Published Jun 3, 2003
I just transferred to the ER after working in Med/Surg and am having major second thoughts. I read posts that talk of adrenaline rushes and autonomy and it seems to me that the only thing that myself and all of the other nursing staff have been doing while I have been on orientation is putting pts in gowns and saying "the doctor will be right with you". I am beginning to wonder why I even bother taking my stethoscope to work anymore, they do not let me use it. The MDs assess apparently not the RN. I enjoy assessments, labs, actually performing procedures instead of holding the patient so the MD can perform them. I am bored, maybe I am just used to the craziness of the floor? Possibly this ER is not quite the right fit for me? It is not a trauma center, however, it is the only ER to serve 7 counties so I had assumed it would be quite busy. It is so frustrating the RNs ask the MDs for orders for everything, I mean everything. I did not think ER nursing was going to entail being the MDs handmaiden. And oh the a## kissing of the MDs by the RNs, enough to make me want to vomit! Rant ended, thanks for listening, now any advice?
gwenith, BSN, RN
OOOPS could get better? Might be better on ND when there is less MDs? Hope it kicks up for you.
Oh well if it doesn't at least it looks good on the CV!:)
Don't know what kind of ER you work in, but doesn't sound like the norm. We usually have the pt completely worked up before the doc gets in the room. We have protocols that we can order labs, xrays ect. When a sick pt comes in for example a bad Pul Edema we start everything and the doc joins in. We just don't put them in a gown and say the doc will be with you when they're struggling to breathe. Don't you get any acute MI's, allergic reactions, OD's, exac of COPD's or GI bleeds. These are all pt's we jump on and do for without a doc standing there.
I can't imagine waiting for an order to do everything. Nothing would ever get done and quite a few pt's would possibly die waiting.
Don't give up. Emergency Nursing is one of the most exciting and autonomous careers out there. You never know what type injury/illness is coming through your door. Just because you don't write it down at this point don't stop doing those assessments. You alone can make such a difference if you just persist. Make them talk to you about your patients. Tell them what you think and ask for their opinion. You have the "whole" picture of the patient and more often than not the MD's focus excludes very important information to speed the healing process. Talk to ED nurses in other hospitals to see how they document and practice. Share some of the findings with your NM. You can always pilot different things. Triage Protocols written by/with your MD's would make the MD's life so much easier. In emergency nursing you are allowed to share the most vulnerable times in patient's lives. It can be the most rewarding thing you'll ever do. If your message relayed the main reason's you are thinking of leaving, just know that you aren't yet experiencing true emergency nursing.:nurse
Too bad. It does seem like you've gotten yourself into an ER that might quite be possibly the only one I've heard of where the nurses wait for the docs to assess before starting procedures. Example: if the pt's there with abd.pain, put in a line, do labs, then hold them if you want to wait for a doctor's order, although you'd know what to send on this type of pt. before hearing it from the doctor. The same with just about anything/anyone coming to the ER. If you're just putting them in gowns and not doing your own assessment, you're asking for trouble. Many times an experienced ER nurse will alert the physician to a pt. that may have not been triaged as critical, but may be when you place them on the stretcher. Be sure of their status yourself, or they may decline before the doc gets to them, but since you have started treatment, it may be on your head. ER's are places where nurses have a great deal of autonomy if you're confident in your skills and can anticipate methods of diagnosis and treatments. I have never met an ER doc in my over 10 years of practice that wasn't grateful for any nurse properly expediting the care of the patients!! Value yourself and your skills, remember, anyone can tell a pt. to get into a gown--if you want to remain in the ER, prove yourself! This sounds like a good ER to get experience in ER nursing, then if you want move onto a bigger ER possibly Level I or II--just be sure you're prepared to do more than you feel you've been doing now. Good Luck!
I'm new to replying, but I did offer my thoughts, then I switched back and read your reply to huggietoes, you put it eloquently. I think huggietoes should watch out; I can only imagine the things the docs and seasoned ER RN's are saying about her nursing methods! Most ER nurses take pride in initiating treatments and sending off labs, getting EKG's , etc. before the docs see the pts. Many ER docs rely on the fact that the standard protocols are already done before they even go over to the patient. The beds in that small ER are going to get pretty congested if all the nurses work like huggietoes!
I think that my post was somewhat misinterprated. I would love to do more, and there are about 2 other new nurses that feel as I do. However, the nurses that have been there for many, many, and perhaps too many years will not allow it. And since this is how they have done it for those oh, so many years the doctors have come to expect this type of nursing and do not allow any procedures, assessments to be carried out without their approval. And yes, in response to one post, the ER does get backed up, quite considerably. When I do attempt to assess a pt I am told that is not my role and I am taking up time, time from what I would like to know. Time from standing around the desk watching my life tick away. It is, as scary as this is going to sound a level II ER, I think that there needs to be a changing of the guard sort of speak. Things are done differently than when the majority of the nurses began in the ER in the 1960s, I think they also resent that I am pursuing an advanced degree. They let the techs do more than myself or the other new nurses. My belief is they are trying to break us, I had heard that they drive out new help. They are afraid of change and by keeping out new nurses the ER will continue to run the way they are comfortable with the nurses having no responsibilities. I hate my new position and feel trapped, I do not want to leave so soon or have to look for another position but I am so unhappy, I did a per diem shift the other day on a med-surg floor and was so much happier, the staff was certainly friendlier and I was much busier which made the time go by much faster. So, should I stick it out or throw in the proverbial towel?
Thanks for clarifying. You're right, I interpreted you completely wrong. I thought you were thinking ALL ER's are like that one; they're not, most allow/encourage autonomy amongst the nurses, and the doctors treat the nurses more like colleagues than subordinates. These are major reasons I have only done ER my entire career, I could not imagine doing med/surg. I cringe when we are holding patients for days and I have to try to figure out the floor med.schedules to keep their meds up to date while they're waiting for their floor beds!
Sounds like you have a handle on the situation. Those old-timers do not like you or those like you who try to change the way they've been doing things. I suspect, like you, that much idle time is spent with the justification that "the doctor didn't see the patient yet", and don't forget, if the beds are filled, no more patients can be brought in from triage! Will it change? Only with enough "new blood" to push the issue! I don't know what your personality is like, but many ER nurses I know kind of "go to the beat of their own drum". The nurses currently working who are from the 60's will have to change eventually, or retire. You should stick it out for as long as you can so it does not look like it is YOU that can't cut it. Do the per-diems as they come up on the med-surg floors to keep yourself sane. If things don't change in a reasonable time limit, or you don't feel able to practice in your own way, try to find another ER. Just from your short note, I think that you may be happier in a more aggressive ER. No matter what "Level" an ER is, if it is in a large, urban area, the nurses may be more your type. Patients must be moved along, and everyone benefits from more aggressive workers. Don't forget, those RN's are not above you no matter how long they've worked there. They depend more on the techs because they can delegate to them what they must do and not do. They cannot delegate to you, as RN's cannot delegate to RN's. They are probably intimidated by you. Again, stick it out if you can, but if it's torture, try and find another ER position. Having the chance to literally save people's lives and see the fruits of your labor (or unfortunately the failings at times) is probably the most rewarding aspect that I've come to love in ER nursing. Remember, even the dinosaurs became extinct eventually; yours will too!!
Good Luck! Patty :)
Huggietoes - Hang in there and stir that place up. Do those assesment and be aggressive. Never ever accept it when someone says to you - "because that's the way we always do it." When nurses start responding with that attitude its time to start changing some things. It might not be easy, but you know what that pt needs. Do your assessment, discuss it with the doctor, and treat that patient. Eventually you will start to feel comfortable enough in different situations and with different doctors to become more autonomous. You might not make many friends, but your not really there to make friends. And who knows - maybe some of your coworkers are ready for some change, but are afraid to rock the boat.
I would have to share the sentiment of the rest of the posters. I work in an ER where the nurses are expected to have a great deal of the assesment and start of the work up done by the time the doctor sees the patient. Not all tests are resulted back by this time but it helps speed the process along. ER is fun and in my experience allows for some of the most autonomous working environments. Good luck and find a better ER! And who cares what the others do, get in there and use your skills and intelligence and push for protocols!
renerian, BSN, RN
I hate when people automatically say that is the way we have always done it. I agree shake up the joint.....
I hate that Huggietoes is having a bad time of it. I had good relationships with the docs (male & female) in our ER, they were friends for the most part, sharing dinner, magazines, trips to conferences (they paid). Many felt they should take care of us since we work so closely together & they wanted to keep us happy. Their were a few that were "bears" to work with but for the most part they were fine. When admin got involved I gave it up because I couldn't do all the crap they wanted us to do (it got unsafe). Self preservation is my key to success!
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