PerfectlyNumb

I did 2+ years in med/surg before taking the jump to ER. Get some codes under your belt (although I know these are scary on the floor). Get used to seeing people crash…hard. I think some of our most valuable nurses came from ICU. Moving to the ER is a game changer, but I wouldn't ever go back to floor nursing, ever! Sure, there is more stress in the ER, but the team work with other nurses and providers is like no other kind of nursing you will experience.

Unfortunately, there are always nurses in the ER that will eat their young. New nurses need to ask questions in order to gain competence...and be thankful when you can call any of your co-workers "kind mentors" and they do exist! As for the "bully" nurses, it takes time to win them over. As cliche as it is, you have to earn your stripes. Your co-workers and the providers will gain respect for you as situations arise. Once you have earned the confidence of your cohorts, the whole picture changes (it may take a year to accomplish this). I speak from experience, the bullies have now turned the corner in my ER world and things are looking up. A word of advice to newbies...ask your questions regardless of feeling stupid (everyone feels dumb from time to time), be helpful with your coworkers, be the person who will jump in and make a difference during any given shift, ignore the mean ones...they will come around in time.

There have been many a 911 calls placed by patients. If you are lucky, they call from a hospital phone and it will be routed to in-hospital security. I've had patients call 911 from their cell phones also, which triggers security to track me down and inform me. Mostly, 911 is called because more pain meds are requested. I've even had a patient call 911 because she lost her call light…true story.

Research found nurses who worked shifts longer than eight to nine hours were two-and-a-half times more likely to experience burnout... I completely agree with the above quote. I previously worked 12 hour shifts and felt burned out all of the time. I switched to 8 hour shifts and I feel like I can take on each day on a "shift by shift" basis. I can do nearly anything for 8 hours…but 12 hours is just too daunting, especially in the ER. And get three 12 hour shifts in a row…wow, I had nothing left for myself.

Wow, music in my heart…that is what really bothered me. My terrified patient, struggling to breathe, looking me in the eye for comfort, trying to talk to me…then subsequent intubation and cardiac arrest. My last words "try to focus on breathing, we are going to help you breathe." I felt so helpless as the situation deteriorated…family in room during code. I felt horrible that he couldn't talk to me. I felt even worse because he was so scared in the moments before he died.

There is simply no time for a brain sheet. Actually, the only time I write things down is during EMS report upon patient's initial arrival….or during a code that just rolled in and the patient info isn't entered into the computer yet. I get my ambulance arrival note and assessment charted while I'm in the room, then chart everything else as it comes. I keep detailed electronic nursing notes to help jog my memory, and review these notes as I give report….next, I go through abnormal labs, what medications we gave, what access we have, VS, and imaging results. It may help you to have a blank template to follow while giving report; that way you can follow it each time you give report while simultaneously accessing the information in the computer.

For some reason it still bothers me immensely when someone comes into the ER breathing (even if gasping for air) and we are unable to save them...although if an ambulance comes in with CPR in progress, it bothers me less if we are unable to "fix" them. Maybe it's my mindset? If CPR is in progress by medics, I assume that we are lucky if we can bring them back in any capacity. However, it eats at me if someone is breathing, talking, and heart beating, but the end result is death. I find myself running over the process in my head...what could we have done differently? Why did this person irreversibly code in our presence? Did we do something wrong? I think I am being naive in believing that we can fix almost anything that comes our way. Does anyone else feel this way?

Verbal abuse is frustrating, better than patients taking a swing at you though....Some people will never be pleased and seem to thoroughly enjoy degrading hospital staff. I would loooove to hand the disgruntled patients directions to the several other hospitals in my city (damn EMTALA). There is no other job in this world like an ER nurse's. Through all the bad, I somehow still love it.

Personal life can take a toll on you, as well as simply working in the ER. I say take a few days off, get a massage, go out with some friends and enjoy a good dinner and some drinks. Go to the lake, the beach, wherever you can clear your mind. You may go back to work feeling better and coping better. It's a tough job and often leaves us emotionally drained. I find it hard to find a balance of home and work life myself....I too need a vacation :)

It's m/s on speed. The patients you transfer to ICU as soon as possible are the people who come to you via ambulance or triage. Think a code on your unit is scary? Wait until your patients roll in the door with the LUCAS pumping. Perhaps a ruptured AAA to get your day started? Arterial bleeds, MVCs, traumas, ODs, active strokes, etc. There are a lot of stressful situations and you are truly dealing with multiple life and death decisions within a few minutes span. Then there's other stuff...boatloads of drug seekers. Lots of street drug use/ETOH combined with psych issues. Increased potential for violence. Rapid assessments (and sometimes judgements), frequent chest pains, and mystery belly pains. Frequent fliers that torment you with each visit. Extensive workups, narcs and more narcs, starting IVs, managing family members constantly. Did I mention lice and bed bugs? It's a different beast and not for the faint of heart. You get to work closely with the PAs/NPs/Docs, and your input really matters; they often ask, "what do you think?" You actually feel good when you are able to walk a scared patient and their family through what is happening during their ER visit. Sometimes simply telling them, "I am here with you, we will do this together" can make them feel at ease. I enjoy the increased autonomy as a nurse...I can actually put in orders for things that are necessary without calling and asking permission. I love it and would never go back to floor nursing again!

Us ER nurses get each other. We know why we react to situations the way we do, we understand reasoning that seems unreasonable, we don't trust anyone, we see things under a skeptical microscope, we know we live amongst an undercurrent of chaos that normal people don't see, we assess risk at all times, we are cautious of strangers and very cautious of drunk/high strangers, we are annoyed by many people but we still sincerely empathize with others, we have a keen ability to sort out situations quickly, we judge everyone within 3 seconds, we are always planning the next move, we live in craziness, we thrive in stressful situations, and we love commiserating. We must commiserate to make it in this environment. Our family and friends cannot understand us the way our coworkers can. Our loved ones are blissfully unaware of the reality of our society. We can relay an entire message to each other with a simple look. A complaint you have about patients or hospital politics, you can be assured that your fellow nurses completely understand. We can spot a drug seeker as soon as they roll in on the stretcher. We know what we are in for by a simple glance at the patient. We know people die, sometimes they show up unpronounced but nonetheless dead, and we take it in stride. We all fear pediatric and OB patients will show up in our ER. We witness tragedy. We see the human condition in its primal form. We comfort patients and their family, even if we are scared too. We need to vent, we listen to each other vent. Even though there is a clear YOU and I at work, we know we are ultimately a team that fights off the daily ER terrorists. We save lives, even though we minimize this because we deal with so many cases of benign or fake belly pain, headaches, chest pain, etc. We are humans that see/smell/touch things that nobody should ever be subjected to. We do unimaginable things. We witness unimaginable situations. We deal with violence at our jobs regularly. We are soldiers. We may lose many battles, but we must stick together to win the war on our souls.

Just curious, are other EDs seeing an increase in staff assaults compared to prior years? Are people becoming more aggressive in your ED related to synthetic drug use/ETOH or untreated mental illness (or a combination of these)?

The physical spit of the nice nurse and the mean nurse inside of me…who will take over?

Oh Ruby Vee, that's awful. You're 100% correct, if patients/families know they have a way around the "rules," they will certainly over utilize it. It's going in the opposite direction of bringing people back to the reality of necessary medical care. I would certainly guess that insurance companies refuse to pay for unfounded cares (ICU requests!!), but it makes no difference to most of the people who are on state funded insurance anyway. Those types of promises made by a PVR would infuriate me.

You've got that right SweetdreameRN, unfortunately, the squeaky wheel does get the grease most of the time. Rewarding people for their bad behavior just perpetuates the problem. I don't know of many other jobs where "customers" believe they have the right to be abusive to staff! It's funny that people feel comfortable treating nurses and other hospital staff like incompetent dummies, but have enough trust in us to care for them. It just doesn't make any sense. Believe me, if you are in need of admission because you are truly sick, I fully support it. Thanks for all the responses, I know we have all dealt with similar situations at some point.