Where do I belong?

[Jrhemming]

Hey guys I am a new nurse and have been working in an ED for 2 months. From the time I started school I wanted to be in ED but now I'm here I'm second guessing things. Some days are great and I love it other days I want to just go home and quit. The days that are good are when we have actual critical pts. The days I find most stressful and overwhelming are when we are full of the sniffles and drug seekers. It's weird I thrive in the critical situations but get overwhelmed with trying to manage 3+ low acuity pts.

Am I where I should be or should I think of going to ICU?

I love working a pt doing quick interventions watching for changes and making quick interventions to correct when things go south. I like getting a critical pt from ems and being the first line to stabilize that pt. but I get annoyed with all the low acuity stuff. I love patho especially complex where I really have to think about what is going on with a pt. and how to juggle all of their problems.

I know in ICU I'm always going to have a critical pt. But I'm just scared I'll miss the pt coming in from ems and I'm setting up intubation and getting other interventions in quick. Do you get to do these kind of things in ICU?

I know I'm a new nurse and I'm going to stick my current job out for awhile because I am getting good experience it's just tough on some days dealing with just riff raff. Am I where I belong and just gotta learn to deal with the riff raff or could ICU be for me?

[Kiki1970]

Me think you'd be bored in ED with all the non-emergent drug seeking riff raff.

... Hmm. Don't they talk about certain departments suited for... Wait for it... Adrenaline junkies?? Certainly not the ED or ICU tho...

Good luck girls!

[Lunah, MSN, RN]

I already said I am staying where I am at for at least a year, because I know I am getting good experience. I just wanted to know if ICU would eventually be a more fulfilling, enjoyable job based on what I do and don't like about my current position.

I am glad you are giving it a chance. Yes, sometimes you have to swim through a sea of non-emergencies before you have that moment that makes you feel like it is all worth it. I hope you find that. Are there other EDs in your area?

[traumaRUs, MSN, APRN]

I did level 1 trauma center for 10 years and loved it - still miss it in fact.

Yes, there are lots of non-emergent things we see. However, they ARE emergent to these pts

Yes, you do have to wade thru them to get to the "fun" stuff (and please don't blast me for this as the true ER nurses know exactly what I'm talking about).

Please be respectful everyone!

[aevans88]

While I have never worked in an ED, I did some rotations there and I know what you mean. I have spent the last 6 years in the Cardiac ICU and while it can get slow in the middle of the night, ours is usually fast paced and we VERY rarely have long term patients. We also are the Code Blue and Rapid Response team so always have to be on our toes! I think you may still end up enjoying the ED, but what you are voicing definitely rings true to me, and I find ICU work anything but monotonous or boring. Plus there are often new devices/procedures to learn and we are expected to think autonomously and make decisions as far as drips and extubation go without the surgeons there. I recently finished NP school and love my new job, but I will always miss CICU. Good luck!!

[Been there,done that, ASN, RN]

Nobody, including you,knows where you belong after 2 months.

Nursing is a mixed bag anywhere. How unfortunate that your current position does not provide YOU with the constant gratification that YOU need.

By the way, they are not called RIFF RAFF, they are called patients. Perhaps during month 3 you could work on developing a modicum of compassion.

[That Guy, BSN, RN, EMT-B]

I Left after 4 years because I was feeling how you were. I only enjoyed it when the people were sick as the time went on. Which is only like 5% of the time. So I left and am in Cath Lab now and it is a very welcomed change of pace. Give it a little more time but keep an open mind. You are too new to be that jaded

[Ruby Vee, BSN]

I Left after 4 years because I was feeling how you were. I only enjoyed it when the people were sick as the time went on. Which is only like 5% of the time. So I left and am in Cath Lab now and it is a very welcomed change of pace. Give it a little more time but keep an open mind. You are too new to be that jaded

There's a big difference between someone with four years of experience who only enjoys sick patients and someone who is only two months in.

[chylerlove]

Hi There! I am coming up on 5 years experience and currently have 1 year in the ED. I worked on a fast paced Neuro med/surg floor prior. A few things that you might want to think about

What bothers you about non-emergent pts (bear with me here because i hear you :) ) ? i know some of them are rude and demanding but there are others who really are easy, friendly, grateful "treat and street" types. I think for your sanity figuring out what bothers you is important. If you are bothered with the fact that they should have a PCP, one thing i try to remind myself EVERYDAY is that i cannot control that part or our healthcare system... i try to focus on treating them just like I do all my patients. If it bothers you that they ask for things like food, water, coffee, etc. I try to think about how to them it really is a small request (even though on some days it really irritates me) and how i would want to be treated. Also, rest assured that no matter where you work these requests from patients, families etc. will always exist. Seriously unless you are in the OR where the pt is out and family is not allowed you can't escape the customer service part (and that's not to say surgical services doesn't come with it's own long list of nursing frustrations, because that surgeon may be waaaayyy worse than any grouchy patient or dramatic family member!)

Anyways, I just wanted to write because you seem a bit dissapointed and that makes me sad. one important thing I have discovered about being a nurse is you have to "check yourself" regularly. Not to be too touchy feely but self evaluation is crucial. I hope the questions above help you, they did when i was struggling with the same issues. best of luck!

[Jrhemming]

Thanks so much for you reply very helpful

[NickiLaughs, ADN, BSN, RN]

I did ICU for 3 years. There are times I'd have the same patient for 6 months. It's very charting focused a day most of the time, your just playing with medications, doing a head to toe assessment every hour or two and turning them if they're stable enough. There are some really neat skills you can learn like CRRT. But if you like action you may be sorely dissapointed. I saw way fewer codes but I pulled a lot of life support.

The drug seekers and bandaid pts will always frustrate you for the level of neediness they have when you have a truly sick patient. I pulled back an obviously sick esi 2 kid recently and the pt who was a soft 3 demanded to know why the kid who'd been there less time was getting seen first. No matter the argument, they never see things from your view point unless it's their kid.

Give it time. It took me 6 months to feel somewhat comfortable in my jobs. I love the ER and I think you will too.

[Bobjohnny]

Well this has been therapeutic. I explain what I like and don't like about where I work to see if another area will be a better fit and I get eye rolls and told I'm doing it wrong because I don't like dealing with an er full of drug seekers and things that could be easily handled at a pcp.

It get slightly more interesting once you've been a nurse long enough to be in Triage. Deciding in 2 minutes of talking to a patient, doing a set of vitals and an observational assessment if a patient is an ESI 1-5. Is this belly pain a UTI? A rupturing AAA? An appy? An ileus?

You want to see somebody that should have an overdeveloped 6th sense for the sick person? Not only do most nurses that work in acute car develop this, but more so your ICU & ED nurses. I've seen it more with ED and especially those that frequently work triage due to the nature of their patient contact.

OP I think the reason you're getting the proverbial "eyerolling," is because you're still a very recently graduated RN. Nobody has stated or implied that you are an idiot. As Pixie indicated, without the patients that could go to their PCP or an UC many of us would not have jobs in the ED. In fact my ED would lose something like 25-30% of it's staff, as ESI 4s, 5s, & 3s that could be handled in those environments comprise approximately that amount. Heck, I probably wouldn't even have my job because my department couldn't justify having an ANM with that volume decrease.

As others have indicated there is always something to learn with every patient. Especially if you also have a new provider. Not only do you have to know all the nursing stuff but you need to also help watch out for things for them as well. Your new grad PA/NP/Resident may not know to look for an elevated CRT to indicate an upper GI bleed or to look for those inferior & posterior wall STEMIs on the EKG.

Use this as an opportunity to learn up the limits of the scope of practice allowed within your facility. ICU is not all just critical patients, a lot of it is monotony. Titrate diprivan, titrate norepi, take bp in a bit, suction, titrate diprivan again.

[Jrhemming]

Thanks to you that haven't passed judgement and have given very good insight. I feel the fire to get back at it this week and make the most of it.