Job Stress: Floor vs ED

nurse2033, MSN, RN · Jan 13, 2011

You sometimes have that in the ER with a critical patient to boot. It's just more varied in the ER and more predictable on the floor in my opinion.

PAERRN20 · Jan 13, 2011

When the floor is full, that is it, no more admissions PERIOD!

When the ED is full, here comes 3 ambulances, a sore throat, oh, and the overdose patient who just showed up via the front door is gonna need intubated and there is not a bed to be found! My ER never diverts and can't refuse anyone, which leads to patients in the halls and a very full waiting room. It is very stressful, and I am cutting back my hours big time in the ED.

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Jan 13, 2011

I really don't think there is a fair comparison to be had. To survive in the ER you have to live for the excitemnt of it. If you work in the ER and only feel stress, it'll tear you up IMHO. ER staff live for turning chaos into order, the more chaotic the prouder they are to overcome it.

Whereas I can speak for ER staff, I'm only guessing about the floor. I can't do floor nursing, and admire those who do. My thinking on floor nursing is that there is a routine which is satisfying. Meds, meals, glucose checks for instance, are scheduled, and I guess floor nurses find that more tolerable than the constant changing of needs and priorities in the ER.

One thing I'm certain of. Any job that only stresses you out, like losing sleep, hating to go to work, finding it hard to be pleasant at work, anytime you're under that kind of stress you're in need of a job change. Doesn't matter what floor you work on. IMHO of course. Longish answer, and as always I'm open to other views and constructive criticism.

PAERRN20 · Jan 13, 2011

One thing I'm certain of. Any job that only stresses you out, like losing sleep, hating to go to work, finding it hard to be pleasant at work, anytime you're under that kind of stress you're in need of a job change. Doesn't matter what floor you work on. IMHO of course. Longish answer, and as always I'm open to other views and constructive criticism.

You hit the nail square on the head. I am at this point in my short 3 year ED career, and I find I feel all of this. I am in a transition period changing jobs. I have mixed feelings of leaving the ED. I know I am not a failure, because I have had great performance reviews and patient compliments, but I can't keep it up. I am starting to feel burned out. The ED is simply now where I am meant to be long term, but it sure gave me a damn good nursing foundation.

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Jan 13, 2011

You only get so much time in this life, and the time spent being miserable isn't refunded at the other end. Staying in a job that's burning you out just doesn't make sense. You can be proud of your accomplishments, and nobody's gonna take that away from you. Via con Dios, mi amiga.

SummerGarden, BSN, MSN, RN · Jan 13, 2011

former med surg nurse here!!! the stress is the same it just goes by a different name in the ed. stress is stress! would i give up the ed for the floor??? no. my reasons:

one, i always wanted to be a trauma/critical care nurse so i spend my off days happily studying topics that help to better my ability to provide such patient care. i hated having to study the stuff i needed to know when i worked med surg.... i could care less about all of the new policy and procedures and certs though i studied and worked for them any way because i took my license and job seriously...

two, i do not like the other tasks assigned to me when i work the floors. i prefer patient care. if med surg did not have so much paper work and rules that placed patient care second, then i might have liked (not loved) med surg. in addition, within the er getting the critical care, trauma care, or any other care done efficiently (quick+safe) is emphasized over being methodical (slow+safe+doing additional unnecessary tasks that do not support patient care).

three, i do not like having to work several days in a row in order to have a smooth shift (on the floors it is always better to be assigned to the same team of patients in order to minimize the amount of adjustment to chaos of a shift). plus, i did not like having the same patients or family members to deal with for an entire week. some family members and/or patients are crazy!!! in the er i know i will be able to discharge my patients somehow some way quickly and so the crazies do not bother me as much.

four, the lack of support. i worked in a state with no mandatory ratios so i had to take on 6-8 patients that were not ltc patients in need of iv therapy. rather i had patients that in many hospitals would belong in an icu. not to mention having to reposition, lift, and clean my patients without any help because the tech(s) had the entire floor during so-called low census or 14 patients each when the floor was full.

five, the routine. the routine of the floors was mind-numbing to me. i know that many nurses like routines that are the same from the moment he/she walks onto the floor until he/she leaves, but i am not one of those people.... i am happy to not have a "brain" sheet any more! therefore, routine of the ed is what i prefer to the floors. although lay people and nurses who float and/or are new to the ed might think that the er is complete chaos, it is not true! the ed is described by those who really understand the environment as "organized chaos". for instance, after you gain some experience working full-time you will see that there is predictability in patient conditions based upon s/s, physician orders, problems that occur within the ed, patient complaints (you'll even be able to spot the type of patients or family members who will complain before he/she opens his/her mouth), etc.... therefore, you will be able to anticipate needs and head off issues without difficulty.

good luck! by the way, the excitement of the ed fades away once you have experience. don't get me wrong, my heart still races during a full arrest, but this only happens to keep me awake and alert... i do not find full arrests fun any more. in fact, though i continue to love to learn about and receive traumas of all kinds, i accept that being an er nurse is just a job. i know this statement does not make sense to you now... it will after a year or so.

icuuci · Jan 13, 2011

ED nurses at my hospital chill at an incomprehensible rate. perhaps cuz we are across the street from a trama center. But at my hospital ED nurses essentially work in a clinic.

alem-tsahai · Jan 13, 2011

I've worked med-surg, ICU and currently work ED. All I can say is that medsurg stressed me out in a way that the ED never could, mainly because of crazy demanding family members. Demanding family members will work you out and test your patience to the max. They will report you to the supervisor for not coming quick enough with a bed pan. What's more, most shifts weren't all that routine. A pt crashes, or dies, and you have a sicker one coming to occupy your now-empty bed. You have 2 hour pt turns to remember, you need to dress some of your pts mutitple pressure ulcers. One confused pt falls and another soiled him/herself and there's no aide to help. All this going on and you still have to get your am labs and vitals done on time. I learned a lot working medsurg but I certainly won't be doing it again anytime soon.

The ED I work is always busy, and some days I am just not up to running around juggling 8-9 pts at a time (one which invariably will be an ICU hold). Working the ED, in my opinion is more physically demanding than the floor, but less mentally draining. Family member drama is kept at a minimum and the turnover is quick if you get a particularly demanding pt. You see and learn alot, and you can also get a good sense of what health issues afflict the surrounding community. Of course I don't like the drunks/druggies and frequent flyers but even they are easier to deal with then a family member who refuses to gown up for your pt on iso precautions on the floor.

Anna Flaxis, BSN, RN · Jan 14, 2011

They're both stressful, but the nice thing about the ED is that you don't have the same patients from shift to shift. Every shift is a little bit different.

llltapp · Jan 18, 2011

I did 1 year (years ago) of med/surg/ortho and have been working the last decade of my career in very busy regional trauma center ED. What I hated about the floor (that I worked on, not judging all floors :):

-Coworker drama (in the ED we are usually too busy to gossip and get into each others business)

-feeling like a task master on an assembly line i.e. meds, feed, dress, pm care, turn, (in the ED you go through every skill you ever learned and many you never learned all in one shift)

-I hate all the RULES on the floor, in the ED you do what works at the time (within reason of course :)

-I couldn't stand the inconsistencies of the CNA's and fellow nurses for that matter (in the ED if you don't put up, and carry your weight, your out)

-I didn't like calling the doc for every little thing, in ED you are allowed to have a brain and make decisions and the docs (if you are trustworthy) back you up. If you're not trustworthy your out anyway

-I couldn't stand having the same patients or the same types of patients day in and day out. In the ED you saw something different every hour. If you like your patient you get to spend 2-6 hours with them. If you didn't like your patient, you only had to spend 2-6 hours with them :).

I love the ED. I love meeting all the diverse people, being there at the worst time in their life and making them laugh. Most days, I think to myself "damn, I'd do this for free" LOL. If you can say that, you are in the right career

86toronado, BSN, RN · Jan 27, 2011

Thanks for all the great posts. I am starting ED next week after four years in med-surg (2 as a secretary/tech, 2 as an RN). I have no idea if I'll like it, but I do know that the of the jobs I've held in the past, the one I enjoyed most was being a caterer, because each day was different from the one before. So I'm hoping that will be the case for me in the ED as well!