How do you know if you've got what it takes to be an ER nurse?

MMARN, BSN, RN · Dec 29, 2005

Just wondering and it may be a stupid question, but can you shadow a nurse while you're in nursing school or do you have to wait until you're out of school or before school? How does that work? Thanks for the help.

JMBM · Dec 29, 2005

There's been so much good advice on this thread - I will chip in another plug for shadowing, especially if you can do it at the facility you hope to join. ER's vary tremendously. Shifts also vary tremendously, so try to hang out a few different shifts, weekends, etc. Realize that most of your work will not be trauma/cardiac dramatics. Most of the issues will be fairly routine - migraines, flu, kidney stones, UTI's, etc. I really don't like the term "adrenaline junkie", since the best ER nurses I've worked with deal with critical situations with calm, quiet confidence. I think a better description is that an ER nurse has to be comfortable working in chaos with priorities that change minute-to-minute. You have to be fairly thick-skinned, since every patient and doc needs what they need RIGHT NOW. You have to have a sense of humor, since there will be times when you have to laugh or you'll cry. Mostly, you just need to see, so find a spot where you can shadow.

pikevillenursing21 · Dec 31, 2005

I am a 4th Semester ADN nursing student!!--YAY-- Anyway, I really want to work in the ER--I haven't done any preceptorship there yet or anything, but I love working in the moment--not knowing what is going to happen from one minute to the next--

My question is--how important is it for me to go to a Floor and work my first year? Or is it possible just to go straight into the ER and learn just as fast as you would on a floor?

I have been battling this decision since I started nursing--I really want the ER and don't want the floor but others have told me "youre asking for it if you go straight to the ER"

I really want this though--what do you all think? Does any one have any similar problems?

chip193 · Dec 31, 2005

I am a 4th Semester ADN nursing student!!--YAY-- Anyway, I really want to work in the ER--I haven't done any preceptorship there yet or anything, but I love working in the moment--not knowing what is going to happen from one minute to the next--
My question is--how important is it for me to go to a Floor and work my first year? Or is it possible just to go straight into the ER and learn just as fast as you would on a floor?
I have been battling this decision since I started nursing--I really want the ER and don't want the floor but others have told me "youre asking for it if you go straight to the ER"
I really want this though--what do you all think? Does any one have any similar problems?

I had a similar conversation this morning with my Nurse Manager.

So long as your hospital's orientation period is long enough for you to become comfortable and provides you with enough critical care education (nursing school really misses the boat on this one!), then you're fine going right to an ER. In fact, she PREFERS new grads to folks who are ICU or med/surg nurses as she doesn't have to "unlearn them of any bad habits!"

For the record, we have 55K visits a year, are a trauma center, stroke center, and are an isolated tertiary facility providing back-up to two Critical Access Hospitals in our health system. So, no, we're not some little place!

Chip

Beth_audrey · Jan 1, 2006

what are some of your expierences that you would definetly have had to have a sense of humor to get through the day?

chip193 · Jan 1, 2006

what are some of your expierences that you would definetly have had to have a sense of humor to get through the day?

well, last night, i had a patient who had a sense of reality that was parallel to the rest of us! after attempting to placate her while she was being medically cleared, she became beligerant and started screaming at the top of her lungs at me because i had not taken care of the biological warfare reminents on her lip. she then fired me. yes, she told me that she was the ceo and was firing me.

chip

Jen2 · Jan 1, 2006

What are some of your expierences that you would definetly have had to have a sense of humor to get through the day?

I once had a patient yell at the top of her lungs in the ED that I could not come near her because I fu#$@d her husband. I then had to go in the room across from her and administer antibiotics to a 4 month old baby of very nervous new parents. When I walked in the room the parents asked me if it was true what I did (not knowing that the patient was a psych patient), and I said, "Only on my days off." We all got a good laugh out of it. Instead of getting mad and upset you have to move on to the next patient and still care for people.

Beth_audrey · Jan 1, 2006

well, last night, i had a patient who had a sense of reality that was parallel to the rest of us! after attempting to placate her while she was being medically cleared, she became beligerant and started screaming at the top of her lungs at me because i had not taken care of the biological warfare reminents on her lip. she then fired me. yes, she told me that she was the ceo and was firing me.
wow that must have been a great night:chuckle

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Jan 6, 2006

I'll admit to 20 years of ER.

1. Just going in remeber nobody was born knowing all this stuff. We all had to learn, now it's your turn.

2. In the "worst case scenario" don't judge how well it went by the book. Something always goes wrong (cracked suction canister, burnt out laryngoscope bulb, etc.). Judge how well it went by how the inevitable SNAFU got handled.

3. You're an ER nurse as long as you find it all exciting. If it's all stressful, find another area of nursing to enjoy. If it's boring and there's nothing new anymore (my problem) find a new are to go learn and be challenged.

4. Two essential skills. Prioritization and continuous reprioritization, and good assesment skills.

5. Don't worry about a sense of humor. The ER is always entertaining. You can recognize a long term ER nurse because he or she wont bat an eyelash when a patient claims "I have no idea how that got in there."

Beth_audrey · Jan 6, 2006

How do you, the expierenced er nurses, cope with some of the really sad stuff you see? Do you have a stories that have really touched you?

carlarn, BSN, RN · Jan 6, 2006

There are always going to be some bad things. Here are some that I have had to deal with and how I dealt with them. Not that I cry all the time, just when I feel it is warranted.

I have had to tell a man his wife died in a car accident he walked away from with just scratches. I had a patient who arrested in CT while I was praying with him.

I had a patient confess murder to me. The police were in the room and missed the entire confession. Yes, I had to go to court and yes, he went to prison on my testimony. That was a real party.

How did I cope with these things? Well, I cried with the man whose wife died, literally for hours. I talked with him about her and called his family for him. Then when I went home, I cried some more.

The man who arrested in CT--I cried while we coded him. I cried as I wrote my notes. I cried when I talked with his family and told them he and I prayed before he died. I cried some more when I got home.

The man who confessed murder--well, I talked with my doctor and coped by taking Xanax. There is only so much you can do on your own. I also talked to a counselor. The Xanax worked better. My colleagues were, for the most part, very supportive. The administration, on the other hand, was less so. I was advised not to talk to ANYONE about the confession. That is why the Xanax was so wonderful.

The very best advice people here have given is to have a sense of humor. OK, so it isn't funny when someone dies, but when you are in the middle of a code and someone does or says something funny, well you just laugh. It cuts the tension. Like the time I told someone to go towards the light. Or the time I thumped this guy on the chest when he went into V-tach (hey, it worked). Or the time the ED doc thumped an LOL on the chest and she told him to not do that again because it hurt.

It isn't fun trying to change wet linens from underneath an obese patient, but it is funny when she farts when you roll her over and the nurse who is helping you totally loses it and tries not to let the patient know she is laughing hysterically.

It is very funny trying to walk a 6' 4" drunk to the bathroom when he doesn't have a steady gait. He is also wearing clothes he has urinated in and is leaning on you because he is incredibly drunk. His last name was Shannon and I dubbed his drunken walk the "Shannon Shuffle". This same guy had also been in prison for armed robbery. I pointed out to him that, of course, he was an armed robber because he still had both of his. He loved my joke.

If you have a sick sense of humor, can see humor in other people's misfortune, can work with some of the bossiest/most aggressive/most assertive nurses ever, function semi-independently, and still maintain compassion for all mankind, then you can be an ED nurse. If you don't think you can measure up to any of that, don't bother. The ED nurses can be extremely tough. I know, I used to be one (though I wasn't necessarily tough, just extremely distrustful of new people). The reason for this is because they are trying to save lives. If you need to have your hand held during these times, the ED is not the place for you.

Please don't get me wrong, I loved the ED. The fact I didn't have to live with the same patient for days on end was definitely a plus. Not having to float to other units helped, too. Good luck to everyone who wants to work in the ED. It is a great place to work.

Thanks for letting me go on for so long. I can be a bit long-winded.:zzzzz

Mander2 · Jan 6, 2006

I am a new LVN (graduated 08/05), and recently I began to work in an area of the ER called specifically for admitted pt w/o a bed avilable, so there is a high turnover rate. I have spoke w/ my team leader regarding concerns/fears I have about being able to provide adequate care for the pt. There are ICu/ extremely sick tele pts that come back there, as well as medsurg/trauma. Being new I feel as though I don't have the rolodex of experience and interventions as well as the pathophysio aspect of it! It is very overwhelming!!! Make sure you have the experience (knowledge of interventions) and assessment skills down, and if you enjoy the fast pace you'll love it!! I worked as a tech in the ER, adored it and would do it again, however as a nurse,(at least until I get years under my belt) I don't think it is for me! :) Try it out!!!!! You might love it!!!!