Would like a few answers from ER nurses

MunkiRN, BSN, RN · Jul 14, 2012

I've been in an ER for 4 1/2 years, and you problems are unfortunately not all that uncommon. Of the three ER's I've been in over that time one was worse then the others. Add that to the fact you are working the HARDEST shift available. I worked a 11-11, 12-12, 1-1 and 7a-7p but I would NEVER work the 3-3 shift and the last hospital I was at had a really hard time staffing that shift because of the workload. Breaks are sporadic or non existent and lunch is usually late, it just is how it is for that shift I'm sorry to say. If the team lead hasn't done anything to help you out have you talked to the manager or department director? They won't be able to fix the paperwork but they can at least assure your breaks are given to you in a timely fashion. The only real options I see for you are to try to switch to a better shift, try to find a new job now, or stick it out a year and try to find a job when you have more experience in the ER. I love working in the ER, I have worked other areas and the ER is by far the most fun for me, and I get to get rid of my patients which is a big plus :) however there are challenges to working there and if your fibromyalgia is flaring up due to the stress or environment or workload then maybe it won't be a good fit for you. Other ER's will be run more efficiently and staff will be more supportive but that shift won't ever be easy no matter where you go. Just my experience, good luck and hope things get better for you!

brainkandy87 · Jul 14, 2012

Yeah, I work mids and I get screwed on my assignment nearly every day. Day shift people don't understand it. When you come in on day shift, you usually have time to get your stuff together and you aren't immediately slammed, most of the time. There are certain days. Know what helps? Having people know that, while I work my ass off, I have no problem standing up for myself. One day, I came in and immediately, within ten minutes, got four patients. How the triage nurse even triaged the patients that fast, I have no idea. However, I told her if she ever did that again, I'd walk those patients back out to the waiting room. If there are non-emergent patients that are waiting, they can do just that -- wait. In the waiting room. Five minutes apart. Our ER has very, very short wait times compared to most ER's, especially ones that are near us. There's no excuse for slamming any nurse with four patients within ten minutes. None. Know what? Haven't had it happen again since.

As far as not announcing you've got a chest pain.. well, I can understand them not seeking you out to tell you that you've got a chest pain. As a nurse with room assignments, you are responsible for seeing what's in your rooms. Triage doesn't have time to triage the patients and find the nurse every time they have a CP, etc. There might be another CP or a dyspnea waiting in triage. This is where it's so valuable to have floats that can help out if an emergent pt comes in and the assigned nurse is tied up.

One1, BSN, RN · Jul 14, 2012

CPs are paged overhead where I work and we have strict time goals for EKGs so when we get a CP page we will always have at least 2 staff members come into the room to get the patient settled in. I work midshifts as well and breaks (other than lunch break) don't exist. I take my lunch break in the early evening but that is personal preference. It is pretty common for me to walk into my shift and receive an ambulance within 5-10 minutes or less (as in they roll in the door before I have time to put down my lunch box) and there are often a few patients waiting on the board for me to be picked up as well. Midshifts are the hardest and busiest shifts in my opinion. Maybe you can switch into a day or night shift?

Esme12, ASN, BSN, RN · Jul 14, 2012

Welcome to AN! The largest online nursing community!

3P to 3A....that is a hard shift. Those are peak busy times and the 3p-3a person is frequently forgotten. You come in at 3 and the day crew is at the ending of the day and are happy there is a fresh face....they expect you to jump right in. Come 6-7 you're hungry and they are ready to leave and don't remember it's time for you to eat. The next thing you know it's 9pm and the department is busy and full. Then it's 12 to 1 and the night crew is hungry and forget to ask because you're leaving in a couple of hours. Historically.....the 3p3a shift is brutal. Peak times the entire shift.

I don't know how many rooms you are responsible for...but those are your rooms. In the department I managed the nurse had to be notified by triage/charge any patient with chest pain that was placed in a room or needed to be seen immediately. The ED is a tough environment.....face paced, aggressive, over whelming. It takes getting used to.......don't get walked on, put your foot down. It will take some acclimation to get used to the ED.

Documentation is very important to the ED for billing purposes.......patients are not only charged for items, they are charged for time in the ED and acuity........all which must be properly documented. Triage levels equal billable time. The higher the triage the more they can bill, the more that is billed the more documentation that needs to be done. There are specific requirement that need to be fullfilled before insurance wil pay the ED bill.

Take a deep breath and push forward. It may not get better but it will get easier for you to navigate.

Good Luck!

itsnowornever, BSN, RN · Jul 14, 2012

I know I dont have real experience here, but during preceptor we had the 10-10 shift and when we were slammed, we were slammed. Everyone's lunch was forgotten. A real quick "Im gonna grab a bite" was cool as long as your patients were covered and my nurse and I would run back, literally stuff food in our mouths and take off again. We were also allowed to have drinks in the nursing area with us on the floor so I learned after that first day, water (large) and pre-mixed protein drink were must haves on the floor so I could chug it really fast when we were slammed and that would tide me over for a bit.

ERNURSEPATTY · Jul 15, 2012

I've been working the ED for 27 years. You can't swing a dead cat without hitting a chest pain pt any time day or night. The key is to get the EKG early!!! If the doc is unconcerned OR if you know how to read it yourself (and if you don't, I encourage you to learn to do this) and there is no sign of infarct or ischemia, move on to expediting the cardiac enzymes. Oh course, you are considering all the risk factors. If I find a 25 year old, of ideal body weight, no significant history, assigned to me, I don't get excited. How long has the pt had the pain? 2 hours, 2 weeks, 2 months? Many of these types of pts wait in the lobby until enzymes are back without ever being connected to cardiac monitor and no IV. How am I, or are we, so confident? Doctor in triage!!! Has made a huge difference in our ED. Lots of diagnostics going on from the getgo.

FlightJunkie · Jul 15, 2012

I'm not gonna sugar coat it. This is the ER, do what you can to make it a better/safer environment, but it is what it is. It is busy, hectic, chaotic, energy zapping, life altering. You love it or you HATE it. My advice to you is to either accept this is the craziest most horrible job you'll ever LOVE and drink the cool aid... Or go somewhere with a nice easy pace. I'm not making any judgements on you or why you are having personal struggle, but I will say that the ER is as much a personality fit as anything else. Sounds to me like you might enjoy a different kind of nursing. -Aaron RN CEN CCRN, ER and Flight RN.

Hagabel · Jul 15, 2012

Where does the mentality come in that it is ok to do a 12 hr shift with no break????? I agree that ED can be crazy, hectic and fast paced but you have to look out for yourself.

I used to work somewhere where a 30 min break was seen as an entitlement!!! I quit.

I have no easy answer for you except maybe change shift as a PP stated. And be proactive and verbal re your break.

I moved from US to NZ recently, we do 8 hr shifts and get a 30 min break and 20 min tea break. You know how much better I feel!

So I have not got an answer but when we get busy and have to cover each others pts (4 each) for breaks we make sure as much as possible is done and give all the pts call bells.

ecerrn · Jul 15, 2012

I agree, that is a tough shift to work, and after 3 months maybe they figure your ready to take on a full load...at first they helped, now? Is everybody else overwhelmed as well with the changes? Are you short staffed with techs? I would start looking for another position...dumping a cp I your room and not telling you is wrong, are they following their own notification procedure? It sounds like you think its a poorly run er to me and you're clearly not happy...so what do you do to fix it if you're determined to make it through? Make sure you eat well before the shift. Have a high energy snack and drink available to you at all times....take your break, it's a federal law for a reason, and one they can get federally fined for denying.

Concentrate on organizing your time to comply with the stupid forms they think is most important...and figure out if those dumped cp are really cp at all, or just went to you because they wanted them somewhere....communicate with the person who is asking how you're doing...tell them your concerns, and your solutions and find out if that's OK, ask their advise on what you should do. As a new nurse I wouldn't expect you to handle it all by yourself, but sucking it up and internalizing is wrecking you...try a new approach and see what happens, that can be a good shift to work as you get day shift, and when you're tired of looking at their faces, you get a whole new shift to look at...be clear about what's really bugging you, write it down so you're clear...too. are you afraid you'll get something bad and can't handle it? Remember, you can always holler Help when you have to, make sure you really have to though...no crying wolf allowed.

It can all get overwhelming at times and dealing with personal health issues compounds that...speak with your doctor for a treatment plan to manage your fibromyalgia during this stressful adjustment time...trust me, this is good advise. :-)

ecerrn · Jul 15, 2012

I agree, that is a tough shift to work, and after 3 months maybe they figure your ready to take on a full load...at first they helped, now? Is everybody else overwhelmed as well with the changes? Are you short staffed with techs? I would start looking for another position...dumping a cp I your room and not telling you is wrong, are they following their own notification procedure? It sounds like you think its a poorly run er to me and you're clearly not happy...so what do you do to fix it if you're determined to make it through? Make sure you eat well before the shift. Have a high energy snack and drink available to you at all times....take your break, it's a federal law for a reason, and one they can get federally fined for denying.

Concentrate on organizing your time to comply with the stupid forms they think is most important...and figure out if those dumped cp are really cp at all, or just went to you because they wanted them somewhere....communicate with the person who is asking how you're doing...tell them your concerns, and your solutions and find out if that's OK, ask their advise on what you should do. As a new nurse I wouldn't expect you to handle it all by yourself, but sucking it up and internalizing is wrecking you...try a new approach and see what happens, that can be a good shift to work as you get day shift, and when you're tired of looking at their faces, you get a whole new shift to look at...be clear about what's really bugging you, write it down so you're clear...too. are you afraid you'll get something bad and can't handle it? Remember, you can always holler Help when you have to, make sure you really have to though...no crying wolf allowed.

It can all get overwhelming at times and dealing with personal health issues compounds that...speak with your doctor for a treatment plan to manage your fibromyalgia during this stressful adjustment time...trust me, this is good advise. :-)

Esme12, ASN, BSN, RN · Jul 15, 2012

I've been working the ED for 27 years. You can't swing a dead cat without hitting a chest pain pt any time day or night. The key is to get the EKG early!!! If the doc is unconcerned OR if you know how to read it yourself (and if you don't, I encourage you to learn to do this) and there is no sign of infarct or ischemia, move on to expediting the cardiac enzymes. Oh course, you are considering all the risk factors. If I find a 25 year old, of ideal body weight, no significant history, assigned to me, I don't get excited. How long has the pt had the pain? 2 hours, 2 weeks, 2 months? Many of these types of pts wait in the lobby until enzymes are back without ever being connected to cardiac monitor and no IV. How am I, or are we, so confident? Doctor in triage!!! Has made a huge difference in our ED. Lots of diagnostics going on from the getgo.

You don't necessarily need a doctor in triage....you need confident doctors that allow the ED nurses to do their jobs and follow a triage protocol that includes labs and x-rays. ED nurses, especially if they are in triage, should know how to read EKG's.