Inexperienced ER help

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Specializes in MedSurg, phone triage.

Please forgive the long story!
Our ER is seriously drowning. As in patients waiting full DAYS (not hours), EMTs being requested to stay with instead of drop off patients because there is no one to care for them, etc etc. On a particularly bad day the hospital had to enact their disaster plan and pull employees from all departments, ancillary staff included for extra hands just to get almost stable. We weren’t able to go on diversion bc the other area hospitals already were. 
I have worked at this hospital for years, and I truly love our organization. However, I have been away from bedside nursing (Telehealth)for 4-5 years. Prior to that, I was med surg. Not only are bedside skills likely super rusty, I have zero ED experience as an RN. 
I would really love to help for the sake of our patients/ community but I know transitioning to a specialty like this in a struggling environment will be an extreme challenge. I would truly love to hear any and all advice/opinions/thoughts you may have. Should I run to the fire or away from it?? 


SN:

I have already put my name on the list to be called as a disaster volunteer if the need arises again. My husband is slightly concerned about the risk of bringing home COVID as well since we have small children who are too young to be vaccinated.  He says he would be less anxious if I did all I could to be safe. What measures are you taking to limit transmission?

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6 hours ago, HospitalNurseIsOnThePhone said:

Our ER is seriously drowning. As in patients waiting full DAYS (not hours), EMTs being requested to stay with instead of drop off patients because there is no one to care for them, etc etc. On a particularly bad day the hospital had to enact their disaster plan and pull employees from all departments, ancillary staff included for extra hands just to get almost stable.

 

What is the reason for this situation? Meaning, is this a new thing?

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Specializes in MedSurg, phone triage.
7 hours ago, JKL33 said:

 

What is the reason for this situation? Meaning, is this a new thing?

I’m not really sure of the base issue. We’re understaffed across the entire hospital and have been for as long as I can remember. Things got worse with COVID when they had to open new units and pull staff from already understaffed floors and units. We’ve never really recovered. Recently we had to reopen our COVID units, and it seems lately in our community there is an increase of general illness. So more patients than usual combined with way less staff than usual. Hospital is hiring, offering sign on bonuses, but positions just aren’t being filled. I’m not sure why. 

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22 hours ago, HospitalNurseIsOnThePhone said:

I have worked at this hospital for years, and I truly love our organization. However, I have been away from bedside nursing (Telehealth)for 4-5 years.

Things have gotten very bad in acute care in about that same time-frame, perhaps a couple of years longer. I would say markedly/noticeably worse. Expectations have risen significantly without the resources that would be required to feel like one is doing the job any justice at all. It isn't a good feeling. And, for all the talk about just culture, etc., acute care seems to have been accomplishing new lows as far as disparagement of nurses.

I am not sure if your organization has any of these problems but if they do, then...people are just tired and fed up. Before covid.

I don't mean to be a complete Debbie Downer, but the ED used to be quite fun and now it isn't remotely pleasant. Everything is timed, patients are everywhere, pulled straight to rooms whether they're sick or not (maybe not at your place).

The main plus I see in your scenario would be that if they need help that badly you might be able to retain some control of things. "I'll come help but [here's what I need]..." etc. It could be a good opportunity to get in there, but there's a decent chance it'll be straight up trial by fire. Dumpster fire.

Good luck whatever you decide -

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Specializes in ER.

You really have to ask yourself: Is it realistic to go from telehealth to ER in the middle of a crisis? Is there anyway you could work on an acute care floor instead of jumping right into the ER?  I'd be very concerned for your ability to practice safely in this kind of situation. As much as you love your organization, it is still your license on the line. ER is not a floor you can just show up on and muddle your way through. I hope you can find a way you contribute without risking your license.  

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Specializes in MedSurg, phone triage.

Great points! Thank you!

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Specializes in ER, Pre-Op, PACU.
On 7/29/2021 at 3:27 PM, JKL33 said:

Things have gotten very bad in acute care in about that same time-frame, perhaps a couple of years longer. I would say markedly/noticeably worse. Expectations have risen significantly without the resources that would be required to feel like one is doing the job any justice at all. It isn't a good feeling. And, for all the talk about just culture, etc., acute care seems to have been accomplishing new lows as far as disparagement of nurses.

I am not sure if your organization has any of these problems but if they do, then...people are just tired and fed up. Before covid.

I don't mean to be a complete Debbie Downer, but the ED used to be quite fun and now it isn't remotely pleasant. Everything is timed, patients are everywhere, pulled straight to rooms whether they're sick or not (maybe not at your place).

The main plus I see in your scenario would be that if they need help that badly you might be able to retain some control of things. "I'll come help but [here's what I need]..." etc. It could be a good opportunity to get in there, but there's a decent chance it'll be straight up trial by fire. Dumpster fire.

Good luck whatever you decide -

This is very realistic advice - I don’t think it’s being a downer but being practical. Let me tell you - our healthcare system in the US has always had fallacies, but covid really illuminated these aspects. I respect your interest in wanting to help your ER but the ERs in my area are for a lack of a better term - a complete total disaster who can’t get staffing. I transferred to surgical services in the middle of covid and have been much happier. I was an experienced ER nurse and was drowning - my license was on the line every day, but even more - I felt like I was sacrificing my morals and ethics by clocking into an ER with minimal staffing, prolonged wait times, no rooms for ER patients because the entire was full of hold patients, etc. 

I don’t want to be the bearer of bad news either but I also want to express how the ER really is - especially during covid times. I used to enjoy the job - never had any interest in anything other than the ER. However, it wasn’t worth it anymore after feeling I contributed to deaths that could have been prevented because of lack of staffing, lack of resources, and lack of inpatient units. No one could pay me enough to ever go back to the ER.

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Specializes in MedSurg, phone triage.

I appreciate this! Thank you for your honesty. Our COVID19 triage line has actually quite picked up in volumes so we’re needing assistance ourselves. Of course it’s not the same, but I feel like I am contributing being here. Thank you!

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I'm in a similar situation as you although I do have ER experience (but from 5 years ago). I stepped away from the bedside to work for a medical device company and really miss it, so I am going back to the ER. It's been 2 years since I was bedside and 5 years since I was in the ER (I was ICU in between). I'm nervous to run into the fire as well but they assured me that PPE has never run out and that orientation will not be altered due to the increased need for ER nurses. My husband has always been an ER nurse and is still there now, so here is our decon routine when he (and soon to be me too) gets home:

Enter through the basement backyard door, at the steps inside is lysol spray, antibac, and Clorox wipes. He strips out of his scrubs and down to underwear, balls them into a neat ball and puts his shoes next to the door. Antibac's his hands, then Clorox wipes his phone, lunchbox/ cooler, and wallet. Everything else (badge, stethoscope, etc) stays down with his shoes in a work bag. He grabs a Clorox wipe and comes up from the basement into the house and goes straight into our guest bathroom, which has our washer and dryer. Any light switch or door handle that he touches on the way, he uses a Clorox wipe in his hand to touch. Uses the Clorox wipe to open the washer and throws in his scrubs and all clothes he wore at work. He turns on the shower, tosses the Clorox wipe, and then showers. And that's that! It has kept COVID out of our house since the very beginning of this mess in 2020. He also never eats in the break room even though it's been allowed- always either outside if the weather is nice or in his car if he needs the heat. He's also incredibly diligent about never touching his face, mask, or glasses with unwashed hands. In the beginning of COVID I was immune compromised, pregnant, now I'm healthy but we have a young infant so will be continuing this process once we both return back to work.

 

Good luck! You'll do great.. they'll be grateful to have you!

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Specializes in MedSurg, phone triage.
5 minutes ago, Orange123456 said:

I'm in a similar situation as you although I do have ER experience (but from 5 years ago). I stepped away from the bedside to work for a medical device company and really miss it, so I am going back to the ER. It's been 2 years since I was bedside and 5 years since I was in the ER (I was ICU in between). I'm nervous to run into the fire as well but they assured me that PPE has never run out and that orientation will not be altered due to the increased need for ER nurses. My husband has always been an ER nurse and is still there now, so here is our decon routine when he (and soon to be me too) gets home:

Enter through the basement backyard door, at the steps inside is lysol spray, antibac, and Clorox wipes. He strips out of his scrubs and down to underwear, balls them into a neat ball and puts his shoes next to the door. Antibac's his hands, then Clorox wipes his phone, lunchbox/ cooler, and wallet. Everything else (badge, stethoscope, etc) stays down with his shoes in a work bag. He grabs a Clorox wipe and comes up from the basement into the house and goes straight into our guest bathroom, which has our washer and dryer. Any light switch or door handle that he touches on the way, he uses a Clorox wipe in his hand to touch. Uses the Clorox wipe to open the washer and throws in his scrubs and all clothes he wore at work. He turns on the shower, tosses the Clorox wipe, and then showers. And that's that! It has kept COVID out of our house since the very beginning of this mess in 2020. He also never eats in the break room even though it's been allowed- always either outside if the weather is nice or in his car if he needs the heat. He's also incredibly diligent about never touching his face, mask, or glasses with unwashed hands. In the beginning of COVID I was immune compromised, pregnant, now I'm healthy but we have a young infant so will be continuing this process once we both return back to work.

 

Good luck! You'll do great.. they'll be grateful to have you!

Thank you! This is an awesome routine! Thank you for sharing!

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Specializes in Med surg long term care.

I am also considering going back to work, I’ve been out for 3 years and I have an interview for ER Wednesday. I didn’t like working internal medicine or med surg in the past, I quit nursing for awhile to care for a family member, I have worked critical care in 2013 for 2 years a transplant unit ,LTC for awhile  but never ER. I’m sure they will have a good orientation before starting. I don’t want to leave nursing because I didn’t like those 2  areas. I’m not giving up on nursing there’s so many different specialties to try! 
Reason I say this is because I don’t think you should do ER unless you are looking for a change and YOU want to do it. Not just because they need you, believe me the entire hospital needs you, any unit actually. I can’t believe how many offers I’m getting, but I’m leaning towards ER because it’s so different from anything I’ve done yet and it’s the only offer I’m excited about. That’s another good indicator of whether you should do it, does it make you excited, how does the idea make you feel? 

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Specializes in ER.

Just go to a hospital that properly trains you and gives you an adequate orientation period.

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