Please dont hate me for saying this...

tencat · Aug 30, 2008

ERs, especially in a big city, are war zones. I think nurses in these positions must be efficient and 'cool' to survive, or they would be overwhelmed by the horrible tragedies they see every single day and wouldn't be able to be ER nurses. Something is wrong with the system, not the nurses. I don't know what the answers are, but until hospitals figure out a way to fix the ER problem, things aren't getting better.

bscn_rn_10_years · Aug 30, 2008

I have worked in the ER for a few years now, and the fact that nurses are sitting around doesn't mean that they are lazy, most of the time they are waiting for additional orders. NOw don't get me wrong there are alot of nurses that would rather do nothing than something. In the ER you have to ensure that you have the patients wait in their assigned rooms because we do talk about patients when we are at the desk because the docs (and us) are on the go there is no other area to do it in, we just can't step aside into an empty (if there is any) room to talk about room 4!!!!.

The CTAS score also determines how often vitals are taken and how acute a person is. Please don't judge us prior to working in our area or walking in our shoes. I have been punched ,kicked, spat at, had things thrown at me and I have been sworn at and told that I was worthless (usually by family members).....but still I did my job, so if I want to sit down and cool my heels please understand.

Hootnhollern · Aug 30, 2008

It sounds like OP got it...I haven't walked in enough shoes yet either... :wink2:.

alwayslearnin · Aug 30, 2008

RN2BENAUSTIN

I really appreciate your posts and that you have been willing to keep an open mind and grow. Those are qualities of a great nurse!

I remember when I was in nursing school and did my ER clinical-I was appalled at my preceptors negative attitude about her patients and her views about the ER in general. I had to write a reflective paper on my experiance and I asked some of the same questions as you did (funny-I still have the paper 12 years later) And here I am working in the ER-but with experience and a whole lot different understanding.

I remember in nursing school they talked briefly about the shock that nursing students go through when they get hit with the reality of nursing when they are actually working as nurses. I don't think my school talked enough about it. For me I was very idealistic about nursing and it has been quite a shock at times to see/work in the reality of nursing as it really is.

I am a good nurse. I work very hard. You don't see me sitting on my butt hardly ever because I don't get that luxury very often.I am in and out of patient rooms constantly giving quality nursing care-that is who I am. That being said, I certainly now understand that nurse that I had such a difficult time with and wrote about in my paper years ago. As has been previously mentioned-we see incredible things in the er daily. And not just the tragidies. How about the patients that have 60 ER visits-all for dental pain, migraine pain and abd pain that all there scans, tests, etc are negative and they are drug seeking( yes it happens and yes I am aware of the legitamacy of each problem but please I am not a dumb-bunny-there are our constant flyers for drugs) Or the people who come into the ER for a hemmorhoid or cyst or very small cut and are the most DEMANDING people you have ever met. Or people who come to our ER because of a "cold" and are seen-but really they wanted the free taxi ride to where-ever because they have DSHS and get that service. I had a man the other day call 911 for abd pain and after arrival his main want was for our social worker to call his girlfriend in another state because she wasnt taking his calls and had phone ID so he figured if we called for him-she would pick up the phone because she didnt recognize the number and he could talk to her. We did abd scans,labs etc and the whole time he kept asking us to make this call. When I flat out told him were not going to call for him he got up and said he was ready to leave and left. He really didn't even have abd pain-he just wanted the phone call.

These are the things that can take away your idealism very quickly and you can get quite cynical if your not careful-but you don't have to! Sometimes you have to talk it out to get through.

I do love the ER and if you see me there someday-talk with me about your concerns/perceptions and fears. Maybe I can share some insight and you can remind me again of why I started this in the first place with that new enthusiasm and hope-sometimes I need that reminder.

God bless you whereever you end up and keep asking those questions:yeah:alwayslearnin

WannabeFlight · Aug 30, 2008

I have been a Medical Assistant in a Hosiptal Out-Patient Facility for several years while awaiting entrance to Nursing School. But I can sympathize with what you are feeling. I work among staff of CNA's, RMA's, LPN's and RN's. And those behaviors are not specific to one level of training. It is evident throughout all levels, even some MD's act that way. :twocents: I feel that it is a bad combination of reasons that this happens. One reason is personal choices. One is administrative choices. And another is just that they know no better. Administratively that behavior should not be permitted and personally people learn from the people they are around during training (in most cases, I have witnessed that).

In many years of waitressing the old saying was "If you have time to lean, you have time to clean." :wink2: I personally adhere to that mentality that there is always something to be doing... And find that asking people who sit and do nothing to help you often rubs off on them.

You cant change what they do, but you can change the presence that your actions have. :up:

SweetLemon · Aug 30, 2008

I am jumping on this tread a little late in the game and still in catching up on what was written so if I completely repeat what has already been said sorry in advance....

As a Pre-Nursing Student I think it is wonderful that you are getting a chance to shadow and see what nursing truly is about. I am sorry that you were so incredibly disheartened by the staff in which you were working with. I have to caution you a little... while talking about patients in an unprofessional matter is never appropriate some of what you saw the nurses doing (or not doing) could possibly be because of the atmosphere of an ER....which is very different from being on any other floor. The pace is a lot faster and while their definitely are protocols on vitals and type of care that is given, it is possible that more was going on behind the scenes that maybe you were not aware of. Because the nurses are so use to what they do all day long they tend forget to explain... If Nursing is what you want to do and this truly bothers you I say work hard continue on and get your degree and be the one to bring change.....through your own actions and excellent care as well as possibly going on into management where you can help re-educate some of the less cautious nurses. Sadly poor behavior will be found everywhere...people are lazy no matter what profession you are in. Being nurses that is a truly a scary thing when you think of the type of care we provide as well as the drugs we administer (a lot can go wrong fast when you have a lazy nurse).

sissiesmama, ASN, RN · Aug 30, 2008

I'm not sure how you figure she doesn't belong in the ER. That is just where she has seen the behaviors she described. Such is not exclusive to the ER, nor are all nurses in ER like this.
It's very interesting - she begged everyone not to take offense yet it seems like almost everyone here did. Have I misperceived?
For OP: Just be the best you can. You are going to find all kinds of people in Nursing, just as in Medicine or any other field of work. Emulate the good ones, eschew the others, pray for all to walk a mile in the shoes of the patients and their relatives; and vice versa!

Vito --I among other posting here do not think that they have taken offense with the postings she requested. However, I think you may have to look opon your self to see what may be bothering you.

Anne, RNC

sissiesmama, ASN, RN · Aug 30, 2008

Thank you for stating this, I do think I should have put more thought into my original question. I did not mean to put people on the offense, I understand that many people (inc myself) do not understand in full how difficult a Nurse's job is. Since there are so many misconceptions, I think it was natural for some of the responders to automatically think I was attacking their integrity. Like I said, I wish I put more thought into how I asked, because that was not my intention. I have the utmost respect for Nurses and appreciate their dedication and the sacrifices they make on a daily basis. I can see where they are coming from, how can I begin to question a situation before I experience it. Sure, I witnessed nurses having down time, that I can understand, I am not sure I can understand some of the comments I overheard, but I agree that I will understand more as I am in those shoes for a while.
Thanks again to everyone that responded, you have opened my eyes a bit towards what I will face, I am up for the challenge!

Just find the traits you find positive and find your happy medium!

Anne, RNC

Lurksalot, BSN, RN · Aug 31, 2008

I do want to say, I did not mean to judge, my intentions were to learn more about the means of the change in attitude. I guess wanting to prepare myself for what all I will encounter. Please try to remember how you all felt when you were first able to care for a patient, I know you must have been eager, just as I am. Yes, I agree 100% that I should not judge until I have been in those shoes. But, what is wrong with wanting to know what aspects of nursing bring upon this change in attitude in some nurses?

You ask a very timely question that has caused me to post after a very long absence here.

I very vividly recall how I felt as a brand new nurse. I was eager to join the team in the ER, learn as much as I could, and truly do some good by making a difference for the patient population I chose to care for. I jumped out of bed every morning because I could hardly wait to get to work. I tried to gain the respect of my coworkers and become a trusted member of the team, and a tough bunch of type A personalities it was! I tried to help the brand new residents, because I sure know how they felt--new and lost! I would gladly skip my lunch because everyone was too busy to cover for me. Hardly a shift went by that I did not cry in my car on the way home, thinking about the patients I cared for that day--those that made it, and those that did not. I thought to myself, "I will always remember every patient we coded that died..." My nights were spent trying to find a way to fall asleep because I was so ready to get up and do it all again.

Then things began to change. I was exhausted but happy to get up and go to work. I was beginning to feel like part of the team, but still painfully aware that my glaring lack of experience was a barrier to gaining the respect of my coworkers. I still tried to help the residents, but I was quite busy watching my own backside because I'd been burned by the residents too many times. The nights that I drove home crying were getting less, and I spent more time at the bedside holding a family member's hand and feeling like I had finally achieved composure enough to comfort people most effectively. (Since I had been told multiple times I was way too caring for the ER.) My nights suddenly became battles to get to sleep---all day I had kept a stoic demeanor, but when I laid my head on that pillow at night the images just would not stop. I wondered if I triaged that patient correctly, or if I had just done something different the outcome would have been better. It haunted me that I could not recall the number of codes I'd been in, or the faces of people I had watched die.

And things still change more even now. Just today on my way home, I thought back on the day, and I wonder what on earth is wrong with me. Am I sick in my head? Have I become some kind of monster? I did not sit and hold the hand of a heroin addict who came in for a broken needle, instead I gave him teaching on drug abuse and informed him he should be more worried about the heroin he just injected than the needle broke in his arm. I make sure I get to eat, even if it is sitting at the nurses station looking like I am being lazy. I don't trust the residents for a second, but I still manage to be nice to them. My coworkers have become like a second family, and a closer group of people I could not imagine. I've gained trust and respect, and am part of the team. No longer do I dream at night, but when it's been really bad at work I might have a glass of wine so I can drift off to sleep as quickly as possible. I wonder how I arrived here, because sometimes it hits me that I no longer cry on the way home from work, and I think something must be wrong with me. The other day I realized that I had lost track of how many failed pediatric codes I'd been in on, and I could not recall all of their faces anymore or what happened to them.

But I still do what I need to do. I am efficient, I prioritize, and I give excellent patient care. Have I taken vital signs on a person and then not gone back for a long time--yes, I have, if the person came in for papercut or a runny nose. Yet it is probably because I am at the bedside of a patient we are about to send to the cath lab or intubate, and because this is what I do for a living I am certain the runny nose will be okay without me at the bedside. Do I want to be at the bedside, holding the hands of patients and family members, fetching pillow and socks, or getting snacks for them? Yes, I do, when someone is sick and/or sad. Do I have time to fetch a pillow for the third visitor of the runny nose? No, and it makes me aggravated to be asked something like that as I am running down the hall with my arms filled with fluids and supplies. Have I ever referred to someone as "the bloody GI bleeder"? Yes, I have--because thinking of him as the 'sweet little old man who is probably going to die as his wife sits crying at his bedside' keeps me from functioning to do what I need to do.

Daily I remind myself that I have not changed inside as a person--I still am the same, brand new nurse, who wanted to help people and make a positive difference in the community. I still care. But I have to care for myself, too. I prioritize my care for the patients I see in the ER, and I prioritize care for my own sanity. I have to grow and change, and I can see that the way I cope is by adapting along the way. I love my job, and love nursing. I miss the "old" me, but I know the change has happened to allow me to keep doing what I love.

So this was a lot of rambling, but I hope you can see how things can change. I wish you luck in your future career.

suanna · Aug 31, 2008

ER may not be the best place to get a real perspective on nursing as a caring and nuturing profession. The nurses in E.R. are on the front lines of some of the most manipulative, abusive, and downright evil people that nurses ever have to deal with. I would become a bit jaded working in that pit of dispair. In addition, at least at my hospital, ER nursing is given very little autonomy. You don't scratch your nose without an order from an attending ER doc. When nurses are made powerless by the phylosophy of the unit it always drags down the drive to provide optimal care. See if you can shadow in L&D or even a good med surg floor. They would be happy for the help and you mignt get a better impression of nursing.

sissiesmama, ASN, RN · Aug 31, 2008

I am sorry to have upset some of you and honestly did not intend on stirring the ****. I had a talk with a friend that has been a nurse for over 20 years, 11 years in the ED. She was explaining how and why the reality or nursing is not what many new nurses expect. And you know my husband asked me how I felt about firefighters, regarding the down time they have between calls, and then I realized what I had wrong all along, this is my first experience and I dont know what I was expecting, but obviously I needed to consider (the obvious) fact that it was the EMERGENCY dept, not mother/baby unit. That's these are situations where you dont necessarily have the time to bond with a patient, just a smile or a pat on the back or holding a hand to show you care, may be the extent of outward "care" that time allows. And, that does not mean that you care less than another nurse, it just means you have to put it in perspective for the unit you are on and the limitations on time and energy that one person can possibly shell out. I dont know if what I am saying makes any sense, and I know with time I will understand it better and be able to articulate my thought processes better, but for now, I can say I will have a whole different attitude and will open my mind and my eyes to all aspects of nursing that I am fortunate enough to experience so early on.
Thanks again to all that commented, good or bad, it honestly has helped me and I appreciate your taking the time to give your input.:heartbeat

RN2B - You started out by saying please don't hate me but... some of the comments made by others were unnecessary. I think, every situation and every incidence at work will bring out the best and worst in you, whether or not it is a positive thing , or negative thing. You just find your own niche and go with it!

I hope I was not offensive to you!!!!! Anne, RNC

**canoehead, BSN, RN** · Aug 31, 2008

Lurksalot- I think that was worthy of our essay contest- you should post it there. Or submit it to the ENA. That's exactly how I feel but haven't been able to put in words that fit.