle someone who is not very nice? I've been treated poorly by patients, but I've also been treated very poorly by doctors and nurses while working as a tech.

I look at some of the jobs I've been involved in and realize that thick skin looks different to each person in each job. We kinda choose which battles are worth it to us in our jobs. I would never have the patience to put up with doctors all day in an OR. I remember the few times a certain plastics guy would come in and berate us all every time he came in to do a sew job. Same with an ortho who was frequently on call.

Our ER docs were mostly very easy to work with and allowed a ton of autonomy on the nurses' part. There were a few that weren't all that great to work with but not so bad on a personal level. The medics that came in were tolerable and fun. The patients were a toss-up, half were easy and half were difficult. That kind of environment worked for me. Patients were typically in for less than 5 hours in the ER (unless we were holding for the floor due to lack of room) and then they were gone. That also worked well for me.

So, I think that pretty much every place you can work as a nurse might be a place to encounter thick skin, BUT you pick the places where the negatives are outweighed by the positives in your mind.

What do you think?

Jen D.

nursingisworkRN · May 8, 2008

I recently transferred to the ER and feel that it is helping me develop "thick skin". This is not to say the negatives outweigh the positives. I have a great job with plenty of autonomy and my input is respected (for the most part). My coworkers and the environment have helped build my thick skin. I have always been sensitive to criticism and nastiness, and even if not involving me I would often get teary eyed. In the ER if there is conflict, it gets resolved on the spot. I don't mean people complaining, but rather problem pointed out and problem solved. No catiness, no backstabbing makes it so much easier to go to work and do your job.

As far as just being jaded, I am not there yet and when I do it is time to move on. With some of the difficult pts I have to be nurse ratchett, but with others I am free to smile or laugh or cry and just be in the moment. It usually has to do with how busy the ER is, how sick my pts are, and of course if the pt is trying to kick me or bite me. Then come the restraints and I do laugh from time to time when I see someone trying to chew through them.

For me the thick skin comes from watching my role models-aka nurse heroes- demand respect by their actions with pts, mds, etc. They are not pushovers, but they also admit when they are wrong and correct mistakes. They don't let people talk down to them and then feel bad, and really nobody ever should.

TraumaNurseRN · May 14, 2008

I don't think working in the ER has anything to do with growing a thick skin. I work on a WIC floor and we have some of the thickest skinned nurses you'll ever see. But then again we code babies, kids, deal with fetal demises....traumas aren'ts the only way to callous your hide. I'm very interested in the ER and I've pulled a few shifts down there just to see what it was like...my first trauma was a drug overdose/attempted suicide who was paralyzed from his waist down due to previous bullet wound injuries. He was only twenty-six, but it was a heck of a lot easier than coding a twenty-six week, 1 lb baby who had to be c/sectioned early because her twin died in the womb and was making her septic. My thick skin might also be due to the fact that I'm a medical examiner on the side, but never let it be said that ER is the only breeding ground for a second epidermis.

We code the babies as well. We get the whole spectrum, fetal demises, traumas and delivering of healthy bouncing babies. We had 2 SIDS babies just last week, and a trauma of a 9 year old who died as well. The ED is the front door to the hospital. Many times all of your patients are tanking at the same time. :smokin:

Trauma Columnist · May 14, 2008

ER nurses deal with some of the worst of the worst. Yes, I certainly got a lot tougher in the 10 years I spent in the ER. However, I also developed more compassion and empathy because I realized how truly frail and fragile life is. Is it fair that babies and children die? Nope, but it happens. Is it fair that people abuse older people who can't defend themselves? NOpe, but it happens. Finally, is it fair that the innocent die? Nope.

We as ER nurses offer hope to our patients and support to our co-workers. When we are done with an awful 13 hour shift where we have had multiple codes, the ICU is full so we have held ICU patients in the ER all night, the waiting room is full and oh yeah, EMS is brining in the 100th drunk of the night, yep, I get a little jaded too. However, we go home, get some sleep and face it again.