echmorrill

It's the day after Christmas, and the ER is packed. The line to register is 10 patients deep, and I take deep breaths as traumas and critical patients rush to the front of the line. A mother comes in, hysterical after her own toddler has apparently ingested some of grandpa's medications. I flag down a nurse for her, biting my tongue to keep from jumping in – this isn't my ER, after all, and this time, I'm here with my own kid. My shoulders are aching from holding my 18-month-old and pacing the floor for an hour. I know if I set him down, he'll start touching everything and putting who knows what into his mouth. He's too young to wear a mask, so I'm doing my absolute best to at least minimize the risk of contact infections during a global pandemic. Finally, it's our turn. We enter the triage room, and I ease down into the patient's chair, trying to balance both child and enormous diaper bag in my lap. "What brings you in today-- " the nurse begins, then pauses. "Do I know you?” "Um, we were here three days ago, with my three-year-old.” I blush and shift my crying one-year-old to a more comfortable position. "And, um, a week before that, with my six-year-old.” It's never a great sign when the triage nurse recognizes you. Especially when you're back in the Peds ER for the fourth time in a month. Especially when it's not the ER where you used to work. Where I worked before it all became too much, that is. A combination of bad luck and clumsy kids had landed us back in the ER yet again for another round of stitches. The jokes about when we'll earn our VIP frequent-visitor punch card are sounding thin. I'm only half-joking when I ask when they'll be sending CPS to our door. As an Emergency Room nurse myself, I try to picture what my family looks like from the other side of the triage desk. If I were assessing this kid, would I smile and joke along with the obviously distressed mother? Or would I sigh under my breath, wondering how I was going to pull two nurses to burrito-wrap this baby while the doctor stitched the laceration, when we already had 12 in the waiting room and all beds full. The nurse starts asking questions, and I find myself wanting to explain, to justify why we're here yet again. I cut myself off. I picture the triage form and adjust how I answer the questions – just give her what she needs to triage and assign a room, I remind myself. "I would have gone to urgent care, but you guys do PO Versed before sutures, and I think the outcomes are so much better,” I find myself justifying anyway. I want them to know that I'm sorry for taking their time, that I know these sorts of injuries could be handled in urgent care. The thing is, my baby is acting lethargic and I can't tell if it's because it's nap time and the ER is hot and his head hurts, or if it's something I should mention. I don't want to be one of those moms. I know what it's like to bite your tongue at the dooms-day patient – after all, it wasn't that long ago that I'd had to stifle a laugh when a patient told me, "I googled it, and it's either leukemia or Celiac disease.” (It was gas.) I decide that my duty to my kid trumps my own embarrassment, and I mention that the baby is acting a little dazed. As if to support my statement, the baby droops back into my arms and closes his eyes. We get a room right away. But by the time we get there, the baby has perked up, curious about the equipment and the hustle of nurses and doctors. His neurologic exam is normal. I can't stop apologizing, can't stop saying, "I know you're busy, December 26th is the worst day to come, I swear he was acting differently before, I'm so sorry…” When the doctor comes in to suture the laceration, they raise their eyebrows when they see the bandage on my son's forehead. "That's a good dressing. Did we do that or did you?” I pause. Do I say I'm an ER nurse? I don't want to be an ER nurse right now. I just want to be a tired, anxious mom. I want to be able to ask stupid questions. I want to be able to ask for help. But the ruse is up as soon as the doctor asks about the last time my son was here, just before Thanksgiving. "He slipped getting out of the bathtub. It was a minor lac, but urgent care wouldn't touch it because it crossed the vermillion,” I explain. That raised eyebrow again, as soon as I say "vermillion.” I nod when they ask if I work in healthcare. "I used to be an ER nurse, but I switched to remote work after my second child was born. It was...really hard.” In that one sentence, I try to communicate everything: the work. The leaving. The shame that I'm not in the thick of it anymore. Everyone is beyond kind. One nurse brings in a stuffed bear, delighting my son. Another holds him for me while I run to the bathroom. They laugh when I tell them how, last week, my three-year-old threw a tantrum until we unrolled her from the burrito wrap and re-rolled her "like an enchilada,” per her request. When we get our discharge instructions, the doc slips me a suture removal kit after I admitted I'd been using my (sterilized) eyebrow scissors to remove the sutures rather than dragging my kids to the pediatrician's office. After four hours, we're discharged and I strip the bed before we leave. The nurse waves "bye-bye" to my little one and hands him a set of matchbox cars from under the Christmas tree behind the nurses' station. They couldn't have been kinder. Could I have been kinder when I was working a packed ER, too many patients, too many frantic parents, too many hysterical kids? Had I gotten jaded? Sometimes it felt like I was on auto-pilot when I was on the other side of the nurses' station, the smiles forced, the jokes perfunctory. I loved my patients, but that light dimmed somewhat under the crush of too many critical patients and too few nurses. It was a big part of why I left. As I drive home, I wonder why I was so embarrassed to use the ER. Why I was so anxious to appear calm, helpful, reasonable. Of course, we hope that all our patients will be calm and reasonable, but the reality is that my time in a very rough, very understaffed ER had left me wary of each new patient walking through our door. I'd become callous. Thank goodness these nurses hadn't. I realized that with every "I'm sorry,” what I was really trying to say today was "I'm a good person. I'm a good mom. I love my kids, and today is a real rough patch.” And of course, that leads me to wonder what my own patients had been trying to say to me through their cries, their threats, their own nervous laughter. Maybe the guy who incessantly googled his symptoms was saying, "I'm smart, and I'm scared. I'm doing my best to educate myself, but I just don't understand this stuff.” Maybe the teen mom, who called an ambulance from her pediatrician's waiting room -- for her baby's minor cold symptoms -- and who was now trying to bully me into getting her a prescription for diaper cream, was really saying, "I'm overwhelmed and I care about my baby more than I can express. I'm scared I'm going to screw this up. Please help me.” Maybe the drug addict who purposely shoots up in the hospital bathroom was saying, "I want help. I don't want to die, but I can't do this on my own. Please watch over me.” I think about all of this as I rock my baby to sleep, safe and warm back home. I think about how I've had the application to work at this ER open on a tab on my laptop for three weeks. I think about finally sending in my resume. I did the right thing by leaving the ER when I did, I decide. Patients need nurses who treated me the way I was treated today – with compassion, understanding, and respect. I had lost that perspective in my old job, which meant that no matter how competent my care had been on a skill-level, I had no longer been able to provide comprehensive care. And that meant it had been time to walk away. But here was a new ER, a new staff. After three years of being the patient or the patient's parent, I was increasingly inspired by the multitude of staff who hadn't lost their perspective. Maybe I had finally regained mine. Maybe being a good nurse is knowing when it's time to step down or switch gears for a bit. Maybe being a good nurse is knowing when to take care of yourself and your family until you can come back to the bedside with a clear head and a genuine smile. We all end up on the other side of the triage desk, sooner or later. If I should end up putting on my scrubs again, I hope that I can remember this feeling the next time it's me in the triage seat, faced with a long line of tired, hurting, and scared patients who come to me, looking for help, for safety, for answers. My baby received three stitches today. I received support, understanding, and kindness. Our family needed both.

I have worked SO HARD to become a nurse. I quit my cushy desk job, went back to school, racked up huge amounts of student loans, and finally, FINALLY, I am a nurse. In an ER, no less, which is exactly what I wanted! It's a supportive environment (if busy), and even though the work is really hard and I sometimes feel like I'm drowning, I do potentially see the light at the end of the tunnel if I just stick with it. But I'm not sure I want to. (Sorry for the long post - Skip to the very end for the actual question/point of this post) I had a baby in the middle of all of this, and now we're ready for a second. I work two 12s and two 8s, with mandatory every other weekend/holiday. Days go by when I don't see my husband. I am lucky if I get an hour with my baby in the morning before I head off for my back-to-back 12s (11am-11:30pm). That hour is foggy and not very high quality due to the fact that I'm constantly recovering from my last shift. The commute is an hour, but that's what I had to take if I wanted an ER job as a new grad. My husband works full time and leaves very early, so I'm up with the baby even though I get home at 12:30pm or later. I HATE that every day, every week is different. There is no predictability. We just moved to this town, and I can't join any baby gym classes or playgroups or whatever to try to meet people because my hours are different every single week. Friends from work don't help because, like I said, it's an hour (48 miles to be exact) away from our house. We have no family, no friends here, and we are so isolated. As a brand new nurse, I don't feel like I can ask to go per diem or for reduced hours (and honestly, we need the money). I am constantly exhausted, constantly playing catch-up. The thought of another baby right now is laughable (my husband and I don't see each other often enough to even get the deed done....). I had hyperemesis with my first and I cannot imagine trying to work in the ER and deal with that. But hubbie is 41 and we don't want to wait forever (our "baby" is 19 months). I am four months into my new job, and I am miserable. I cannot imagine continuing with this for the full 12 months I promised myself I would do before I made any changes. I could handle suckiness if it were just me but my whole family is suffering, and it's not like I can ever get these early years with my baby back. But I am devastated to think all that time and money for school would be wasted if I quit, not to mention fearful that I wouldn't have a career in the wings to fall back on should anything happen to my husband. I just don't know what to do. Is it unreasonable to ask for reduced hours as a brand new nurse or do I need to suck it up until I've hit some milestone, like six months or year?

Just FYI, I ended up enrolling in a few classes and I had a mixed experience. The Adult Health Assessment class on day1 was little more than PPT slides that had NO useful information. Spending 10 seconds per slide on odd, unusual eye problems or skin lesions just isn't useful in a clinical role. I took the phlebotomy class and that was a little better because it had much more hands-on practice. I unfortunately wasn't able to complete the Health Assessment class because of conflicts with work, and I was pretty unhappy that I couldn't get ahold of ANYONE in regards to refund/rescheduling. The admin never returned any of my MANY emails about the problem (which I sent way in advance of the conflict). So I basically just lost several hundred dollars, with no communication from the school. I'm wary about re-enrolling in anything moving forward. I will say that one week on the floor is better than a semester of powerpoints, and I'm fine in my new job (although slow, and still making silly errors). In retrospect, the classes weren't worth the money for me.

I am super excited that I found a position in an ER for my first job as a nurse. ER is definitely the speciality I love most, and I can't believe how lucky I am to be able to start out here! But I graduated from school 2.5 years ago, and I'm very nervous about loss of skills during that time (I had to move overseas right after school for my husband's job). I did a few nursing internships over the years while I was overseas, but I've never worked in a paid clinical role. I am looking at some of the nursing refresher classes at Boston College (PIV, phlebotomy, adult health assessment) to help regain some confidence, but these are just lab-based classes and I won't have time to enroll in a formal practicum anywhere before my new job starts. 1) Does anyone have any experience with the nurse refresher courses at Boston College? 2) Do you have any advice for otherwise preparing for my first job in the ER? I feel pretty solid on theory still, but I'm really just looking at getting my hands dirty (well, scrubbed and gloved, and THEN dirty) to regain confidence with the basics, like inserting IVs, taking blood cultures, identifying heart and lung sounds, ECG reading, and other common ER skills. I plan to look into TNCC and CEN certifications after I start my new job, and I already have ACLS. I could do PALS, but I'd rather wait and get it through work (where it will be paid for). However, I'll do whatever I need to in order to be prepared and safe on my first day. Looking forward to your advice and thoughts!

I am super excited that I found a position in an ER for my first job as a nurse. ER is definitely the speciality I love most, and I can't believe how lucky I am to be able to start out here! But I graduated from school 2.5 years ago, and I'm very nervous about loss of skills during that time (I had to move overseas right after school for my husband's job). I did a few nursing internships over the years while I was overseas, but I've never worked in a paid clinical role. I am looking at some of the nursing refresher classes at Boston College (PIV, phlebotomy, adult health assessment) to help regain some confidence, but these are just lab-based classes and I won't have time to enroll in a formal practicum anywhere before my new job starts. 1) Does anyone have any experience with the nurse refresher courses at Boston College? 2) Do you have any advice for otherwise preparing for my first job in the ER? I feel pretty solid on theory still, but I'm really just looking at getting my hands dirty (well, scrubbed and gloved, and THEN dirty) to regain confidence with the basics, like inserting IVs, taking blood cultures, identifying heart and lung sounds, ECG reading, and other common ER skills. I plan to look into TNCC and CEN certifications after I start my new job, and I already have ACLS. I could do PALS, but I'd rather wait and get it through work (where it will be paid for). However, I'll do whatever I need to in order to be prepared and safe on my first day. Looking forward to your advice and thoughts!