What goes on in an ED?

Editorial Team / Admin · Apr 29, 2017

Definitely not true- and I'm not even an ER nurse! Since I can't really give you an insider's look into the ER, I recommend checking out the Articles and FAQs tabs that you'll find at the top of the ER forum.

Guest374845 · Apr 29, 2017

You mostly chart í ½í¸‚

We put in a hell of a lot of IVs, that's true. But we use those IVs to give drugs, blood products and manage drips. The floors don't usually appreciate it when you don't initiate those things.

We (assist physicians to) take or make airways. Another thing the floor doesn't like to be without. Then co-manage the vent that they're subsequently hooked up to. And the sedation and analgesic drips to keep them down.

We code people. Give rocephin and penicillin shots. Give nebs. Give popsicles. Start IOs. Write work/school notes. Place splints. Hand-mix critical drips. Take vitals. Zero art-lines.

Jack of all trades. Floors just don't know.

BlueBoxSearcher · Apr 29, 2017

Interesting.It truly is a diverse specialty.I think this specialty is good for those who enjoy a wide variety of patients,but you must be able to keep up with the pace of the ED.Thank you.

blackribbon · May 1, 2017

I had a patient who was given an enema in the ED before being sent to the floor.

amzyRN · May 1, 2017

EDs are extremely diverse places, from ED to ED the patient acuities will be different and things they see will be different. Some EDs might have a poor sick population while others have a more affluent population that tend to be in better health. Most EDs have fast track patients that are essentially clinic patients that you would see in a primary care office or urgent care.

Most often LVNs see those fast-track patients, but if fast track is not open, those get filtered to the rest of the ED. Then you have life-saving things that go on, intubations, cardiac arrest, sometimes chest tube insertions and such for a pneumothorax or something. ED docs will do LPs and paracentesis and the nurse might help in some way with those. You might help the MD with a central line insertion.

I don't see a lot of trauma patients in my ED, but if you work in a trauma center you'll see more chest tubes and such. There are lots and lots of IV starts, lab draws, foleys/straight caths and the like that go on. Lots and lots of tasks running around shifting from one thing to another. Each shift will be different. There are things I am starting to dislike, but one thing I do like is that I don't have the same patient for very long. Triage is kind of fun too.

Darth Practicus · May 1, 2017

HAHA!!! That has to be the funniest assumption ever. However, after several years of working in ERs of various types and sizes, it's not surprising such assumptions are made of ER nurses.

ER nurses literally save lives. Patients do not enter the hospital proper in emergent situations without first having had the touch of an ER team. An ER nurse often gets 5 minutes or less notice of a trauma arrival that will upend a large portion of one's shift. At any given moment, you might be hanging life-saving medication while dealing with a repugnant drunk who thinks it's okay to cuss you out over the hospital's choice of plain turkey sandwich as their main ER entrÃ©e. One minute you should be silently swearing to yourself over the self-serving complaints about the wait time over their mild cough and sniffle while you're trying not to lose your sh@t because you know part of that wait was due to a police officer getting shot and the whole team trying to rally to save him. ER nurses do their best to walk into a patient's room to offer a refill of ice to a patient who's been hammering the call light while you've been busy performing CPR on a young boy and his brother who were shot in the head by a deranged parent. And despite your best efforts, you now have to somehow gather what remaining willpower and strength you have left for the family who now has two empty seats at the table.

It's not all doom and gloom, but I don't know of a single other environment that has such various elements (highs and lows) in a shift. You could be at the end of your rope of patience in dealing with people who aren't really sick or who just want a place to crash because they got drunk again... and in the next moment have to refill your compassion bucket to deal with someone who is on death's door.

Just as inpatient nurses may feel they get endless admissions, ER nurses do not get to tell ambulances to go somewhere else. We just take them because that's what we do. Even when we are at capacity. That's usually when we really need nurses on the inpatient side to understand that delaying that report, or pushing admissions off on the next nurse may seem like its helping you, but in the end it's compromising patient care.

It takes a team. Assuming all ER nurses do is "set IVs" and such is just about as insulting as someone assuming that non-ER nurses just sit at a nurse's station. We can do much better.

Thanks,

Darth Practicus, NP and all-around good guy

Former ER Nurse, ICU Nurse,

BlueBoxSearcher · May 2, 2017

Thank you for giving an example of what ER nurses really do.Even though I am not an ER nurse,I was quite angry with the friend who said ER nurses dont do much except IVs.I will be able to show them the hard work that is put in the job.Thank you.

WKShadowNP, DNP, APRN · May 2, 2017

Hone critical thinking skills and prioritization minute to minute. That's what we do. And I loved it. Everybody is really sick or hurt gets my higher priority while those who can afford to wait have to have serious attitude adjustments when they pitch a fit.

I've said iterations of the following: "At least you don't HAVE to go back right away. That's a good thing."

And I'll honestly tell a patient, 'I'm sorry you waited for your discharge so long, I was doing Cpr."

DayDreamin ER CRNP · May 3, 2017

What does an ER nurse do? Everything. The ER nurse does everything.

In addition to what's been written already, lets not forget that we have good gut instinct and know when a patient looks sick and when a patient looks "sick as stink." We recognize changes and act accordingly and often autonomously. We continuously triage and reprioritize our care, we interpret lab values, CT results, etc. and anticipate our docs' next moves.

I wish I felt like writing everything that is running around in my head but, you see, I'm too tired from starting IVs all day.

bgxyrnf, MSN, RN · May 3, 2017

One of the things that I appreciate about the ED is the variety...

patients from 5 days old to 105 years old.

We care for patients and support families and assist providers in all kinds of situations...

Acute medical emergencies like strokes, STEMIs, sepsis, PEs, GI bleeds, poisonings, status epilepticus and anaphylaxis.

Acute trauma emergencies like GSWs, stabbings, blunt trauma of every sort from baseball bats to the face and falls from 30 feet to people being hit by trains and run over by cars.

Acute surgical emergencies like cauda equina syndrome, burst appendices, globe entrapment, perimortem c-sections, surgical airways

Acute burns which are their own category in my book.

Procedures like chest tubes, emergency thoracotomies, EVDs, central lines, Quinton catheters, art lines, LPs, intubation, Steinman pins, emergency D&Cs, and even ECMO on rare occasions.

We take care of patients ranging from malingerers and the worried-well to the acutely psychotic and suicidal; from kidney stones to hyperkalemia; from the most stable med-surg patient to the sickest ICU patient who's boarding because there isn't an open bed in the unit(s) or the patient is too unstable to transport.

We hang boluses, run the rapid infuser, give blood products, hang piggybacks, give injections, titrate vasoactive drips and sedatives, push meds from narcotics and antiemetics to ACLS and RSI meds.

We cardiovert and difibrillate; we sedate and stimulate; we operate pacers, both external and transvenous.

We start easy IVs and hard ones using ultrasound, drill IOs, draw blood cultures, draw ABGs, drop G-tubes, place Foleys, change trach cannulae, suction ET tubes, and pack wounds.

We hold hands, hug, and console; we restrain combative patients; we defend ourselves and our colleagues from assaults; we clean up patients who're covered in dried feces and sometimes covered in wet feces. We see people at their very best and at their very worst.

We care for patients who the floors refuse to take for various reasons.

We work closely with our docs and the surgeons and the intensivists; we know all the radiology folks very well; we know all the local cops, firefighters, and paramedics... and have cared for many of them.

Rather than ask what we do, ask instead what we don't do -- it's a much shorter list.

BlueBoxSearcher · May 5, 2017

One of the things that I appreciate about the ED is the variety...
patients from 5 days old to 105 years old.
We care for patients and support families and assist providers in all kinds of situations...
Acute medical emergencies like strokes, STEMIs, sepsis, PEs, GI bleeds, poisonings, status epilepticus and anaphylaxis.
Acute trauma emergencies like GSWs, stabbings, blunt trauma of every sort from baseball bats to the face and falls from 30 feet to people being hit by trains and run over by cars.
Acute surgical emergencies like cauda equina syndrome, burst appendices, globe entrapment, perimortem c-sections, surgical airways
Acute burns which are their own category in my book.
Procedures like chest tubes, emergency thoracotomies, EVDs, central lines, Quinton catheters, art lines, LPs, intubation, Steinman pins, emergency D&Cs, and even ECMO on rare occasions.
We take care of patients ranging from malingerers and the worried-well to the acutely psychotic and suicidal; from kidney stones to hyperkalemia; from the most stable med-surg patient to the sickest ICU patient who's boarding because there isn't an open bed in the unit(s) or the patient is too unstable to transport.
We hang boluses, run the rapid infuser, give blood products, hang piggybacks, give injections, titrate vasoactive drips and sedatives, push meds from narcotics and antiemetics to ACLS and RSI meds.
We cardiovert and difibrillate; we sedate and stimulate; we operate pacers, both external and transvenous.
We start easy IVs and hard ones using ultrasound, drill IOs, draw blood cultures, draw ABGs, drop G-tubes, place Foleys, change trach cannulae, suction ET tubes, and pack wounds.
We hold hands, hug, and console; we restrain combative patients; we defend ourselves and our colleagues from assaults; we clean up patients who're covered in dried feces and sometimes covered in wet feces. We see people at their very best and at their very worst.
We care for patients who the floors refuse to take for various reasons.
We work closely with our docs and the surgeons and the intensivists; we know all the radiology folks very well; we know all the local cops, firefighters, and paramedics... and have cared for many of them.
Rather than ask what we do, ask instead what we don't do -- it's a much shorter list.

That is such an inspiring message.Through all the hard work shines so much dedication to this work.Nursing is truly work more then just a job.I look foward to giving as much hard work and care as you give to your patients.Thank you very much for giving me such a detailed analysis of the things that ER nurses do.Thank you.