What should I expect in ER nursing?

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I've been on Tele/ICU stepdown but it feels like med surg for a while now. And I'm being interviewed for an ER nurse position at a local community hospital.

My classmate worked at that hospital and told me that their ER has an extremely high turnover rate, you need knowledge on pediatrics, and is not a trauma center

How much different is it than on the floor? Is there room for autonomy or am I basically at everyone's beck and call again? What personality types thrive in the ER and what types suffer?

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What's driving u to ER position? No offense, these do kinda seem like questions someone would ask before they applied for a position.

Every ER is different. Yes, you should have a good comfort level with all ages. You have no control over what walks in the door, even if you're not a trauma hospital.

While EMS doesn't typically bring us trauma, it happens, especially if we are the nearest hospital.

IMO, I think a lot of icu nurses that come to ER are great. They understand both sides of the fence and handle and prep pts for icu pretty graceful. But know that your ratio is going up, and you could have 4 criticals at 1 time.. Which is a different ball park when they all come in without much to go on and no iv access ;)

Attitudes? Teamwork. The skin has to be thick. Even if its going to put you behind, you're gonna jump in and help your friend cuz trust me, you'll be in that spot appreciating extra help.

It's different. I love having a doc right there and not having to make phone calls.

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A high turnover rate is a red flag for me. This means that people don't stick around long, and there is usually a reason for that. Also, it's likely that you'll have a high ratio of inexperienced nurses on certain shifts, like noc. This is scary dangerous.

Yes, you do need to know peds...and adolescents...and young adults...and middle aged adults...and elderly adults. You need to be able to provide care for people across the lifespan, from cradle to grave. You'll probably care for lots of pregnant women, miscarrying women, and OB/GYN complaints. Mental health crises, sexual assaults, intentional overdoses, intoxication, housing crises, and lots of non-emergent boo boos and owies.

Just because it's not a trauma center does not mean traumas will not come in through the lobby. You'll still need to know how to provide resuscitation and stabilization and transport to a higher level of care.

Level of autonomy varies from ED to ED. If there are nurse initiated protocols in place, you can do things like initiate IV access, draw labs, order an EKG, give Tylenol to an infant with a fever, etc. If not, then you have to wait for the doc to see the patient and order the appropriate diagnostics and interventions. I'm not sure what you mean by being at everyone's beck and call, but this seems to be just part and parcel of nursing to me, and I've worked in a few different areas. You will still have demanding patients and family members who do not share your priorities and expect you to make their wants your number one priority.

As far as personality types, I've seen all different personality types be successful in the ED environment. Those that seem to thrive, however, are people who can shift priorities rapidly, who can handle frequent interruptions, and who can communicate effectively. You can be a quiet and reserved person and be a great ED nurse, so long as you can be assertive when it's called for.

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I applied because I want to get the hell off of the floor. Two people in my career that have been something of a mentor for me advise that I should take any opportunity to advance.

I merely just applied, it's easier to say no in the end than to do anything at all.

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Specializes in Med/Surg, ICU, ER, Peds ER-CPEN.

I went from the very small 10 bed all ages ER to a level one Peds trauma unit, I saw A LOT more in the small ER trauma wise, most of what I see now is "recycled" and already stabilized so smaller doesn't mean you won't see stuff, you'll see it before we do most times and is an excellent place to start. It is VERY different from the floor, most times lower patient ratio but higher acuity with a faster pace, out spoken type A makes up the majority of my co-workers with myself included lol good luck with the interview.

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Specializes in Behavioral Health.

I came from ICU to ER. My nurse manager was actually hesitant to hire an ICU nurse because in her experience, "most ICU nurses don't make it in ED." The reason being is that you have to expect the unexpected in the ED. Things are always changing, you never know what's coming in the door, and what sounds like a simple run of the mill complaint can quickly escalate to critical critical critical! My opinion is that in ICU, you at least have an understanding of where the patient is at...and plan accordingly. In the ED, best laid plans come undone all the time. I have been in the ED for a year and I LOVE it. But, you absolutely must be open to rapid changes and a sense of urgency more often than not.

You definitely need a broad knowledge of care of all age groups. Within 6 months of being hired, I had to get my ENPC and TNCC. Good preceptors will help you adjust and teamwork is an absolute must.

It is extremely different from the floor for reasons I described above. There really is no "routine" in the ED as there is on the floor.

And yes, you do need thick skin. Having a doctor there all the time is a bonus for sure, but I can almost guarantee, you won't get along with all of them. And you just have to grin and bear it and keep it professional.

If it is something you want to do...go for it!! Good luck with your interview!

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Specializes in MS, ED.

Agree with the previous posters to ask yourself why you want off the floor and what you're looking for. I started in med-surg, went into float pool and pursued an ED position for about six months before one finally gave me a chance. Like you, OP, I 'wanted off the floor.....NOW', *laugh. Mostly: I wanted to be challenged, to advance my skills and learn new ones, to turn and burn patients and have some variety in my day. JME.

I cosign Stargazer 100%: every ED is different when it comes to staffing, teamwork, acuity, autonomy, etc, but I too would be concerned with a department with high turnover. The department which gave me my chance also was one of those 'challenged' units; I received less than two weeks orientation and was one of the only three nurses in *four* hiring cycles to stay through probation. The experienced ED nurses I met in my hiring cycle and the subsequent ones quit on their first or second shift. I should've bolted as well given this but didn't want to start over in the job search, still with no 'real' ED experience to offer. I stayed almost eight months and secured another position elsewhere, but the experience has been really rough. I'm not sure I would do it this way again, honestly - learn the right way with a supportive orientation because these patients NEED you to know what you're doing.

Regarding acuity and teamwork, specifically: my first department tied nurses' hands. You triaged at bedside, MD on your heels, and you had to literally stand there and wait for initial orders - IV, labs, diagnostics, etc. It was frustrating as all get out but it was the department's protocol. One of the day MDs would write all his orders and you basically could not touch that patient until he was finished; one of the night MDs expected you 'to do the important things', (sometimes without orders), and would be upset if you didn't start that line or draw a certain lab. Total miscommunication and total mess. My new job: mostly order sets that can be nurse-initiated, thank God.

Biggest thing that I've noticed different than the floor: teamwork. On the floor, we all had our assignments and when we could help each other, we did, but mostly it was every man for themselves. In the ED, I can't tell you how many times we grab labs for one another, transport a patient up, call a report and so on - it's like we all share the load so no one gets buried. It was very welcome but hard to adjust to - at first, I wondered if they were helping me because I was too slow or 'not getting it'.

Personality types: I've met so many different types of nurses, so not sure there is any one type. As a previous poster said - you can be any type of nurse but you have to be able to 1/ move and 2/ be assertive when necessary. Things change very quickly and there have been a couple instances that I never saw coming - like the walky-talky fast track patient with the visitor who all of a sudden dropped to the floor. @&^@^!%% There really is no routine and getting used to things changing all the time - taking over patients for others who are swamped, having patients elope, being forever interrupted and having to quickly change priority while dealing with the inevitable complaints those changing priorities create...THAT is what I had to adjust to. Oh - and knowing nothing other than '45, male, c/o stomach pain x 2 days' when trying to set that patient up, assess him and get moving while managing my others with the doc on my heels already asking 'what's this guy's story?'.

For me? Totally worth it. For you? You'll have to try it on for size. Good luck!

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