New ER RN- does it get better?

TheCommuter, BSN, RN · Nov 18, 2015

Welcome! We have moved your thread to our Emergency Nursing forum to increase the likelihood of receiving responses from ER nurses. Good luck to you!

StudyinginCT · Nov 18, 2015

#1 - that won't change. The patient population is what it is. Doesn't matter which town you go to - if it's in the middle of nowhere or the big city. The only thing that changes is the volume and the creativity in how people decide to f**k themselves up.

#2 - Yes! Press Ganey! Have you met the *****? Super fun, right. You totally want to take her out for cocktails so she can tell you how you should have been faster responding to your bells or provided more warm blankets or more cranberry juice to your diabetic with belly pain. I know, she's such a gas. Don't worry - she's in PACU and Day Surgery and other places too! She doesn't just haunt the ER.

#3 Health care is changing/has changed, will continue to do so until we die. So saddle up and hang on or jump ship, but it takes gifted people to do what we do and we will always be in short supply. If you can't take the heat,get out of the kitchen. We do important work with unnecessary ******** like lactics and blood cultures on afebrile patients. But we do it anyway. If there isn't a bigger reason for you to do this and you can't reconcile the ******** then yeah, go do something else. But beware, all nursing professions involve some degree of ********. So do all jobs for that matter.

Guest219794 · Nov 19, 2015

I have been a RN for about six months. I am currently working in the same ER that I worked as a tech for 3.5 years before I graduated from nursing school. I am looking for some advice from more experienced nurses. Several issues are going on right now:
1. I am becoming very jaded with the population of ER patients. I am dealing with things that I didn't have to deal with as a tech, or I would have thought twice about accepting an ER job. I am tired of having charts shoved back at me when I have patients sign their discharge papers because they didn't get the drugs they wanted from the provider, the provider took too long to discharge them, or what have you. The other night, a psycho mother went ballistic on me after I was completely pleasant with her child, refused to use my pen to sign discharge papers, and said "I saw how you looked at my son. You wouldn't even care if a kid had cancer!" Meanwhile, her boyfriend or whatever is trying to drag her out of the ER so she doesn't make an even bigger scene. I always said I would not tolerate anything in my professional life that I wouldn't tolerate in my personal life, and there is NO WAY I would tolerate that from a friend or romantic partner, yet here I am. I am tired of the vagrants who take an ambulance for dental pain and then expect us to give them a cab voucher to get home, the ones who will steal anything not bolted down, the drug-seekers, the welfare trash who are wasting taxpayer dollars with their nonsense because they refuse to get a PCP (because, of course, the PCPs will actually make them pay).
2. My ER has a 5-minute bedding policy. If there are open beds, patients are placed in rooms within 5 minutes. This means that if multiple patients sign in in rapid succession, the triage nurse puts the patients in rooms, hooks them up to get vital signs, and leaves to go room the next patient, which means that not only I am now responsible for total care of up to four patients (sometimes more if a family gets put in one room), but I am now also responsible for triaging as well.
3. I hate how medicine/nursing has changed from patient care into customer service. It is perfectly acceptable appease druggies (because Heaven forbid they wait more than 5 minutes for their next fix), but I could get written up by the charge nurse if I don't fill out the stupid white boards after every patient (meaning I have to erase my name, and re-write it for every. single. patient.). The charge nurse has to round on so many patients each shift, and asks things like "Did the nurse tell you her name?" "Did the nurse inform you of your plan-of-care?" "Did the nurse inform you of approximate wait times to get your results?"
I have a degree in chemistry, and I have considered either going back to work as a chemist or going to pharmacy school. I think I would be happier in an OR or PACU setting, but I have told myself that I will stick it out for six more months, as they have invested a lot of money in training me. I figure I can tolerate just about anything for six months and I can start taking Celexa or whatever to get me through. Right now, the only thing stopping me from opening up a vein is because I know this is temporary and I have other options. So my question to the experienced nurses is: Does it ever get better? Should I stick it out or jump ship now? I am quickly morphing into someone who I don't like being around. Thank you for reading.

No, it does not get better. Assume that all the problems you point out will get worse. You can't control that, you can only control your attitude and outlook.

I always said I would not tolerate anything in my professional life that I wouldn't tolerate in my personal life, and there is NO WAY I would tolerate that from a friend or romantic partner, yet here I am

This is a pretty unrealistic expectation. And, what do you see as an alternative to "tolerating" it? Arguing with irrational people?

I am not justifying her behavior. I recently, prior to a medical screening, told a patient to leave. He was angry, referred to the staff in general as *ssholes. I was willing to be patient and try and talk him down. Then he referred to my charge nurse as a c*nt. I instructed him to leave, and told him he was welcome to come back if he wanted our help. Had my actions been questioned, I would have explained my concern for safety of staff and patients with this angry patient who was escalating. My documentation supported my concerns and the action I took.

"Did the nurse tell you her name?" "Did the nurse inform you of your plan-of-care?" "Did the nurse inform you of approximate wait times to get your results?"

This a perfectly reasonable expectation, easy to do and takes no real time. It's good nursing.

the welfare trash who are wasting taxpayer dollars

I am pretty jaded and have never even thought anything like this, let alone said it.

Right now, the only thing stopping me from opening up a vein is because I know this is temporary and I have other options.

OK, that's a little melodramatic, don't you think? If not, get help. Now.

triage nurse puts the patients in rooms, hooks them up to get vital signs, and leaves to go room the next patient, which means that not only I am now responsible for total care of up to four patients (sometimes more if a family gets put in one room), but I am now also responsible for triaging as well.

Same deal where I work. I don't think it's safe, and I think it's here to stay. Nice that the charge at least hooks them up- not always the case where I work.

I am quickly morphing into someone who I don't like being around.

Definitely leave.

I strongly recommend jumping ship now. It's just gonna get worse. And, despite what others may say, other fields don't deal with the level of shyte we do- at least not in the issues you describe. Go to PACU or interventional radiology or endo.

tech1000 · Nov 19, 2015

No, it will not get better. I've been in the ER for 5 years now and it hasn't changed at all. While I am burnt out, I don't think I have quite that negative of an outlook. It is unreasonable to expect that you can be a nurse, but not to have to tolerate things in your professional life as you would your personal life. You work with the general public. I would expect that you are respected by your employer and wouldn't tolerate that from your employer, but the fact of the matter is that in ANY job working with the public, you WILL be treated in a matter that is at times extremely unacceptable. It will probably be worse in the ER because some patients are actually sick, some families are actually worried, and some people are actually drug addicts who are just angry about their drugs. If you are this jaded, find a different area of nursing.

shorty3 · Nov 23, 2015

I started as a new grad in the ER, working in 2 different ER's over 4 years. That's how long it took me to escape to the ICU. I left for all the reasons you listed above. I hated it, and I hated knowing that people hated me. I've never actually felt like a nurse, until I left the ER and started where I am now. You need to get out and try something else.

ERs hoard the most undesirable people. My view of moral for people in general seriously plummeted during that time. I have to say I am much happier now.

Work2Live · Nov 23, 2015

I am beat after a long shift of working with challenging M/S patients and not enough resources. So, I'll keep my response short and sweet. Your concerns and feelings are valid. Don't take too many of these responses to heart. A lot of these nurses are evidence that nurses eat their young. If you're not happy in the ER, try a different specialty. Perhaps sit down and write out the pros and cons. Also consider your long-term goals (in nursing as well as in life). I sincerely wish you well. I have been a nurse in A LOT of different areas in the past nine years and I am plotting my escape. There are too many hurdles in nursing as we approach 2016. Life is short. Be happy.

wannabecnl · Dec 3, 2015

6 months is a rough time in any specialty. You're done with orientation, you're on your own, but the comfort level is just not there yet. And right about now you're realizing that some of your patients are just plain not nice. Go look at the humor thread about what ED nurses can tell you! Also, you have good insight into the fact that being a nurse in your ED isn't the same as being a tech; I was a nursing student in the unit where I work, which you'd think would be blindingly similar, but I've had to adjust as well. Nurses bear a tremendous responsibility with little credit, okay but not stellar pay, and varying degrees of respect from colleagues, patients, admin, docs, everyone. It is not an easy job, but it does get easier over time.

ED may not be a good fit in the long run, but I'd love to encourage you to try to stick it out for a year. You are going to learn skills in the ED that will serve you anywhere, but jumping in as a new grad in another department runs a risk of landing you in this same boat 6 months from now. I made myself stay in my job until I didn't feel like I sucked at it anymore, and I'm still here 3 years later, but there were many nights that I scanned all the nursing jobs in the area instead of sleeping. It does get better, and getting comfortable in the ED will start you out a lot more comfortable in a different place down the road.

(And for the well-meaning folks who want to send everyone who is disgruntled to the PACU: come shadow me for a few shifts before you assume that we don't get any crap! Whatever crap--family baggage, comorbidities, oddball heart rhythms, mental health issues, drug/alcohol addiction, or just being a garden variety jack***--they came in with, they are bringing to PACU; as my preceptor used to say, we didn't fix that in the OR!)

Dragonnurse1, ASN, RN · Dec 13, 2015

I fear for you that it will not get any "better" as far as the patients, families and sometimes other staff go but it can get "better" if you change just a little. I have been out for about 10 years now and sounds like the same patient profile I worked with. You are too jaded for only 6 months in, wait until you have to confront a father whose clothes are covered with cocaine and he wants to see his son and "baby mama" but does not know the names of either or have to tell a stable patient to go back to the lobby after they followed the man that just walked in having a massive cardiac arrest to the treatment area screaming that they were there first. When you tell them that the cardiac arrest comes back first because they might die you are told "I do not give a damn I was here first." Just when you think it cannot get worse a car pulls up at the bay doors and throws out a dead body as it rolls by and it is followed by his gang members. But then there is the man who walks in with his throat slashed from left ear to just under his right cheek with all the sub-structures visible that you help save. Or the family of a woman that is dying and in pain and you are the one to help the family to say goodbye to their mother while signing a DNR so that she can get pain relief that she needs knowing she will die as a result...then one year later getting a card at work thanking you for your time spent with them that fateful night. Or the child that you got into social services because you realized the mother was a Munchausen by proxy case. The little victories are the only thing you should hang on to and everything else you let go.

5 minute bedding? Do you not have different "tracks"? Are critical patients being shoved into your rooms? Half the time the patients complaints changed between triage and the room.

Yes unfortunately it seems that there is a push to change from treating "patients" to treating "customers". The problem with that train of thought is that the the patient is not always right and does not know what they really need just what they want. I am glad that I no longer work as I would have probably been fired for telling a patient that they were being stupid. We use to joke about setting up tables out on the dock with chicken on one, beer on another and work excuses on the third. We even set a price schedule, $5 got you one piece of chicken and 1 day off work, $15 got you 2 pieces of chicken, one beer and 3 days off. But for $100 you could have all the chicken you could eat, 6 beers and a week off work.

One of the best ways to survive and enjoy the ER is to have a very dark sense of humor. The darker the better and the longer you will last and the less jaded you might be.

I went straight to the ER from school, it was the same ER I worked in as a nursing asst (basically a tech) and I stayed for 9 years 4 months and 17 days until the latex allergy got me. If you decide to change without giving it a year please float to other units multiple times to see if you like it, just remember that those pesky types of patients that were in the ER and made you nuts there often get admitted to other units as well. You may find it necessary to bail out of nursing sooner than later.