I am really thinking this is not the right job for me - Am I Crazy?

peggyon, BSN · Mar 22

You are not crazy. You are working in the worst environment possible-a public, under-funded hospital with the most challenging patient population.

Try to complete one year and then apply to an ER in a private hospital. It will be better funded and the patient population will be less needy.

You seem bright and capable-how about adult ICU? ICU nursing will place you on another level clinically. You will work closely with intensivists and other specialists. It can be stressful but it is more controlled than ER. You will not have more than 2 patients.

I worked in ICU for 10+ years and was then able to transfer into PACU (my favorite job)

and lastly Case Management where my clinical knowledge afforded confidence when I needed to advocate with MDs for patient's needs.

JKL33 · Mar 22

Quote

I often have over 20 or even 30 patients between myself and one other nurse, no tech and no phlebotomist.

At once?

That just sounds stupid. High volume is one thing; high volume without anywhere near enough manpower quickly becomes intolerable. I think not wanting to practice that way is perfectly reasonable.

Birdsofprey, BSN · Mar 23

peggyon said:

You are not crazy. You are working in the worst environment possible-a public, under-funded hospital with the most challenging patient population.

Try to complete one year and then apply to an ER in a private hospital. It will be better funded and the patient population will be less needy.

You seem bright and capable-how about adult ICU? ICU nursing will place you on another level clinically. You will work closely with intensivists and other specialists. It can be stressful but it is more controlled than ER. You will not have more than 2 patients.

I worked in ICU for 10+ years and was then able to transfer into PACU (my favorite job)

and lastly Case Management where my clinical knowledge afforded confidence when I needed to advocate with MDs for patient's needs.

Thank you for your suggestions and insight.
I think I will try lasting until 1 year and then try for ICU or PACU, or at least ER in a private hospital. I'm just tired of juggling so many patients with so many needs, hence the areas you suggested will be more tolerable/I can keep leaning more.
Even if I decide to go back to travel I'll try to wait til I get a year of ER in so at least I have that on my resume.
In the grand scale of things, a year will be here soon enough.

JKL33 said:

At once?

That just sounds stupid. High volume is one thing; high volume without anywhere near enough manpower quickly becomes intolerable. I think not wanting to practice that way is perfectly reasonable.

Very true.

brandy1017, ASN, RN · Mar 23

You are not crazy! The patient ratios are insane and totally unsafe and not doable! Plus dealing with a very difficult patient population only adds to the insanity. There was a young nurse Tristan Kate Smith that committed suicide who worked in an ER that was understaffed. She had written a letter to her abuser ie the hospital! It was found in her things. She stayed too long and tried too hard to work in unsafe, impossible conditions and it cost her her life!

https://nurse.org/articles/nurse-died-by-suicide-letter-to-abuser/

https://www.beckershospitalreview.com/workforce/er-nurse-who-died-by-suicide-addressed-letter-to-healthcare-system.html

I knew that physician suicide is a major problem, but have since found out nurses are also at a high risk and are twice as likely to do this as those not in healthcare! https://www.aacn.org/blog/suicide-among-nurses-we-have-to-talk-about-it

It infuriates me that nurses are left to work in these unsafe conditions and management refuses to fix things. They don't care! They just want a warm nurse body who is agreeable and compliant and will do whatever they want and pick up OT at the drop of the hat. They refuse to fix things. They refuse to get adequate staff and equipment.

I agree with Tristan Kate Smith working at bedside is an abusive relationship in a lot of ways. But the bottom line is we have to leave the toxic jobs just like we would leave an abusive relationship. That is why I finally put myself first and quit my job end of 2020 and took early retirement after 27 years at the bedside. I stayed too long and the chronic stress caused health problems and the physical lifting caused me spinal stenosis.

Do not stay there a year even! Look for another job ASAP. Quit now if you can financially afford it. You have a variety of experience already and would be able to get another job easily. A coworker quit her job after going manic and trying for Social Security Disability and when she was denied over a year later waiting to hear from them (they almost always deny you the first time) she decided to go back to work and had no problem getting another job! Your physical and mental health and your license is too valuable to remain there where management has decided it is OK to leave their nurses in a dangerous, untenable situation. Put yourself first. Walk away from this toxic job. You deserve better and you need to care for yourself before you can care for the other patients.

Birdsofprey, BSN · Mar 27

brandy1017 said:

You are not crazy! The patient ratios are insane and totally unsafe and not doable! Plus dealing with a very difficult patient population only adds to the insanity. There was a young nurse Tristan Kate Smith that committed suicide who worked in an ER that was understaffed. She had written a letter to her abuser ie the hospital! It was found in her things. She stayed too long and tried too hard to work in unsafe, impossible conditions and it cost her her life!

https://nurse.org/articles/nurse-died-by-suicide-letter-to-abuser/

https://www.beckershospitalreview.com/workforce/er-nurse-who-died-by-suicide-addressed-letter-to-healthcare-system.html

I knew that physician suicide is a major problem, but have since found out nurses are also at a high risk and are twice as likely to do this as those not in healthcare! https://www.aacn.org/blog/suicide-among-nurses-we-have-to-talk-about-it

It infuriates me that nurses are left to work in these unsafe conditions and management refuses to fix things. They don't care! They just want a warm nurse body who is agreeable and compliant and will do whatever they want and pick up OT at the drop of the hat. They refuse to fix things. They refuse to get adequate staff and equipment.

I agree with Tristan Kate Smith working at bedside is an abusive relationship in a lot of ways. But the bottom line is we have to leave the toxic jobs just like we would leave an abusive relationship. That is why I finally put myself first and quit my job end of 2020 and took early retirement after 27 years at the bedside. I stayed too long and the chronic stress caused health problems and the physical lifting caused me spinal stenosis.

Do not stay there a year even! Look for another job ASAP. Quit now if you can financially afford it. You have a variety of experience already and would be able to get another job easily. A coworker quit her job after going manic and trying for Social Security Disability and when she was denied over a year later waiting to hear from them (they almost always deny you the first time) she decided to go back to work and had no problem getting another job! Your physical and mental health and your license is too valuable to remain there where management has decided it is OK to leave their nurses in a dangerous, untenable situation. Put yourself first. Walk away from this toxic job. You deserve better and you need to care for yourself before you can care for the other patients.

Thank you, I appreciate it. I know there's a better gig for me out there. I will find it.
You are so right- no job is worth my sanity or my health.

delrionurse · Mar 27

Birdsofprey said:

I am 9 months into my career as an ER nurse and I am really thinking this is not the right job for me. Which is very sad because I really thought I would enjoy it.

I started in Med-tele fresh out of school at a horrible Level 1 public hospital and then was a travel RN for 3 years. I always wanted to try ER but couldn't turn down the travel opportunities during the pandemic.

I decided last July to stop travel nursing and go back to staff as ED to finally get some Emergency experience. I work in a major city in a Level 1 Trauma, a public hospital that does not turn anyone away. People say if "you work here, you can work anywhere". I often have over 20 or even 30 patients between myself and one other nurse, no tech and no phlebotomist. Despite asking, I barely get cycled into the Emergency ICU or the trauma slot. Since most patients are admitted and waiting for an inpatient bed upstairs, I feel like a glorified Med-Surg nurse, which is what I was trying to get away from. It is a large Level 1 with a separate ER for Peds, so I will not even be trained in peds ER until I am there for a year and a half or so. So I feel like this isn't as great of an experience as I thought. Especially since in my interview I was told I would be cross-trained in peds ER. If I wanted to stay here then this wouldn't be a problem. But the idea of staying almost 2 years just to get peds or more trauma experience makes me wanna vomit.

To top it off, there is so much more liability here. Particularly in triage, I often can only go by what a patient tells me, once they change their story to the providers inside the ED I am asked why I did not catch certain things. Good thing I have thorough documentation. I feel like everything that annoyed me about med-surg is magnified here. Having 30 patients, many of which are intox/homeless/psychotic and having to babysit the nurse techs/other departments and make sure they do their jobs is too much. I understand this can happen in any ER, but the fact that we were not able to tend to certain patients more closely among the collective chaos makes me feel angry/helpless/anxious and want to leave this work situation as fast as possible. I dread going to work now. I promised myself if this ER job made me feel like how I felt at my first RN job then I would leave. Sadly it looks like that is where I am mentally now.

I am very burned out. I am so stressed out that other areas of my life are very lacking. This is way more than I signed on for. I did not feel this way as a traveler in M/S Tele even though I was bored with it and wanted a challenge.

I am trying to be grateful for what I have learned during my time in the ED- I am great at placing IV lines now, I enjoy triage, and I multitask and work faster than I did before. Many of my coworkers are great, too, I just can't justify being in this kind of situation despite that. MAYBE it is because many of them are newer nurses and did not work before Covid/did not start their careers until Covid was winding down- maybe they just aren't as burned out as I am. The turnover here is incredibly high and being here 2 years is a long time.

My plan was to do ER at a Level 1 Trauma for year and then go back to travel as an ER nurse. But now I am about to get out of here ASAP and just do med-tele as a traveler until I pay off my student loans. Maybe someday I will go back to ER... but I am starting to think that I should go to a community hospital or a level III or IV where there is less of a hierarchy and I can see a lot of things every week instead of waiting in line to be placed in those areas.

I don't know. Maybe I just don't want such stressful job anymore. I do not think it is sustainable to have this much acuity/volume of patients.

Thanks for letting me share.

Are you sure you trust this hospital to do trauma? If the patient ratio with a level 1 trauma is 1:1 or 1:2, I would say go for it. But if they give you level 1 traumas along with 4-5 other patients, I would say run. No way you could give good care to a trauma patient with patient ratios like that.

offlabel · 2024-04-22T13:57:42Z

These places are launch pads for ambitious people that want to train hard. Doing the CC and trauma sides in an ER like this is for the core, established and proven staff that have the appropriate certs and experience. Besides, a significant number of patients that come to the CC or trauma rooms come from the "20 or 30 patients" RN's care for in the general unit population and not straight from the ambulance stretcher. This is a different kind of nursing that is not for everyone. Inner city trauma centers, for all practical purposes, can be austere practice environments, occasionally approaching the intensity of forward combat medical units. Doesn't sound like a good fit.

Birdsofprey, BSN · 2024-04-22T14:13:44Z

offlabel said:

These places are launch pads for ambitious people that want to train hard. Doing the CC and trauma sides in an ER like this is for the core, established and proven staff that have the appropriate certs and experience. Besides, a significant number of patients that come to the CC or trauma rooms come from the "20 or 30 patients" RN's care for in the general unit population and not straight from the ambulance stretcher. This is a different kind of nursing that is not for everyone. Inner city trauma centers, for all practical purposes, can be austere practice environments, occasionally approaching the intensity of forward combat medical units. Doesn't sound like a good fit.

Yes. Many times the patients are upgraded to the CC area of the ER from the team area (the 20-30 pt a piece areas I mentioned- which can be a combo of glorified med-surg with some patients who can go south fast).

And yes the place can be more akin to a combat/war zone than a typical ER in other areas.

I actually enjoy the Trauma Slot and would love to spend more time there, the good the bad and the ugly. I recently spoke with my manager about it.

I came here because I wanted to train hard. And I am. Most people last a year here. With 2 years being an outlier. I am also working hard to discern what I like most about this environment and what this means about where I wanna go after this. The good thing is that I am now trained in triage, trauma, fast track and ER teams.

peggyon, BSN · 2024-04-24T17:09:27Z

I would say the only folks who benefit from 'training hard' in an inner city level one Trauma Center are surgical/trauma residents. If they can hang with the gunshot/knife wounds, the rapid bleeding-out, the extreme behavior, the MVA's, the unrelenting trauma and chaos, then they will be ahead of the game when they return to the 'normal' world.