What are your duties?

It sounds like you do a lot of task mastering. You'll be just as busy, but you'll be doing assessments and actual nursing. Primarily you need to be with the pt, diagnose the big problem, initiate diagnostics and tx, and continually reassess because regardless what people think, the ED doc isn't always there. Sometimes the ED is getting killed and if your pt isn't actually coding at this time, the MD won't be able to get in the room for a couple of hours. You've got to stop the pt from circling the drain meanwhile. If my other pts don't get dinner, I don't lose any sleep.

Actually, I WISH I was doing all that in the ED! Big city ERs will have techs, aides, paramedics, RTs, and housekeeping staff all doing part of your present duties. Oh, and pharmacy will do part of what you're doing.

Coming from a background as an army field medic and paramedic, I was used to doing it all; at least as much as we could and did. It was frustrating to find, for instance, that my chest pain pt. has to wait for the EKG tech to come do their 12-lead. If they're busy already, and we have to wait 5 minutes, well tough! That's policy. (And yes, I recently got chewed out when my CP pt. looked bad coming in and I decided to grab the EKG without waiting. We had already verified that the tech was legitimately tied up, but too bad...) Or another frustration is when my asthmatic pt comes in wheezing and struggling, but I have to call RT for them to get a neb that outside the hospital I give myself.

OTOH, you'll have lots more patients, so you can't possibly do it all efficiently like you do now. When a CP or trauma comes in, we've got three or four people in the room right away getting things done. You probably don't have that where you are. Clerks and secretaries do all the admit stuff. When everybody works well together, it is beautiful. And good for the patient.

As I said, in many ways I like what you do. You do it all for the patient. But in a larger hospital that really isn't possible, and the patients wouldn't get good care. I'm in a city of only 70,000 and our hospital has all the help I mentioned (well, at least on the nights that we're fully staffed).

Right now you're getting great experience and good skills. That's irreplaceable. It will be very different when you move to a bigger city and hospital.

It sounds like you do a lot of task mastering. You'll be just as busy, but you'll be doing assessments and actual nursing. Primarily you need to be with the pt, diagnose the big problem, initiate diagnostics and tx, and continually reassess because regardless what people think, the ED doc isn't always there. Sometimes the ED is getting killed and if your pt isn't actually coding at this time, the MD won't be able to get in the room for a couple of hours. You've got to stop the pt from circling the drain meanwhile. If my other pts don't get dinner, I don't lose any sleep.

I guess I forgot to mention that on top of all I listed I also do have to do the assessments and pt care. But I guess we are lucky in the fact that our doc is usually right there on hand since we are not very busy so much of my "keeping the pt from circling the drain" is only a few mins until the doc comes to help.

Did you say a 4 bed ER?

The minute clinic at CVS has more beds than that.

Hey nursegirl...what's your staffing like? Just you and the doc?

Hey nursegirl...what's your staffing like? Just you and the doc?

We have 2 nurses at all times and the ER doc who has a sleeping room right here in the wing. During the day M-F, 8-5 We have lab and radiology on site as well as the clinic nurses and docs if needed. After hours the lab and rad are on call. Not the ideal situation, but like I said there is not much going on here. If something major comes in the EMS crew, our own personal crew, are real good about helping out and we do have a clerk from 1-11 M-Th to admit and answer phones. We also have security after 4 and 24 hrs on weekends, they are real good about helping with phones, transfers, etc if needed. And since we are an IHS, most of the doctors' housing is right across the street and they can be here in minutes if need be.

Sounds like my first ER I worked at and I loved it. I went to a larger ER last year and I struggled a lot because for the first time ever, I had more help than I knew what to do with. I was also just as busy in the bigger ER, it was a different kind of busy. That kind of busy never really grew on me, so I went back to my rural ER.

I'm in OB now but I still dream of my small baby rural ER.