What the ER really like in the USA

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Specializes in Emergency Care.

Hi this is my first post so I apologise if this has been asked before but I could really use some help :mad:, Im a UK A and E Nurse with 2.5yrs experience and have just started the (very long and complex!!) process of

emigration to the US from the UK. I would really like to continue working in the Emergency Department. If any ER nurses could let me know, are ER nurses able to do long days (12hr shifts)? what amount of hours are classed as full time? are all new employees expected to do permenent nights!! and although ER doesnt have nurse/patient ratio how many RNs are on per shift in relation to presenting patients???? and roughly how are they split between the areas :bow: i would appreciate any help you could give me. Thanks x

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I am a paramedic.

ER Nurse shifts are 12 hours standard. 40 hours a week is considered full time. This is made up with an extra shift every 3 weeks.

Not all ERs are the same. Some are small community ERs. Some are large trauma centers built to serve an entire region.

Certain hospitals are stroke centers, cardic centers, burn centers, trauma centers and pediatric centers.

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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

Most large ERs have a mixture of people working 8's, 10's and 12's although I think 12's are probably the most frequently seen. Shifts are often staggered to adjust with the normal patient load. For example in my ER we have 7-5pm, 7-7pm, 8-8pm, 9-7pm, 9-9pm, 10-10pm, 11-11pm, 1-1am, 3-3am, 5-5am, 7-7am. Our planned patient load is 4-5 but we often have to add patients in hall beds and chairs to the mix so it can occasionally go up to 6-7. We have 4 "Zones". Each zone has 12-13 beds with one MD, one PA, three RN's, one tech, one medic (if we are lucky) and a secretary. Our ER is extremely busy seeing 240-300 patients a day in a moderately sized department. Other ERs in my city have nearly 100 beds and see the same number of patients as we do. I'm not sure if you see the same abuse of your Accident and Emergency Department as we see in our Emergency Departments here in the US. Also our "medic" scope of practice is different from yours in the UK. They are under nursing supervision while working in the hospital. You are considered full-time in most hospitals if you work 36 hours a week. I'm a little confused by the hierarchy in the British nursing system. I know you have to be at a certain level to be able to do certain things and you have "sisters" and other designations that we don't have and I don't understand. Otherwise it's the same old stuff! Good Luck on your journey!

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Specializes in Emergency Care.

Thanks guys (or girls) for the replies, very useful, and yep we do get our A and E abused, recently triage a sunburnt arm and a very nasty paper cut!!! glad to see its not just us! Im not a sister yet but do everything except Team Lead!! usual rule of thumb in UK hospitals is the darker the uniform the higher the grade!! x

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Specializes in ICU/Critical Care.

I have to give major props to any nurse in the ER. I could not do it. I just find it to be very disorganized at times. It's fast paced too. I'll stick with ICU.

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Specializes in Emergency Department.
I have to give major props to any nurse in the ER. I could not do it. I just find it to be very disorganized at times. It's fast paced too. I'll stick with ICU.

It's organized chaos, it just seems disorganized!

To the OP, In my ER most full time employees work 3 12's which is 36 hours a week. That's full time for them. PRN employees sign up for what shifts they want, and fill in with 4, 8, or 12 hour shifts. Also, when we sign up for overtime, we can do 4, 8, or 12, (or 16...blech) hour shifts.

Hope this helps! Good luck with the process

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Specializes in FNP/WHNP.

Hi,

I work in an ER, got my nursing license in the US but I'm from the UK. Our shifts are 12 hrs but can pick up extra hours 4, 8 and 12 hrs. We are usually short staffed-there is a big employee turnover, not just with our ED but all the hospitals in this area. This is mainly from many health care facilities but not enough nursing graduates!

There is no hierarchy of sisters and matrons here, but have chief nursing officers, nurse managers, unit directors, charge nurses etc. Also, no blue uniforms with caps and upside down watches!

Other than just a few differences, it's proably much the same as nursing in the UK. :nurse:

Good luck with your process and all the paperwork.

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Specializes in Neonatal ICU (Cardiothoracic).

The ER I worked in was 80 beds, with separate areas for Peds, Chest Pain, 4 trauma bays, Major Care, Urgent Care, Women's ED, Psych ED....

It was 1 RN: 4pts, unless a trauma came in, in which case the assigned trauma nurse/s were relieved of their pts by the other RNs.

Most people worked 7p-7a, 7a-7p or 11a-11p with the occasional 3p-3a. You have to wait your turn to come to day shift, but usually the turnover is so high in most ERs, your turn comes up fast...

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I am also from England and have been working in the USA in ER's for 12 years.The biggest differences are: gunshot wounds versus stabbings or fist fits !, Crack cocaine instead of ecstasy and alcohol

(although we get those too!), documentation is your worst nightmare as you have to cover your butt/bum all the time! But would I change anything that I have done here in the last 12 years- hell no! It has been a great experience.Go for it!You will learn heaps and also be prepared to change the way you pronounce your English medical terminology so your colleagues can understand you! You'll understand what I mean when you get here!

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I am also form England and have been working in ER's in the US for 12 years.The biggest differences are: gunshot wounds versus stabbings or fist fits !, Crack cocaine instead of ecstasy and alcohol, ( although we have those too) documentation is your worst nightmare as you have to cover your butt/bum all the time! But would I change anything that I have done here in the last 12 years- hell no.It has been a great experience.Go for it!

Be prepare to change your English medical pronunciation's so that your colleagues can understand you. You will understand what I mean what you get here! :)

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I am also form England and have been working in ER's in the US for 12 years.The biggest differences are: gunshot wounds versus stabbings or fist fits !, Crack cocaine instead of ecstasy and alcohol, ( although we have those too) documentation is your worst nightmare as you have to cover your butt/bum all the time! But would I change anything that I have done here in the last 12 years- hell no.It has been a great experience.Go for it!

Be prepare to change your English medical pronunciation's so that your colleagues can understand you. You will understand what I mean! :nurse:

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