Physical Ability in the ED

[abq rn]

I know this will be an unpopular thread but I am getting more and more frustrated by the day. I cannot understand why nurses who never manage to adapt to the ED pace remain in the department. I am sure we all have at least one person in our department that is unable to physically or mentally keep up the demanding pace that ER medicine requires. I do not understand why there is no self awareness that this is not the place for them.

One RN I work with has been licensed for 6 years now. I think she has been in the ED for 3 of those years. If she has more than 3 patients and even one of them is really "sick" she has a meltdown! The charge nurses have an unwritten rule to keep ill patients out of her section at all costs. If it looked like there was improvement over time I might not be so irritated. Nothing seems to change in either her behavior or the approach to managing her employment in the ED. Why has no one sat her down and talked to her about moving to a less acute area where she won't be overwhelmed every night? More importantly why can't she see that she does not belong here? I am not trying to tell anyone where they can or can't work so don't misunderstand me. If I came in to work every night and felt like I was in crisis each hour of my 12 I would consider a change after a brief period.

Now I understand everyone needs a chance to get their legs under them and some need more time than others. But if you are a person that needs more time to get you're "nursing on" is the ED really the place for you? Some people thrive on the excitement of Emergency nursing and can't get enough of it but that is not enough reason to put a RN in a position that he/she can't handle! More importantly why do these nurses put themselves in this position?

Then there is the physical issue. I won't say I am a track star or a marathon runner by any stretch of the imagination. I will say however I can stand in Trauma for 12 hours doing CPR half the time and still walk home after my shift. I work with nurses who can't stand up for more than 1 hour at a time! Some of them are so out of shape they get chest pain in the middle of the shift and have to be census managed before they wind up being coded. Why do they keep coming back?!!!! If you are physically unable to keep up with the pace of ER medicine then it is time to find something else to do! Go work in a clinic or a school, for gods sake help us all and go teach! Why would you beat yourself up every night? I like being on my feet and I feel reasonably good after 3 12's in a row but some of my coworkers can barely stand up at the end of the 3re day. The management makes accommodations for them by putting them in triage or putting them in ER Obs where the acuity is not that high or you don't have to stand up for more than 30 seconds at a stretch. How is this reasonable? The rest of us carry the workload that these nurses should be shouldering instead of having help from a teammate.

I have made plans to move to a less demanding nursing field when I can no longer keep up in the ED. With all of the opportunities available for nurses these days, why don't others?

[Quickbeam, BSN, RN]

I think it is because most nurse don't ever seem to have a Plan B for what they will do if the job in front of them doesn't work out. I find your example generally more apt with nurses who have never had other careers. Most career changers have already had the jarring experience of changing jobs and trying something new...when one RN job isn't for them, they can roll on to another. Just my opinion and all of that.

I knew from my first year working full time hospital nursing that I'd never make it to retirement doing that type of physical work. I never stopped interviewing and looking at career options. Although it took 12 years, I ended up in a form of nursing my joint disease could sustain. The amazing thing to me was how many people expressed astonishment that I left for a lesser paying, lower stress RN job. I had people outright call me stupid for not finding a way to get injured on the job and riding the WC disability train. (WC rights are extremely strong in my state).

I think every professional has an obligation to assess their strengths and weaknesses and look at jobs accordingly.

[Altra, BSN, RN]

I think every professional has an obligation to assess their strengths and weaknesses and look at jobs accordingly.

:yeahthat:

[mianders, RN]

I worked in the ER for many years and left after a major MVC caused long term physical problems. I had other options open to me. Some of the nurses you are speaking about have probably been in the ER for many years and that is all they know. Have you ever looked into the pay scale for clinic nurses or school nurses. I have and it is not very good. Some of these nurses are probably the breadwinner for their families and that kind of cut in pay is not an option. Going to the floor is also very physically demanding, so that is also not an option. Maybe you could come up with some kind of constructive options for these people who have probably been nurses for many years and paid their dues many times over.

[yeSICU]

I worked in the ER for many years and left after a major MVC caused long term physical problems. I had other options open to me. Some of the nurses you are speaking about have probably been in the ER for many years and that is all they know. Have you ever looked into the pay scale for clinic nurses or school nurses. I have and it is not very good. Some of these nurses are probably the breadwinner for their families and that kind of cut in pay is not an option. Going to the floor is also very physically demanding, so that is also not an option. Maybe you could come up with some kind of constructive options for these people who have probably been nurses for many years and paid their dues many times over.

We have had 2 ED nurses that have left the ICU because they found it more physically challenging than working in Emergency. Hearing that def. threw me for a loop because looking in from the outside I would think it more challenging. Where I am at though there are numerous techs in our EC so the nurses are mostly pushing pain meds and assessing depending on their area of course. I never thought about the fact that even though we only have 1-2 pts that you truly are on your feet most of the shift and we do total pt care (bathe, stool, bathe stool, lather, rinse repeat, throw out your back).

[Dixielee, BSN, RN]

"Then there is the physical issue. I won't say I am a track star or a marathon runner by any stretch of the imagination. I will say however I can stand in Trauma for 12 hours doing CPR half the time and still walk home after my shift."

WOW. I thought I was in pretty good shape to work the ER at my age, but I Know I could not perform CPR for 6 hours of my shift in an 80 degree trauma room and then walk 30 miles home. I guess I should just get my walker and toddle on home now.

[BethulieRN]

"Then there is the physical issue. I won't say I am a track star or a marathon runner by any stretch of the imagination. I will say however I can stand in Trauma for 12 hours doing CPR half the time and still walk home after my shift."

WOW. I thought I was in pretty good shape to work the ER at my age, but I Know I could not perform CPR for 6 hours of my shift in an 80 degree trauma room and then walk 30 miles home. I guess I should just get my walker and toddle on home now.

Dixielee, do you feel singled out as one of those nurses abq rn is talking about?

[BethulieRN]

Then there is the physical issue. I won't say I am a track star or a marathon runner by any stretch of the imagination. I will say however I can stand in Trauma for 12 hours doing CPR half the time and still walk home after my shift. I work with nurses who can't stand up for more than 1 hour at a time! Some of them are so out of shape they get chest pain in the middle of the shift and have to be census managed before they wind up being coded. Why do they keep coming back?!!!! If you are physically unable to keep up with the pace of ER medicine then it is time to find something else to do! Go work in a clinic or a school, for gods sake help us all and go teach! Why would you beat yourself up every night? I like being on my feet and I feel reasonably good after 3 12's in a row but some of my coworkers can barely stand up at the end of the 3re day

:chuckle:chuckle:chuckle:chuckle:chuckle:chuckle

This part made me laugh so hard. I think you could be a fantastic writer in comedy on everyday nursing problems. If you are interested you could write a lot of these stories you encounter and propose your storylines to tv shows such as scrubs on NBC.

[Dixielee, BSN, RN]

Dixielee, do you feel singled out as one of those nurses abq rn is talking about?

No, not at all. I work in a 50 + bed, regional trauma center and can still run circles around a lot of the young pups. I just thought his post sounded a bit condesending and arrogant. The OP appears to be a fairly new nurse, as his profile still says student. It seems he may think he knows all there is to know about nursing, but his tact seems to need a little polishing, that's all.

[abq rn]

I guess I should update my profile...but then again...aren't we all supposed to be learning all the time?!!

Look... I am not saying that any one should be drummed out or benched from the work they love. What I am saying is that if you cant do what the job demands... should you really keep doing it? Is there no room for self assessment in our profession? Just because your pride or ego wants you to stay in the ED does not justify the lack of care your patients might get or the lack of support your team mates might be subjected too.

As for condescending... I am posing a question. If you (whomever you are) are going to take every thing personally and get your feelings hurt I cant understand how you could work in the ED to begin with. Lets also face the facts that just because you have been an RN longer than I have does not mean you know more by default.

Think for a moment...please

[Dixielee, BSN, RN]

I never took your original post personally, it just smacked of arrogance. I am comfortable with my skills and abilities, and I am sure you are as well. That is my last comment on the subject.

I had all the answers at one time too. The longer I am in this profession, the scarier it becomes, not because I am not learning, but because I AM learning what a critical and high profile job we do. Peoples lives depend on us to be able to deliver fast, accurate and compassionate care. There is no room for egos or urinating contests. We each have different talents and use them in different ways. Sometimes working smarter may look like being lazy. You don't have to be jumping up and down and running around in circles to get your job done, if you are smart about it, and are confident in your abilities.

Dixielee out, not wishing to defend, just making observations.

[traumaRUs, MSN, APRN]

I worked level one trauma center for 10 years in various positions from ages 37 to 47. I absolutely loved it - could keep up and had no problems. That said, I knew in my 40's that I probably wasn't going to retire as an ER RN. I went back to school to give myself more options.

However, I was one of the lucky ones and was able to transition to an APN role. I just went to visitation for one of the best ER RN's I was fortunate to work with. She was my preceptor and truly had all the answers. She was wonderful. However, she did work herself into an early grave: she took much better care of her patients than she did herself and died at 57! She didn't go back to school because she felt that she didn't have the time!

All I'm saying is that sometimes we are much nicer to our patients than we are to each other.

Also - I found that as long as I stayed mentally sharp, it helped more than being the fastest! If I am sharp, I stay better organized, don't keep repeating the same steps and stay focused.