Interested in ER but not quite ER material.......

locolorenzo22, BSN, RN · Aug 2, 2007

You know, your post sounds similar to what I'm thinking about for when I get out of school....although I don't believe I could EVER do ER nursing. Have you looked into ICU or tele nursing.....still important, but not always as "urgent"....just a thought.

JMRBH · Aug 2, 2007

Im fresh out of university as of last year and started working in ED in Febuary and had the same thought as the title-but loving it now, i will admit it was very scary-and you do feel like you know nothing somtimes, i will admit it is also a hard setting to learn the 'nitty gritty' of situations in a resus but if you have good supportive staff around you i find they help alot and are willing to go through everything with you when everything starts to settle. i will tell you that it is not easy but there is just something about it that gives me a thrill. I say give it a go stick it out for min. of 6 months if you can, and you will soon know weather you like it or not.

carachel2 · Aug 2, 2007

Yep, I imagine myself sewing skin and doing other surgery and weird things

Most ER's I know of don't let RN's suture and perform other procedures.

emtb2rn, BSN, RN, EMT-B · Aug 2, 2007

You'll never "know everything". Nobody does and anyone who claims otherwise is truly dangerous. And to me, that's the beauty of nursing (and one of the reasons I'm going into it), there's always something to learn.

My limited experience with mass emergencies (in the field, multi-vehicle MVA's & bus rollovers) is that intially, they're all about triage. Beyond that, as a nurse, you'll be treating your patient(s), but not everybody involved.

If you're going into an ED without ED experience, you'll be on orientation (I would expect), not flying on your own. Why would the other RNs expect you to know everything?

"An emergency can send me to my books in less than a second, but throw something that's not an emergency to me...I'm not gonna move.....(well, I will but at an unmotivated pace)..."

Books? I'm not sure I understand. What's the context? Plus that "unmotivated pace" comment frankly scares me. What constitutes an emergency to you?

I'm not flaming you, but something in your words disturbs me. That said, I'm not an RN yet much less an ER nurse, but I do have more than a passing acquaintance with CPR and emergency care.

Altra, BSN, RN · Aug 2, 2007

Neferet, I'm not sure how "new" you are to nursing. Lack of confidence is pretty common for brand-new nurses. My preceptors routinely told me it would take a year to feel competent and another 1-2 to feel confident.

I'm not sure I'm clearly understanding everything you were trying to say in your post so I'm going to try to tackle it in pieces.

An emergency can send me to my books in less than a second, but throw something that’s not an emergency to me…I’m not gonna move…..(well, I will but at an unmotivated pace)…

Not sure I understand this at all. You're saying you want to work in an ER environment but an *emergency* sends you ... to your books, and not to your patient? I'm sure that doesn't fly any better on a med-surg floor than it would in the ER. Perhaps that's not what you were trying to say. And to be honest, there are a considerable amount of patients who present to the ER, even in a trauma center, whose conditions are not emergent right now. That does not mean that care is not required right now. Even if you read through EMS forums, you'll find that their days are not always filled with one life-threatening emergency after another.

I imagine working in an isolated place where people are counting on me and my team to give them great emergency care. Yep, I imagine myself sewing skin and doing other surgery and weird things

"Surgery" in the ER is limited to suturing (which you will not be doing as a nurse), chest tube insertion, and, in my experience in a Level I trauma center, very, very occasional thoracotomies and chrics. There are things you'll do to assist with these procedures, but you will not do them yourself.

I think confidence is gained from providing great care to the best of your (gradually increasing) ability day in and day out, more so than the occasional moments of "glory."

My suggestion: try to set up a shadowing experience with an ER nurse. Think through specifically why you think you are better suited to the ER than a med-surg unit.

Good luck to you.

GilaRRT · Aug 2, 2007

Yep, about 70% of your ER experience will be filled with screaming snot faced kids and their demanding ignorant parents. It can actually be quite redundant. I know of several facilities that allow nurses to provide basic wound care and in some situations very basic uncomplicated laceration repair. If you can find the time to suture a 1/2" arm laceration when you have an active MI, a screaming kid with an ear infection, and a gang banger wannabe who took a couple of rounds to the box, then you are a better man than I.

Not to say that you will have several emergency situations, just do not think it will be like all of the television shows.

As far as lack of self esteem, I cannot help you on that one. You need to take a look inside and find out what keeps holding you back. Just like many others posted, you will need a couple of years of nursing experience before you start to put it all together.

jjjoy, LPN · Aug 2, 2007

I understand the frustration with people always saying "you can't know everything." Of course not! But I can know SOMETHING... so teach me SOMETHING!

In nursing school, I didn't feel like we learned a lot. We covered a lot of material but it often just came back to a few basics - such as manage pain, prevent skin breakdown, educate the patient. Good stuff, but it doesn't take 2+ years to learn that. So after covering a zillion different conditions at a rather surface level, the new grad comes to a job without having much to offer but a willingness to learn.

Except that no one wants to teach. Instead, you learn by trial-and-error. Common sense and school should keep you from making any really dangerous errors in judgement (the non-breathing patient takes priority over the person asking for water; double and triple check all meds you are giving). But beyond that, the newbie gets underfoot and learns by getting stepped on (don't just stand there, get the XXX! What's an XXX? Oh, forget it, I'll get it myself!).

I learn by observing, asking many questions, learning the background information, observing more, asking more questions, gaining confidence in my knowledge and then acting. Nurses (and perhaps other health care providers) seem to work a bit differently. First, you learn the background info. Without being in the situation, though, it can be hard to know to ask. We spent clinical time on long assessments that had little to do with acute care; we spent lots of time on being careful with medications (important, but again, you don't need two years to get it). We spent lots of time on long care plans in which we had to document over and over why it was important that patient cough, deep breathe and turn.

Then. boom, you graduate, and are confronted with being responsible for everything: several patients with competing needs, rushed MDs, a ton of paperwork, etc. The newbie can see that the experienced nurses are barely getting everything done, though they're not even sure what 'everything' is. So the newbie is trying to figure out all that, AND also has to juggle competing patient needs and yet doesn't yet have the experience to really be able to recognize how to prioritize. Yes, they will learn in time. But meanwhile, they have to continue to show up to work each day knowing that they DON'T know how to prioritize, manage their time, etc and have to fumble through it, hopefully not creating too many problems along the way... though they have to create some problems, otherwise that means they're not taking intiative and are hanging back until they know can be perfect and never learn what they need to learn (eg they HAVE to make mistakes to learn).

It can feel rather confusing. The newbie hears "Be careful. Prioritize. Manage your time." why? so you don't make mistakes. And yet, you HAVE to make mistakes in order to learn - I don't mean careless mistakes or blatantly dangerous mistakes. It's just that the newbie doesn't have much experience or good time management/prioirization skills and thus WILL perform relatively poorly until they do. And too often the culture is such that newbies are shamed for not knowing something (rolling eyes, being scolded, talked to sarcastically) or if hesitant are judged as "dangerous" "unprepared" "having no intiative" and the like. As the OP noted, the newbie must act confident even while being acutely aware that they don't really know what they're doing and won't for some time.

TrudyRN · Aug 2, 2007

Perhaps it is your font, maybe it is a couple of the things you say (unmotivated pace, grabbing a book in an emergency, sewing skin) but I think you are in need of a counselor, maybe a therapist, to help you evaluate your present condition and your future plans. You have an understandable fear of rudeness from teachers/mentors but the ER pace requires more of a tougher skin, I think. Not that people there should get away with being rude but the nature of the setting requires speed. Maybe you're just not quite strong enough mentally/emotionally to deal with that right now and would be better off in a slower-paced setting, where people are more likely to take time to teach you slowly, courteously.

I wish you well.

jjjoy, LPN · Aug 2, 2007

a slower-paced setting, where people are more likely to take time to teach you slowly, courteously.

What setting is that? I must ask because the low-acuity settings tend to give more patients to the nurses (eg 30 patients in LTC) and thus the pace isn't really any slower and the nurses aren't any more likely to have the time, patience or inclination to teach slowly and courteously. When a newbie is having trouble adjusting, the advice is often to find something "slower." Perhaps when people say that they really mean "less acute" because passing med to 30 patients, each of whom have many meds, may have dementia, can't swallow well, etc, in two hours, charting on those patients, checking notes, and running yet another med pass is NOT slow.

Anyway, I agree the OP might be able to use some counseling to sort out what she's (he's?) feeling. I can appreciate, however, that the OP was very honest in her fears and fantasies. It would be tempting to hide those thoughts for fear of being judged negatively and then never getting the necessary feedback to determine how to deal with her feelings and how to progress in her career.

Neferet · Aug 2, 2007

i think icu is too boring…too much intense focused….it’s just not me……i don’t know…i enjoyed tele though….i love tele but the tele floor at the hospital that i was once at was a mistake waiting to happen….everyday i’d walk into to take reports and find that every morning i check meds…there’s always mistakes…somehow every nurse before me has not cross out dc’d meds from one-two days before….they were still being given…..it just throws me into a panic…because they’re heart patients….poor me….i felt so sorry for myself because it was difficult trying to learn new meds, and time management…and there i was….wasting time every morning fumbling through all the old physician’s orders to see when the meds were actually dc’d…..that was me every single morning….it just drove me crazy! i’d find dc’d orders that was crossed off as “dc’d”…but in the mar they’d still be there…and most times were still being given last shift….arrgggg! yep…i couldn’t deal with that. too bad i really liked that place.

other hospitals are too far…and i don’t know if i want to go that far.

carachel2…..i know, nurses don’t really do that in er…but i kind of like that kind of “skilled” environment…. i know that some emergency nurses out in the middle of nowhere do it sometimes. and they’ve had some kind of emergency training. i just kind of like the way the er nurses know what to do when someone codes or something. they’ve faced it so much that it has actually become good skill.

emtb2rn………yeah, i don’t think i’ll be flying on my own…but some rns in the er do expect you to know everything….even though you’re new.

what i meant by an emergency sending me into the books thing was that i get excited when learning how to deal with emergencies (people bleeding, coding, unable to breath, snake bites, anything that causes the nurse to act fast)…….so that i’d be prepared when it comes…….all the other things i do…but it doesn’t excite me….

mlos….lol…i’m an liscensed rn new grad.

[lack of confidence is pretty common for brand-new nurses. my preceptors routinely told me it would take a year to feel competent and another 1-2 to feel confident.]

yeah…tell that to the preceptor that i’ve had.

[not sure i understand this at all. you're saying you want to work in an er environment but an *emergency* sends you ... to your books, and not to your patient?]

no, no…what i meant is that it actually makes me excited and want to be prepared for it….i want to be able to know what to do in case of an emergency…not going to my books in a middle of an emergency…that’ll be a disaster.

["surgery" in the er is limited to suturing (which you will not be doing as a nurse), chest tube insertion, and, in my experience in a level i trauma center, very, very occasional thoracotomies and chrics. there are things you'll do to assist with these procedures, but you will not do them yourself.]

yeah i know….but i can at least see some of the exciting stuff.

[i think confidence is gained from providing great care to the best of your (gradually increasing) ability day in and day out, more so than the occasional moments of "glory."]

this is so true. i feel that if i want to be an emergency nurse in some third world country or serving victims in a mass casualty or something, i at least should do some er nursing to prepare for it.

[my suggestion: try to set up a shadowing experience with an er nurse. think through specifically why you think you are better suited to the er than a med-surg unit.]

uhmmm….i’ve been on med/surg for two semester of clinical, and forced myself to do a third clinical rotation there because i knew i hated it, but needed the skills. i don’t know what drives me crazy about it….i just hated it. not really hating the care of the patients, but just everything else that goes with the environment….most of the time i feel like a robot just filling out paper work instead of being with my patients. medsurg is soo stressful….no, not really because of the care…something in the environment is just not healthy….one thing that gets me the most is co-workers who are unwilling to help eachother…..

i’d rather work in a real stressful, busy place and be supported by co-workers and know that my team has my back and know that they know what they’re doing…….than be in medsurg with 5+ patients and know that i am alone. i’ve been there three semesters…and i think it almost ruined my career.

shadowing is a great idea.

gilarn…..

[as far as lack of self esteem, i cannot help you on that one. you need to take a look inside and find out what keeps holding you back. just like many others posted, you will need a couple of years of nursing experience before you start to put it all together.]

you’re right…med/surg has left scars….i was a young and i got eaten….

jjjoy….thanks for your post, you know exactly what i’ve been through..

[then. boom, you graduate, and are confronted with being responsible for everything: several patients with competing needs, rushed mds, a ton of paperwork, etc. the newbie can see that the experienced nurses are barely getting everything done, though they're not even sure what 'everything' is. so the newbie is trying to figure out all that, and also has to juggle competing patient needs and yet doesn't yet have the experience to really be able to recognize how to prioritize.]

exactly!

trudyrn…..[you have an understandable fear of rudeness from teachers/mentors but the er pace requires more of a tougher skin, i think.]

uhhh…that’s because my worst nightmare of the hospital had come true…working with nurses that don’t just eat their young…they swallow them whole…

i don’t blame myself, because they were rude and fearful. but you’re right when you say the er requires more tougher skin….

[maybe you're just not quite strong enough mentally/emotionally to deal with that right now and would be better off in a slower-paced setting, where people are more likely to take time to teach you slowly, courteously.]

yeah, true……i just wish they’d do that in er too, so that i can at least have a chance to see if i it’s really my nitch.

jjjoy…..

[what setting is that? i must ask because the low-acuity settings tend to give more patients to the nurses (eg 30 patients in ltc) and thus the pace isn't really any slower and the nurses aren't any more likely to have the time, patience or inclination to teach slowly and courteously. when a newbie is having trouble adjusting, the advice is often to find something "slower." perhaps when people say that they really mean "less acute" because passing med to 30 patients, each of whom have many meds, may have dementia, can't swallow well, etc, in two hours, charting on those patients, checking notes, and running yet another med pass is not slow.]

yep, i agree….less acuity places sometimes mean death….even in medsurg they expected me to know everything. one thing i hate is when i ask a question and my preceptor is unable to tell me what the answer is. it’s not really their fault because maybe they weren’t train well either….but i need to know what i should know…

most of the things that screwed with my time management were not even medical related….they were just things like: how do you work this stupid machine, where are all the vs carts?, how the heck should i know how to program the blood glucose machine without being taught or given the secret code needed?, how am i suppose to give 2o po meds to a patient without overloading him with water? cuz he/she can only swallow a pill at a time with a cup of water…..and still i have to worry about my other 4 patients and possibly the lvn’s patients too…..and some patients are missing meds that are not up from pharmacy yet….and then i have to be away from my patients to chart on them 5+ patients….and there are still new orders coming in….and i have to check the charts again because we’re suppose to check or write something within a period of time…… blah blah blah i know that nurses on medsurg have to spend more time on these other things than direct patient contact…..….i hate that medsurg life....it may be a good place for others, but not for me…

i can’t believe i paid so much money in nursing school…..thanks for all your comments...they really helped....

Altra, BSN, RN · Aug 2, 2007

most of the things that screwed with my time management were not even medical related....they were just things like: how do you work this stupid machine, where are all the vs carts?, how the heck should i know how to program the blood glucose machine without being taught or given the secret code needed?, how am i suppose to give 2o po meds to a patient without overloading him with water? cuz he/she can only swallow a pill at a time with a cup of water.....and still i have to worry about my other 4 patients and possibly the lvn's patients too.....and some patients are missing meds that are not up from pharmacy yet....and then i have to be away from my patients to chart on them 5+ patients....and there are still new orders coming in....and i have to check the charts again because we're suppose to check or write something within a period of time...... blah blah blah i know that nurses on medsurg have to spend more time on these other things than direct patient contact.........i hate that medsurg life....it may be a good place for others, but not for me...
i can't believe i paid so much money in nursing school.....thanks for all your comments...they really helped....

i hate to tell ya, but these same things will screw with your time management in the er too.

and frankly, if you're going to make yourself scarce when it's time to take care of the endless stream of med-surg patients who come through the er, and only show up for the good stuff, you will be labeled a "princess" in 5 minutes by your coworkers (regardless whether you are male or female). this does not make for good karma.

you have some thinking to do before you accept a position anywhere.