Join the ER or go to another specialty?

Editorial Team / Moderator · Feb 25, 2019

Only you can decide what is best, but congrats on having so many options! Can you shadow in each area?

PeakRN · Feb 25, 2019

I can't speak to the OR, that is a specialty with little crossover to other areas and really is it's own thing.

ED is very fast paced and priorities are always changing. In many ways the nature of ED opposes perfect care. The ED is also incredibly unpredictable, I've had many shifts that stretched over 16 hours without a lunch because of some MCI or other unpredictable event, but I've also had shifts where we get to watch movies for hours or watch an entire solar eclipse.

Do keep in mind that even as a pediatric ED you can still see a variety of ages and conditions. I remember back when I worked at a peds only center we had an adult female who had an MI from taking meth and running from the cops who decided that we were the appropriate place to come to once the heat was off (she thought the cops wouldn't look for her in a peds hospital). We also took several (very high acuity) adult trauma victims after a MCI since there were few pediatric victims and the adult systems were saturated.

Without any acute care experience I would highly suggest you shadow before choosing one of these areas. They also can limit your ability to transfer to other units, as they are both very unique care areas.

Emergent, RN · Feb 25, 2019

If you like your patients asleep, and enjoy a strong, sometimes intense, team dynamic, go for OR.

If you like interacting with patients, in all their glory, with incredible variety, go for ER. You'll also have a team dynamic, but I doubt it's as claustrophobic as OR.

In OR, you'll probably have call, but otherwise have regular hours.

Personally, I like ER.

akulahawkRN, ADN, RN, EMT-P · Feb 25, 2019

The ED is very "squirrel." Basically all we do is triage. We very rarely get to do definitive care. All the care we give is basically done "now" and not on a given schedule. We constantly are reprioritizing the care. Sometimes we have to "hold" patients in the ED that are supposed to be admitted to the hospital but that's not an optimal thing because ED nurses aren't Med/Surg or Tele nurses.

What do I get to do every shift? Well, I show up, find out what my assignment is and then I go do that. I have absolutely no idea what I'm getting into until I get there. And I have to be ready for it. My last shift I basically had 4 patients the entire shift. At the end of it, only one of those patients was the same one that I started with... the other 3 rooms each changed patients at least 2 times each. That meant that I saw at least 7 patients that shift...

I could have seen more than that if none of my patients didn't have to be held in the ED because they were waiting for a bed somewhere.

I've had the same patient several times. I have had patients suddenly change acuity. I have had patients all from the same family. I've had patients that come in because they basically have a hangnail and I've had patients that pretty much don't come in unless they're dying... and they are.

The ED is both high-performance and very street. The only thing that gets more chaotic is the street and I've done that too.

How did I choose the ED as my specialty? Well, I looked at all the various jobs in the hospital that nurses do and the one that fit my personality best was the ED. While I would do well in other areas, most of them would just be rather boring for me, even though I'd be busy at times, simply because of the routine.

Shimmer580 · Feb 26, 2019

On 2/24/2019 at 8:22 PM, Pixie.RN said:
Only you can decide what is best, but congrats on having so many options! Can you shadow in each area?

Thanks! I’m fortunate to have found myself in such a spot. I shadowed in the ER and a little in the OR. They both intrigue me.. ?

Shimmer580 · Feb 26, 2019

On 2/24/2019 at 8:42 PM, PeakRN said:
I can't speak to the OR, that is a specialty with little crossover to other areas and really is it's own thing.
ED is very fast paced and priorities are always changing. In many ways the nature of ED opposes perfect care. The ED is also incredibly unpredictable, I've had many shifts that stretched over 16 hours without a lunch because of some MCI or other unpredictable event, but I've also had shifts where we get to watch movies for hours or watch an entire solar eclipse.
Do keep in mind that even as a pediatric ED you can still see a variety of ages and conditions. I remember back when I worked at a peds only center we had an adult female who had an MI from taking meth and running from the cops who decided that we were the appropriate place to come to once the heat was off (she thought the cops wouldn't look for her in a peds hospital). We also took several (very high acuity) adult trauma victims after a MCI since there were few pediatric victims and the adult systems were saturated.
Without any acute care experience I would highly suggest you shadow before choosing one of these areas. They also can limit your ability to transfer to other units, as they are both very unique care areas.

Thanks for the input, it’s so helpful! I’m okay with the limitations of transfer as I have little to no desire to move to the other floors like steps downs or med surg. I hear what you’re saying about about the OR being it’s own little world. I agree. It’s probably best to stick to ER for a greater variety of experiences and skills. I just hope I’m cut out to be one of you! ?

Shimmer580 · Feb 26, 2019

On 2/24/2019 at 9:52 PM, akulahawkRN said:
The ED is very "squirrel." Basically all we do is triage. We very rarely get to do definitive care. All the care we give is basically done "now" and not on a given schedule. We constantly are reprioritizing the care. Sometimes we have to "hold" patients in the ED that are supposed to be admitted to the hospital but that's not an optimal thing because ED nurses aren't Med/Surg or Tele nurses.
What do I get to do every shift? Well, I show up, find out what my assignment is and then I go do that. I have absolutely no idea what I'm getting into until I get there. And I have to be ready for it. My last shift I basically had 4 patients the entire shift. At the end of it, only one of those patients was the same one that I started with... the other 3 rooms each changed patients at least 2 times each. That meant that I saw at least 7 patients that shift...
I could have seen more than that if none of my patients didn't have to be held in the ED because they were waiting for a bed somewhere.
I've had the same patient several times. I have had patients suddenly change acuity. I have had patients all from the same family. I've had patients that come in because they basically have a hangnail and I've had patients that pretty much don't come in unless they're dying... and they are.
The ED is both high-performance and very street. The only thing that gets more chaotic is the street and I've done that too.
How did I choose the ED as my specialty? Well, I looked at all the various jobs in the hospital that nurses do and the one that fit my personality best was the ED. While I would do well in other areas, most of them would just be rather boring for me, even though I'd be busy at times, simply because of the routine.

When you say “high performance” and “very street”.. what do you mean? The high performance makes sense, but what about the street part? I don’t like the “longer” term of dealing with patients. I prefer things to be changing and keep my interest but don’t mind the perfecting-the-technique side of the OR . After reading your thoughts though, seems ER is a better fit.