Pros and cons of being an ER nurse

TazziRN, RN · Jul 2, 2007

Pros: lots of autonomy, you see everything, less paperwork, a great working relationship between the docs and nurses.

Cons: you always have to stay on your toes, so after a while it taxes the body. High turnover rate. No matter how busy you are, you can never close the doors and tell people to take a hike. Having every single bed occupied, plus wheelchairs in the hallway, plus a bursting-at-the-seams waiting room.....and finding out that a helicopter will be landing in 5 minutes with multiple trauma victims.

kmoonshine, RN · Jul 2, 2007

Pros:

There's never a dull moment and there is always something new to learn
You're always being challenged to figure out what might be going on with a patient
The freedom to provide care without always needing to run to a doc. I can start IV's, give certain meds, hang fluids, order x-rays, draw blood, order labs, do EKG's, etc under our ED protocols without an MD's order. If I think a patient will need an IV, I'll put one in; if they have chest pain I can start an IV, draw labs and order a stat troponin, and give aspirin, nitro, and morphine without an order.
Being in a "team" environment and working with some great nurses
Being able to develop great working relationships with the ED docs (at my facility, I feel all our doc's treat me with respect and we all help one another out; I love being able to say "Patient xyz is complaining of n/v and came to the ED 3 days ago for the same - and we them sent home a script for zofran, which they couldn't afford to fill; could se send home a script for something more affordable, like reglan?"; or "patient ABC is in pain; can you write an order for morphine for them?")
A great feeling of satisfaction when you anticipate what will be needed for a patient and you're right on. For example, I once had a patient who I thought might have a GI bleed and the doc had not yet seen the patient. They were a/o x3 but I just had a bad feeling...so I threw in 2-18g IV's and drew labs along with type and cross. Within 5 minutes the patient started vomiting bright red blood and crashed; we had to intubate and were basically pouring blood into him; thank god I got in those 2-18g IV's...it's a great feeling when you do interventions that ultimately help save someone's life.

Cons:

Dealing with impatient people ("I have a sore throat and I've been waiting 10 minutes to see a doctor!"; at times, I just want to scream "at least you're breathing, unlike the patient who we are giving CPR to right now - and therefore, the doctor will be with you as soon as they put a tube down that patient's throat so a machine can breathe for them)
Feeling overwhelmed when you are caring for multiple patients who are critically ill
Seeing some of the sad things that people do to themselves and each other (domestic violence, sexual assault, drug abuse, suicide)
Being at risk for battery/physical assault (I just had this tonight; a patient shoved me and tried to punch me)
Frustration when facilities dump their patients. For example, I've had nursing homes that will send patients for fever of 99.1, and there's orders in the patient's MAR for Tylenol prn for fever less than 101 - but no one gave tylenol. Also, once I had a nurse give me report from another facility, saying a patient they were sending to us had a decreased level of consciousness and had a blood pressure of 82/46 at 0600 - the time she gave report and sent the patient was at 1900, and they waited over 12 hours to send them and no one even bothered to recheck the patient's blood pressure! I also love the 92-year old nursing home patients they send to us after fainting while having a BM, and they have a history of this (hello! it's called vasovagal syncope and unless the patient had abnormal VS or hurt themselves when they passed out, it isn't an emergency). I also hate it when nurses at other facilities try to call the patient's doc and can't get a hold of them, so they'll send them to the ER instead for really goofy things (superficial cuts that need a bandaid, etc). I also had a "supposed" resuscitated PNB come in, and the dialysis nurse did 3 chest compressions when the patient "became unresponsive" (without checking a pulse), and they miraculously "brought the patient back to life" - when we got the patient, they were fuming mad because they said they were sleeping and all of a sudden they woke up with the nurse punching them in the chest... (sorry, I had to rant)
Dealing with abnormal family dynamics
Having patients die after everyone works so hard to save them...
Frustrations when all the beds are full in the hospital and you have to hold patients in the ED...or if we're transfering patients to other facilities (especially psych facilities), we often have to hold patients for hours, even days, because all their beds are full...

Itshamrtym · Jul 2, 2007

Hi I am a new member to all nurses, but have been reading threads a long time. Thanks for the great posts. I currently work in the OR (1.5 years, homecare as LPN 8 years), but I have always had

a facination with the ER. Thanks for the great info.... maybe one day

I'll make the leap.

PoppaD · Jul 2, 2007

The only con that you forgot to mention was the psych holds waiting for placement!

teeituptom, BSN, RN · Jul 2, 2007

The pros are all the good stuff that comes in a challenges your skills. MVC's, GSW's, MI"s , CVA's. All that good stuff that is so challenging.All the autonomy and teamwork. The good work enviroment between MD and RN. Multiple problems coming in from EMS all at the same time. Love the critical thinking skills.

Cons really arent that many. Impatient patients and families. And its amazing the Drug seekers are always the most impatient. Stupid parents with even poorer parenting skills.

anything less than ER isnt nursing for me.

bigsyis · Jul 2, 2007

Kmoonshine, your post was one of the best thought-out and well-written pieces that I have seen in a long time.

One other thing that I hated to see was child abuse, :madface: :nono: but I'm sure that was covered when you said that you hated to see the things that people do to each other.

I always liked ER (and was certified) because of the variety of things we saw and the broad knowledge base you had to have, and the respect of the MDs and PMs. Plus, you never knew what was coming through the door next!

bill4745, RN · Jul 3, 2007

It's never boring, every shift honestly brings a new challange and learning, there is a feeeling of pride to be able to do this work and keep cool, I have never had such great relationships with my co-workers, etc.

jojotoo, RN · Jul 3, 2007

Pro: Every shift is different.

Con: Every shift is different.

ShayRN · Jul 3, 2007

Pro: Every shift is different.
Con: Every shift is different.

:roll:roll:roll:roll

I believe that is just NURSING;)

Dixiecup · Jul 3, 2007

Pros:
There's never a dull moment and there is always something new to learn
You're always being challenged to figure out what might be going on with a patient
The freedom to provide care without always needing to run to a doc. I can start IV's, give certain meds, hang fluids, order x-rays, draw blood, order labs, do EKG's, etc under our ED protocols without an MD's order. If I think a patient will need an IV, I'll put one in; if they have chest pain I can start an IV, draw labs and order a stat troponin, and give aspirin, nitro, and morphine without an order.
Being in a "team" environment and working with some great nurses
Being able to develop great working relationships with the ED docs (at my facility, I feel all our doc's treat me with respect and we all help one another out; I love being able to say "Patient xyz is complaining of n/v and came to the ED 3 days ago for the same - and we them sent home a script for zofran, which they couldn't afford to fill; could se send home a script for something more affordable, like reglan?"; or "patient ABC is in pain; can you write an order for morphine for them?")
A great feeling of satisfaction when you anticipate what will be needed for a patient and you're right on. For example, I once had a patient who I thought might have a GI bleed and the doc had not yet seen the patient. They were a/o x3 but I just had a bad feeling...so I threw in 2-18g IV's and drew labs along with type and cross. Within 5 minutes the patient started vomiting bright red blood and crashed; we had to intubate and were basically pouring blood into him; thank god I got in those 2-18g IV's...it's a great feeling when you do interventions that ultimately help save someone's life.
Cons:
Dealing with impatient people ("I have a sore throat and I've been waiting 10 minutes to see a doctor!"; at times, I just want to scream "at least you're breathing, unlike the patient who we are giving CPR to right now - and therefore, the doctor will be with you as soon as they put a tube down that patient's throat so a machine can breathe for them)
Feeling overwhelmed when you are caring for multiple patients who are critically ill
Seeing some of the sad things that people do to themselves and each other (domestic violence, sexual assault, drug abuse, suicide)
Being at risk for battery/physical assault (I just had this tonight; a patient shoved me and tried to punch me)
Frustration when facilities dump their patients. For example, I've had nursing homes that will send patients for fever of 99.1, and there's orders in the patient's MAR for Tylenol prn for fever less than 101 - but no one gave tylenol. Also, once I had a nurse give me report from another facility, saying a patient they were sending to us had a decreased level of consciousness and had a blood pressure of 82/46 at 0600 - the time she gave report and sent the patient was at 1900, and they waited over 12 hours to send them and no one even bothered to recheck the patient's blood pressure! I also love the 92-year old nursing home patients they send to us after fainting while having a BM, and they have a history of this (hello! it's called vasovagal syncope and unless the patient had abnormal VS or hurt themselves when they passed out, it isn't an emergency). I also hate it when nurses at other facilities try to call the patient's doc and can't get a hold of them, so they'll send them to the ER instead for really goofy things (superficial cuts that need a bandaid, etc). I also had a "supposed" resuscitated PNB come in, and the dialysis nurse did 3 chest compressions when the patient "became unresponsive" (without checking a pulse), and they miraculously "brought the patient back to life" - when we got the patient, they were fuming mad because they said they were sleeping and all of a sudden they woke up with the nurse punching them in the chest... (sorry, I had to rant)
Dealing with abnormal family dynamics
Having patients die after everyone works so hard to save them...
Frustrations when all the beds are full in the hospital and you have to hold patients in the ED...or if we're transfering patients to other facilities (especially psych facilities), we often have to hold patients for hours, even days, because all their beds are full...

I work in LTC. Had a pt with 101 temp. no order for tylenol. I called the Dr to see if I could give tylenol and see what happened. But he gave me a direct order to send to the ER,

The ER nurse threw a fit because I sent a pt with 101 temp. "Hadn't I ever heard of Tylenol?" Didn't bother to listen when I tried to tell him that was the Dr. order, not much I could do about it!

kmoonshine, RN · Jul 3, 2007

Originally posted by Dixiecup

"I work in LTC. Had a pt with 101 temp. no order for tylenol. I called the Dr to see if I could give tylenol and see what happened. But he gave me a direct order to send to the ER,

The ER nurse threw a fit because I sent a pt with 101 temp. "Hadn't I ever heard of Tylenol?" Didn't bother to listen when I tried to tell him that was the Dr. order, not much I could do about it!"

Sorry, I did not mean to offend anyone by my statement earlier. The patient in particular that I was speaking about (temp of 99.1 as stated by the nursing home) did not have a temperature upon arrival to the ED, the MD was not called, and tylenol (which was ordered on the MAR) was not given. I've even had LTC facilities send patients for "fever", but when I call to find out how high it was, nobody knows because nobody documented it. I understand that the elderly often present differently when acutely ill, but there are times when the ED is appropriate and there are times when the ED is not appropriate. I often wonder why the MD's never come check out the patient prior to sending them to the ED.

I greatly appreciate the LTC nurses who us send patients for a workup who provide thorough nursing care and document the situation; "pt lethargic, VS xyz, BG abc, MD notified, orders received, tylenol given for fever, MD order to send to ED", etc. It just gets frustrating when we get patients with no documentation, and nobody at the facility seems to know exactly why they sent the patient to us and no nursing interventions were attempted. And I often wonder why we get so many LTC patients sent to us on Friday and Saturday evenings...