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.
I work in a similar ER -- a public safety net level 1 trauma with extremely high volume and acuity.
I thought our ratios were bad but yours are out of the park.
I made it through 2 years in the medical ER, where ratios were usually 5:1. Sometimes I would have 2 or 3 ICU boarders (waiting for their bed upstairs for days) along with 2 hallway patients, usually med-surg boarders (who were supposedly stable but could go downhill fast). I loved it at first but after a while I HATED it. The turnover was very high and after my first year I was often one of the most experienced nurses in my zone.
After two years there, I qualified to transition to the trauma ER specialty unit. I started here a month ago and I LOVE it. The goal ratio here is 2:1. I have occasionally been 5:1, but only for short periods while my trauma bays are doubled because of a lot of activations coming in at once -- I've never had more than a 3 patient assignment here. I also almost never have med surg holds -- when I do have holds they're ICU and super interesting -- and our patients get upstairs MUCH faster, so my assignment turns over the way an ER assignment is supposed to do. I get to focus on stabilization, which I love, instead of passing meds for needy med-surg patients like I often had to do in the medical ER. Plus, because the trauma specialty unit requires experience, I'm now one of the LEAST experienced nurses in my unit, and there are always smart, experienced nurses I can turn to for advice when I have questions. I am so much happier.
If you are one of the most experienced nurses in your ER, then you can fight for better assignments, and you should. Find a manager or a charge who will advocate for you and ask them for the assignments you want. But also, that ER sounds like a mess and you can probably get something way better. If it's anything like my ER, having that mess on your resume will give you a golden ticket anywhere you want to go. These crazy volume public hospitals have a (deserved) reputation for turning out nurses who can go anywhere and do anything. Do some research on the hospitals in your city, find threads on reddit and here on allnurses and figure out where nurses are happiest, and go there.
My best friend from the medical ER recently transferred to the burn ICU, and she's a lot happier too...they have NO turnover in that unit, on average nurses are there for 10 years! That's a great sign of happy nurses. There could be a unit like that in your hospital, and after the ER, you could probably transfer anywhere you want. Ask around to find out where nurses are happy and the turnover is low.
Thanks - Yes I now have almost a year here. While on nights, by the time I was just 6 months off of orientation, I was already becoming one of the more experienced nurses here. I just switched to days where there are plenty of more experienced ER nurses to bounce questions off of an learn from. I know a super busy trauma ER is not where I am going to stay long term but I am trying as much as I can while I am here. I love the rush of it, but overall it is not very conducive to a balanced life. At least not for me.
Day shift suits me better, I will hold on a little longer while I determine what I want next.
It is great that you have such good ratios in the trauma area of the ER. Here, we do not hold onto med-surg admits there, they go back to the main ED. ICU and stepdown holds do stay in the trauma area of course.
It's incredible your friend is in a unit with an average of 10 years in that unit. That's amazing!
Birdsofprey, BSN
58 Posts
Thanks - Yes I now have almost a year here. While on nights, by the time I was just 6 months off of orientation, I was already becoming one of the more experienced nurses here. I just switched to days where there are plenty of more experienced ER nurses to bounce questions off of an learn from. I know a super busy trauma ER is not where I am going to stay long term but I am trying as much as I can while I am here. I love the rush of it, but overall it is not very conducive to a balanced life. At least not for me.
Day shift suits me better, I will hold on a little longer while I determine what I want next.
It is great that you have such good ratios in the trauma area of the ER. Here, we do not hold onto med-surg admits there, they go back to the main ED. ICU and stepdown holds do stay in the trauma area of course.
It's incredible your friend is in a unit with an average of 10 years in that unit. That's amazing!