How do you know if you are ER material?

MedSurgeMess · Dec 22, 2009

Try shadowing in the ER for a shift or 2....especially during a busy time.

chelynn · Dec 22, 2009

I knew from the minute I went to my first ER clinical that ER is where I wanted to be! You definately need quick thinking, common sense, the ability to think on your feet, and be able to multi task and quickly turn from one way of thinking to another; as in you will be room hopping from many rooms and pts of different acuity levels. It is importantto be able to swich gears from the broken hip in one room to the lumbar puncture assist in another to the trauma coming in the door. Good luck at your interview!

proudnurseRN · Dec 22, 2009

I'm not an ER nurse, but I thought I wanted to be. I loved the ER; I did an externship there and tried to get as many clinicals there as I could. On my very last clinical, there was a 20 month old that passed, and a 2 yr old that was being shipped to a children's hospital in bad shape. My son was 18 months old at that time, and it was then I realized I couldn't ER. I couldn't do peds. I couldn't do L&D. So I know that isn't your question, but I thought it might also be helpful to hear why people didn't choose ER. If there were an adult only ER I'd be there with my roller skates on, but *I* can't handle sick kids. I'm glad there are nurses out there that can though, and are good at it. I remember one nurse when I took my son to the ER and he was being admitted. So kind, so compassionate, and so funny. I don't know how she got me from an emotional mess to a semi-composed parent, but she did.

Da_Milk_of_Amnesia, MSN · Dec 23, 2009

If you can stomach, and emotionally deal with seeing people in the worst shape possible, and watching people die, including kids right in front of you then you might survive. If not, then I'd suggest you find a new area to work in. ER is not for the weak of heart or mind. The **** you see will warp you inside out. I've done EMS for 8 years and the people that i pick up are what you eventually get to deal with and most of the time it's not a pretty sight. So learn to deal with death and hysterical familiys and people being just plain ridiculous sometimes. ER is a world all to it's own. And if you think it's easy to 'just forget' think again. No matter how hard to try to leave work at work, it will follow you for the rest of your life. Images of the things you see will be burnt on your retinas. Scared yet? If those are things you've never seen or dealt with. I would be if I was you. Good luck, you'll need it.

kathy313 · Dec 23, 2009

I always joked that my ADD helped in the ED, you have to be able to do 50 things at once some nights. Taking care of someone who's been constipated for a week and decides to come in on Sunday evening (middle-aged male who actually had the nerve to ask for a note for work the next day) to the nine month old in the next room with bruising on her inner thighs and lady partsl area.....you have to keep a steady head and a steady hand and learn to control your emotions. Not saying you have to be cold, but you have to develop a thick skin of sorts. You definitely see people at their worst and sometimes you are the last one a person sees. And definitely a macabre sense of humor helps...lol

Working ED was the best learning experience, there was always something different walking in. It was tough and brutal, but it also gave me the greatest satisfaction.

paacollins · Dec 23, 2009

I'm not an ER nurse, but I thought I wanted to be. I loved the ER; I did an externship there and tried to get as many clinicals there as I could. On my very last clinical, there was a 20 month old that passed, and a 2 yr old that was being shipped to a children's hospital in bad shape. My son was 18 months old at that time, and it was then I realized I couldn't ER. I couldn't do peds. I couldn't do L&D. So I know that isn't your question, but I thought it might also be helpful to hear why people didn't choose ER. If there were an adult only ER I'd be there with my roller skates on, but *I* can't handle sick kids. I'm glad there are nurses out there that can though, and are good at it. I remember one nurse when I took my son to the ER and he was being admitted. So kind, so compassionate, and so funny. I don't know how she got me from an emotional mess to a semi-composed parent, but she did.

I am the same way. I can't handle sick kids cause I always see my own in that situation. I could do an adult ED with no problem. We have a hospital about an hour from here that their ED separated and has one for kids and one for adults. That I could do. I love the ED because of the fast pace. Never boring.

RhiaRN75, RN · Dec 23, 2009

A long post but what a question! It's not easy to answer, and even as long as my post is it only scratches the surface.

See if you can hang out in the ER on a weekend night, all night. Friday is ok, Saturday better. Sunday will be full of all kinds of goodies, from being swamped with work/school note visits to seeing people who tried to wait it out until the doctor's office opens- and waited too long. Sunday night in the ER can be an experience.

If you want to go a step further, try to schedule your night near the end of the month. That's when people are broke, out of medicine, out of food.... just out of resources in general. For the ultimate experience in interesting folk, check the local court docket and see when court is- the busiest court day will be immediately preceeded by an equally busy and interesting night at the ER. Cynical, but true.

To know if you're ER material take a good look at yourself. Strengths, weaknesses, fears- you'll come head to head with almost every situation you can imagine. Can you do CPR on a 16 yr old wearing the same shoes as your son? Can you be open-minded enough to realize even drug seekers get sick? Can you care for a baby having seizures while the parent who probably shook her is right there crying? Can you keep everyone seperated and calm with as much tact as possible when a man and his girlfriend are in a fatal car crash and the wife shows up? (With reinforcements.) Can you keep a straight face and document objectively when someone says their dog accidently knocked the bottle of narcs in a toilet and somehow flushed it? (Can you keep a teeny portion of you mind open enough to realize that stranger things have happened?) Can you de-escalate a violent person? Stand up to a doc, pick your battles, do compressions until you're sure you must have rhabdo, teach an alcoholic basic nutrition because he's not quitting anytime soon, do horrible things to kids to keep them alive, apologize to someone who's had to wait an hour to be seen when all they want is a tetorifice shot (and realize it's easier to apologize in the long run).

Do you want to know everyone in your community, their skeletons, addictions, fears, gynecological problems, and possibly have them want to discuss these things with you at the WalMart? Welcome to ER, lol.

The basics. You need to be a good MedSurg nurse. Float experience is even better. (The exception is EMS experience.) You have to know psych. You need at least ACLS and be able to run a code, but be prepared for NALS, PALS, TNCC, ENPC, trauma certification, and more. You need to know the difference between T-wave abnormalities and Oh Shoot- look at those T-waves! You need to be willing to look up the weird stuff- that pt you see coming in over and over again with nonspecific abdominal pain may not be crazy- he might have carcinoid syndrome.

How do you feel on the floor after a pt goes bad? Wiped-out and overwhelmed? Or do you go home full of energy, unable to sleep because there's a little twisted part of you that likes it when someone tanks? A major storm is coming.... are you excited at the prospect of worse case scenario or do you need to stay home or evacuate?

The ER can be boring, as well. You see a lot of routine doc office type things, it's not all heart attacks and trauma. On the other hand, last call on a Saturday night ceases to be amusing when it goes beyond a cheerful drunk who broke a leg and heads straight into the hell of a family coming home late from vacation T-Boned by a drunk driver. You need a thick skin, but you still have to be able to bleed when necessary. You have to realize that giving the best care to some people only ticks them off. No one behaves in a reasonable manner. The person with a cold is packed and wants to stay a few days. The new sick sinus syndrome pt doesn't give a flip about the impressive 15 second pause- she has kids at home to take care of.

You may find yourself in the incomprehensable predicament of trying to arrange a VA transfer/refusal at 5pm on a friday for an acute STEMI who refuses to transfer anywhere else until the VA approves it.

You'll do this and more in the ER. Size and location doesn't lessen the ER experience. The level I trauma center would seem to be the ultimate experience- after all, they're the experts. Totally true- but who first saw and stablized the MI, trauma, head bleed, psych, abused child, acute leukemia, toxic shock syndrome, hypothermia, flesh eating, about to die right now pt? The teeny tiny hospital in some hick town you never heard of. Which is why I loving working the ER in my little hick town- it has it's perks :)

If you read this and think I've lost my mind- better wait a while. If you read this and you're fired up, ready to google TNCC and see when the next class is- when can you start?

RN <>< · Dec 23, 2009

Rhia thank you for your time to write such an informative post. I honestly feel in my heart that I do want what you speak of. I think standing up to a physician will be my weakness however, I am hoping that will come over time with experience. Also I know that I will need to increase my drug calculation time because I am a little slow. My strengths are that I have to move...no just sitting around...things have to be going on around me to keep me awake. Just like Kathy above I have that ADD and just think that the ER will be perfect for me. HR told me it was a trauma 2 and that they do not get kids. However, I did shadow my instructor about 6 months ago and they had kids. Those kids only had a fever, I honestly don't know how I would react if it were serious--I do know that it will involve tears, just hopefully not in front of the patients.

FlyingScot, RN · Dec 24, 2009

Can you go for a minimum of 13 hours without peeing (and not get a UTI), is food really all that important to you, are you grossed out by people drinking Mountain Dew out of urine graduates or cake from emesis basins, do you mind being called nasty names (not always by the patients), can you hug a homeless guy, can you see the good in maggots feasting on supporating wounds, can you cry, can you laugh at yourself, can you refrain from slapping the child abusing mother, can you figure out how to care for the hysterical Down Syndrome man who is terrified of being in a treatment room but will say "cheese" for a chest xray with the biggest grin you ever saw, can you pray with someone of a different faith over their dying parent, can you push a mop, pull a trash bag and find green jello at 3AM for the dehydrated 2 year old? If so you might be an ER nurse.

BVP910 · Dec 24, 2009

Rhia and FlyingScot thank you so much for such awesome posts!

RhiaRN75, RN · Dec 24, 2009

You're welcome. Add opinionated to the list!

Everything FlyingScot said is so very true.

I must admit though, I am amazed. I am in awe.

:bow: You can find green jello??

My facility has an ironic love of all jello colored red. Sheesh... does it always have to be red?