Should I leave ER?

[amzyRN]

I have been presented an opportunity to go back to my old unit, a laid back cardiac/surgical unit, but am having a hard time deciding. The issues I'm having at my current job are that at times I am overworked in the same assignments over and over with little help. In the past few months, I feel like I haven't gotten hardly any exposure to the critical cases that come in, but instead, go to the part of the department that resembles an understaffed tele floor or I go to triage where people vent on me because they have to wait or I am coughed on or get to interact with all the sick screaming kids which I really dislike.

I haven't really said anything about rotating to higher acuity areas because I feel like maybe they think my skills aren't up to it or something. But how will someone get the skills if they don't practice? One of the reasons I came to the ER was to build critical care experience and that has been few and far between at this last job. My first ER job was better in that regard, they threw us in to gain experience.

At my new job, if you've really experienced you get to do more of the critical care stuff, but if you are newer like me, you'll be waiting a very long time. I realized the other day, when I had to jump in to help stabilize a critical patient that I was nervous, I felt slow to chart everything and definitely got the sense of my weaknesses, but if I don't practice I won't get better.

I also feel like it is so clicky here and people gossip. I've even heard someone say something about me once. I don't want to work in a place like that and so I'm deciding if I should just go back to where I liked my coworkers and things were easier.

I just worry because I left due to being bored and not challenged enough, and don't want to only discover I have made another mistake. Having the same patient for eons sounds a little dreadful too. What should I do? How do I go about making this decision? Any suggestions greatly appreciated.

[Lunah, MSN, RN]

That's a tough call — I know you have struggled with your work environment. I guess I should ask: what is it that makes you want to stay?

[amzyRN]

That's a tough call — I know you have struggled with your work environment. I guess I should ask: what is it that makes you want to stay?

I like the variety of things that go on. I like to be challenged and when I'm working with people I like, the teamwork is nice. I feel like certain ERs are better than others, have better team work, learning opportunities, etc. I don't think my experiences are representative of the specialty. In fact, one of my old co workers who left because of the crappy work environment (gossip, lack of help, etc) landed a travel position in the ER and did well even having less than 1 year. She was in a supportive environment with good co workers.

The environment where I work is not conducive to the development of all staff members (on day shift at least). There is an entrenched hierarchy where certain people are nurtured and given more learning opportunities and others are not. I think if I worked nights my experience would be different.

I feel pretty comfortable with my skill level but feel like I need more support to take it to the next level and for what ever reason I have been uncomfortable to ask for what I need and want. I feel like it is imposing and that is really my own fault. But I also don't feel like I should have to ask, as a member of the unit, they should be trying to develop all of their staff. My last ER was better about that and they didn't gossip and talk badly about people behind their back (at least I never heard it).

I'm going to make a pro and con list and see if that can help a little. Thank you for your response.

[DayDreamin ER CRNP]

I'd say you need to talk to a supervisor and ask for a 'peer' review to see where you stand in the department. If they feel like your skills are lacking to care for the critical patients, then you have to ask for more responsibilities with sicker patients. Maybe ask for him/her to set you up with a coach of sorts to pull you into the sicker patient rooms and guide you through the process.

If you aren't showing initiative, you will be overlooked in most ERs as a newer employee.

[JKL33]

amzy - I feel like you need to talk w/ your NM. You mentioned a couple of things in your OP that would suggest you ultimately will not find too much fulfillment on your old unit at this point. This is a tough one, for sure...the culture and teamwork sound better on the old unit, but the clinical experiences you desire are in the ED. I think it's worth putting yourself out there a little bit and having that conversation, asking for more. Then showing them that you're ready. You could always start down this path (have the convo, ask for more opportunities) and make a goal to see what the next ___ #of months brings. If you get clear signals that they are unwilling to help you move forward (and if that is for no particular reason) then it would be worth it to make a change. Personally my preference would be to seek out a different ED, but that's just me.

How's your pro/con list looking?

[amzyRN]

There are other things about the job that are pushing me to leave, the scheduling primarily. I have no autonomy over my schedule and am at the whim of what the staffing needs are. That is not going to change anytime soon.

Also, the commute is too long and sometimes my day is 16 hours long and if I'm doing multiple days in a row, I'm too tired to do other things in my life that I care about.

I made the mistake of accepting a position too soon back at my old job and then got an interview in another ER that's closer to my house. I would have to renege on a job offer I've already accepted to get out of it.

They didn't give me very long to think about it and I need to get out of my current job, I am so burnt out and exhausted.

[Lunah, MSN, RN]

What about going back to the old job and going PRN in an ER?

[JKL33]

I agree. Keep the ED as per diem for now (although at the particular ED in question you may get even less of an opportunity for critical cases as a per diem employee). It would be a lot of adjusting and probably a little longer time of dealing with stress, but you could 1) Get re-settled on old unit while 2) keeping present ED job as PD 3) seek out 2nd PD ED job at a place with a better culture - which they might go for since you'd still be actively working in an ED 4) Drop the original ED. I realize that's a lot of stressful maneuvering, though.

For now, best wishes with getting settled on your former unit!

[bgxyrnf, MSN, RN]

In my experience, staying on PRN is not something to presume upon. For reasons which aren't clear to me, some departments just won't keep people on per diem, particularly if you're not one of the "core group" of people who've been there for an extended period of time.

I'm not sure how long you've been in this job but I'd generally discourage you from leaving before the 2-year mark.

I'd start by talking to your department educator to get an idea of how things are likely to progress in terms of assignments and to learn if there are classes or specialized training that they might value which you presently lack.

Next, start talking to the charge nurse with whom you most often work and/or are most conversational with. Explain your desire to include other assignments in your rotations and see what they say. They may not realize your desires, your lack of full exposure, nor your skills.

If you WANT to be an ED nurse then you absolutely should NOT go back to your old "laid back cardiac/surgical unit;" there's nothing there that will help you become a more effective ED nurse.

And triage, despite the fact that I loathe it, is good (albeit unpleasant) experience.

Don't leave without actively seeking an improved experience... and don't leave until you have another ED gig to go to... unless you don't want to be an ED nurse, that is.

[amzyRN]

What I decided to do is take a job at a hospital that is a short commute. They offered me an ED position on nights which I declined because I hate night shift (ie. night shift makes me ill and totally depressed, thus not worth it). I took a position on a step-down unit and plan on using it to get into the ICU or into their ED as an internal candidate (after some time in the department of course). What I want out of the ED if I were to work in one again, is a full ED experience where I get the critical cases, not exclusively but at regular intervals.

The last ED I worked at would almost exclusively put me in a 4 patient assignment or triage. I have been in the trauma rooms 3 times as a primary assignment and have worked their 1 year. I came in with 6 months ED experience. I felt like I was a Tele nurse in the ED, except on a Tele floor I had more help. Hence, I do not really feel like this is a step back for me, rather a networking opportunity and I will use my ED background to hopefully get into their ICU or ED (if I'm going to get critical cases and be a fully functioning ED nurse).

In retrospect, I should have gone to ICU prior to ED because then I would already be familiar with critical patients and think I would have been given more interesting assignments from the beginning. I would advise anyone considering ED either as a new grad or experienced nurse outside of the ED to train to ICU prior to ED. Not only will that make your skills more marketable, but your ICU experience will be more valued by your colleagues.

[bgxyrnf, MSN, RN]

What I decided to do is take a job at a hospital that is a short commute. They offered me an ED position on nights which I declined because I hate night shift (ie. night shift makes me ill and totally depressed, thus not worth it). I took a position on a step-down unit and plan on using it to get into the ICU or into their ED as an internal candidate (after some time in the department of course). What I want out of the ED if I were to work in one again, is a full ED experience where I get the critical cases, not exclusively but at regular intervals.

The last ED I worked at would almost exclusively put me in a 4 patient assignment or triage. I have been in the trauma rooms 3 times as a primary assignment and have worked their 1 year. I came in with 6 months ED experience. I felt like I was a Tele nurse in the ED, except on a Tele floor I had more help. Hence, I do not really feel like this is a step back for me, rather a networking opportunity and I will use my ED background to hopefully get into their ICU or ED (if I'm going to get critical cases and be a fully functioning ED nurse).

In retrospect, I should have gone to ICU prior to ED because then I would already be familiar with critical patients and think I would have been given more interesting assignments from the beginning. I would advise anyone considering ED either as a new grad or experienced nurse outside of the ED to train to ICU prior to ED. Not only will that make your skills more marketable, but your ICU experience will be more valued by your colleagues.

I'm pleased for you and I think you have a sound plan.

It sounds like your old ED job is lacking in its commitment to training up the staff to fill every role. I understand the logic behind not pulling the trauma assignment for the first year or so but I'm of the opinion that you need to get people into the critical care assignments as soon as possible so that your staff is broadly experienced in the event of an MCI or staff shortage.

I applaud you for moving forward in your career and not taking the easy step backwards.