Job Stress: Floor vs ED

[BellaRN2010]

Hi all,

To those ED nurses out there that have worked both on the floor (in acute care hospitals) and in the ED, I'm wondering if you can compare the kind of stress you experience in the ED vs floor. For example, as a floor nurse, I often felt overwhelmed by the number of tasks, amount of charting, and being responsible for ALL of the patient's ailments.

What do ED nurses feel are the stressful parts of their job?

Thanks very much in advance for your input!

[MassED, BSN, RN]

really no comparison to the type of stress. Sure, the work LOAD can be overwhelming, but in an ER, you have chest pain, abdominal pain, SOB, etc. all without a definitive diagnosis... so you do not know if you really are in an emergent situation. Once a patient is admitted, most information has been obtained, results are evaluated, so you have a stable patient - unless they're ICU or worsening from the ED to the ICU. The stress a floor nurse feels is still stress, just not my kind of stress that I experience in the ER. I have worked on a floor, and I recall well the level of stress and being overwhelmed. The emergent vs. nonemergent stress is what decides how I respond at this point in the game.

[herowneulogy, BSN, RN]

I hope people continue to respond to this thread. I am a new graduate nurse, eager to start my career in the ED, some people keep telling me to start off with med/surg first, though. I loved reading the responses.

[T14WFLY]

ER can be stressful because you never know what you're going to get. You take care of multiple patients throughout the day ranging from minor to critical. One minute you can be bored bandaging up cuts and scrapes and the next minute a full arrest rolls in followed by an overdose and an MI! Prioritization and time management are essential. You can't spend 10 minutes doing one task. You have to be quick and effective.

ICU you spend more time getting to know your patients. You treat the entire person, not just the Main problem. However, you can have one very sick patient that is so sick that you can't leave their side for 2 minutes to pee because you are so busy titrating drips and hanging electrolyte replacement and blood products.

Med/Surg-Tele etc...You can have 4-8 patients ranging from an observation to a borderline ICU patient. Most of them have multi-pharmacy lists of meds and some sort of pain or nausea requiring PRN meds at least Q 2 hours. You go from patient to patient doing assessments, charting assessments, ADL tasks, accu-checks etc...

Nursing can be stressful no matter where you work. It is a different kind of stress no matter where you work and you just have to find what suits you. Hope this helps.

[FancypantsRN]

I am going to the ED (next week) for many of the reasons listed above. I have been on the floors for about 4 years now - it can be monotonous with the routine. I have done CV step-down and PCU. I tried travel nursing as well to mix things up a bit (needless to say - not for me). I am looking forward to the challenges of the ED, and not having the same team day after day (sometimes week after week).

As for starting out on med/surg - that was suggested to me as well. I think I did fine starting out on PCU instead. I was able to take a critical care class, 12 lead ekg and extra education that my med/surg track friends missed out on at the time. It's all matter of opinion.

A lot of new nurses start out in the ED and good for them! They have more confidence than I had - I am just now getting to courage to go for it : )

[canoehead, BSN, RN]

I'd say the amount of stress is probably the same, but in the ER it has more to do with patients' more acute issues, and you get the stress in fits and starts. So you might have a slow morning, then get 3 chest pains in 30 minutes, one of whom is critical. Can you deal with the life or death nature of the issue? Can you manage three problems at once?

The other stressor I find is that you have to manage the critical patient that you got on no notice, wrap them up pretty, transfer them out, and then you come back to 3-4 other patients almost as sick, and have to catch up on their needs. There is no down time to recoup. If it's busy you're jumping from fire to fire. The ER does have slow times thank goodness, but a lot of people don't have the mental stamina to keep up with a high stress situation for hours on end.

Does anyone remember that ER episode with the pregnant woman coming in to the ER, ended up having about five major complications and finally died? The first time I watched that show my brain shut down after about twenty minutes. Too much information to keep track of, and too many things going wrong. If you work ER you have to hang in there and keep processing, keep thinking, to be successful.

[klarity, BSN]

lol it sounds like you and i work in the same hospital....ours get so slammed they put us in an area where there is a ratio of 8:1 and you have an lvn to help out. its scary!

[SephRN]

Im working in the middle east and dealing with arabs is very hard. It starts with a quiet first 2 hours then one by one their coming like zombies and the moment you notice it you dont have anymore plants to save your area. (Not to mention languange barrier).

Some do relieve your stress when they appreciate your efforts.

[turnforthenurse, MSN, NP]

Both are very stressful, imo. The thing about the ER is that you never know what is going to be coming through that door or ambulance bay. You may get 4 patients all at once and you'll have to start from scratch - figuring out their problem(s), assessment(s), line & labs, EKG, meds, etc. But the fact that you don't know what's coming makes the ER exciting if that's your thing. No two shifts are ever the same and you're always learning something different. I felt like on the floor I was always doing the same thing and honestly I got bored with it. That's one of the reasons why I made the switch from the floor to the ER.

There are also different areas in the ER that you can work in...you can work in the main ER and see ER patients and sometimes fast track (if fast track beds are full). Then there's fast track, behavioral health, trauma and triage. And each one of those areas can be different.

[Pacsun4567]

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.[/quote']

I could have written these exact words and they would pertain to me

Ah, the good life huh? Lol

[Sassy5d]

I could have written these exact words and they would pertain to me Ah the good life huh? Lol[/quote']

Then throw in the diva wanna be lazy coworkers who have no problem slamming your section, pulling your pts out in the hall way while their peeps who are stable, up for d/c and are returning to the nursing home and of 4 pts, 1 of which is deceased have been in your ER an average of 6 hours can't be moved.

*deep breath*

Exactly floor peeps. You know what you're getting and for the most part, those peep are lined/lab'd and stable. You can complain about the bear of a pt we sent you, but keep in mind, there were just 30 equally as unbearable, if not more, that we d/c'd that you didn't have to deal with.

[Austin12]

I think "Stress" depends on the person. I've worked IU, SICU, Behavioral health, Corrections and now ED. I think that they all have an aspect of busy work or "stress." What is Stressful for me is Hall beds and the charge nurse is hammering you with EMS traffic after traffic. I mean really, you can have a GSW to the head in one room , chest pain in the Hall, DKA in the other room and a MVA coming. It's stressful, but that's the same reason I love my job.

[DayDreamin ER CRNP]

No comparison in my opinion. Everyone has pretty much summed up my feelings already but wanted to add that on the floor, the patients you start with are, for the most part, the same patients you have all shift. You don't get hall beds and you don't have the stress of the "urgency" involved in ED care. I get that floor nurses have paperwork and often families to deal with. That paperwork isn't going to kill a patient. I get that mistakes / errors in charting can affect patient care but med-surg patients are generally stable by the time they reach the floor thanks to the ED staff. Yep, we often can't get everything done that is ordered for that floor patient but we DID get them stable before sending him to the floor.

In the ED, the patients just keep coming either by ambulance or through the front door and maybe from the OR or imaging or even a hospital visitor or employee. The just keep coming in. It does not stop. I've run a heart alert / code in the hallway!

ED stress includes diagnosing the patient and often dealing with the unruly. Rarely does a med-surg nurse have a pt in restraints putting me 1:1 with that patient. What about my other patient / patients? My co-workers are also 2:1 or 1:1 with their patients.

I've seen the floor "close" to any new admissions because they are short staffed. The ED doesn't get to "close" because we are short staffed. We have to suck it up and split rooms and take on 3 priority 2 pts.

Don't even get me started on a mass casualty or the GSW that gets dropped off at the ED front door.

Bottom line is: it never stops. Ever.