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Life in the ER: Code Chaos

The emergency room is one of the most interesting departments in a medical facility. Day to day operations are unpredictable and you never know what is about to come through the doors. Open 24/7, 365 days a year, the ER is never without a dull moment.

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People who are waiting to be seen in the ER lobby are the most vulnerable patients in the hospital. One minute, you may be treating a child with an earache, and the next, you may be running trauma protocol on a family of five who were involved in a motor vehicle accident. I was an ER nurse for several years, and though I am partial to the specialty, there is merit to be given to emergency room personnel, especially the nurses. Describing the culture of ER nursing is nearly impossible. However, many past and present colleagues would agree that ER nurses are “a different breed”.

One minute, you may be treating a child with an earache, and the next, you may be running trauma protocol on a family of five who were involved in a motor vehicle accident.
When I was an ICU charge nurse, I recall receiving bedside reports from ER nurses. I couldn’t understand why the ER was so eager to get the patient up to the unit. It seemed like they didn’t care that they were bombarding my ICU with admissions.

One winter, the hospital paid an attractive incentive pay for ICU nurses to float and help cover the ER. I couldn’t resist the pay, so I signed up to cover ER needs on a 6 week rotation. I thought, how different could it be? Boy, was I in for a rude awakening. ICU is somewhat organized chaos, but this, was more akin to a warzone. The action in the ER was on par with any episode of the TV show ER I had ever seen, but much more real.

I never realized that ER nursing was this exciting, yet challenging. At any given time, an ER nurse may have an assignment that consists of a critically ill patient on vasopressors, a toothache, an acute MI getting prepped for the cardiac cath lab, and a violent psychiatric patient requiring restraints. This was pure insanity! From this experience, I developed a greater sense of bed flow, ER nursingand never hesitated taking patients from the ER. I brought stories back to my critical care staff, encouraging appreciation for what the ER does to make sure that we receive patients.

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The ER is a Rewarding Environment

I became so fond of working with such comrades, that I eventually returned years later as a full time staff nurse. I was the prodigal daughter and the ER family welcomed me with outstretched arms. The eagerness was in part to the large need of experienced nurses that could use critical thinking skills, and also fine tune assessment skills to treat a diverse group of patient populations. It was nice to belong to such a unique team of caregivers.

The ER is a demanding and fast paced environment, but the rewards of the hard work are fulfilling. Nothing feels better than saving lives and being the voice of comfort in the midst of chaos.

“I’m bored”, said NO ER Nurse, ever.

ER nursing is a combination of bravery, patience, mercy and grace.
Emergency room nurses are one of the most important parts of the emergency team. The primary objective of the ER staff is to “treat and street”. This means, ruling out an acute medical emergency and discharging the patient in stable condition.

This is a reason many people label ER staff as “heartless” or “rude’’. Yes, we do care that you have experienced back pain for three months, but, honestly, coming to the ER on a Friday night to complain about it (when you are still awake, alert and breathing) doesn’t require us to do anything other than rule out that you are not dying. Due to the vast amount of the population that are uninsured, the Emergency room is heavily utilized as a primary source of healthcare for many people. Due in part to EMTALA laws, those presenting to an emergency room with complaints have to be assessed, stabilized, and discharged. Emergency rooms around the country experience long wait times, and therefore, dissatisfied people. Everyone will present as if they have a true medical emergency, and it is important for the nurse to not become desensitized, because perception is reality to our patients. If they perceive they are having an emergency, they are.

ER nurses professionally handle that variable and treat patients with respect. There are times that the lobby is packed 40 patients deep, and the same psychiatric patient who thinks a worm is eating her brain will show up, but deserves the same treatment that anyone else would receive. ER nursing is a combination of bravery, patience, mercy and grace.

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Job Skills and Requirements

ER nursing requires skills that allow one to remain cool, calm, and have a strong backbone. ER nurses triage, assess, treat, educate and discharge patients from across the life span and all age groups.  Because of the increasing amounts of responsibilities placed on the emergency room physicians, the ER nurse are required to act as the “eyes and ears” for the doctors. ER nurses’ collect the primary and secondary assessments and report to the physician.

The level of trust that physicians have for the ER nurse is honorable, so staying abreast of evidenced based care assures this relational longevity. That being said, ER Travel Nursing ERnursing is not a place for new graduates. It is important for ER nursing staff to have foundational clinical experience prior to working in the ER. ER nurses are required to have one of the following: a bachelor’s of science in nursing, an associate’s degree in nursing, or have graduated from an accredited and approved nursing program. In addition, licensure is required, and may be obtained from graduating an approved nursing program and passing the National Council Licensure Examination (NCLEX-RN).

Depending on the nurse’s state, there may be other requirements. Nurses may specialize in emergency room medicine through clinical experience and continuous education. Departmental policies require nurses to be current with their AHA BLS/CPR, ACLS, PALS, TNCC, ENPC, ESI training, NIH Stroke Certification, to name a few. Education is ongoing and never ending.

PROS & CONS of ER Nursing

Aside from being the coolest nurses ever, ER nurses are unique in their “role with the punches” outlook. Overtime, ER nurses develop the most precise assessment skills. You learn to prioritize pretty quickly.  ER nursing can definitely help keep things in perspective and humble the hardest hearts.

ER nursing can definitely help keep things in perspective and humble the hardest hearts

One night, a young teenager presented to the ER with anaphylaxis. The child had eaten a meal that was prepared in peanut oil. The child had never been prescribed an epi-pen. We worked on this child with all our heart and souls. The parents were there the whole time, and saw the efforts we were putting into saving him. I think that we were all driven by some familiarity of having children. After what seemed an eternity, the mother told us to stop, and let her son pass with dignity. We had to let go. We didn’t win this one. The parents left the room briefly in order to allow us to clean the patient up as family would be there soon to pay respects. When they left, we all had a moment of exhale. All of us cried and called to check on our own babies afterwards.

Sometimes ER nursing places us in alignment with our humanness. Experiencing trauma, chaos, violence, and mental taxation can lead to burnout, decreased productivity and physical ailments. Other things to consider in such a setting is that breaks, lunches, or sitting may never happen on your shift. Learning to prepare for this can make work not be so grueling. However, at the end of the shift, there may be many lives saved due to the ER nurses’ diligence.

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Advancements

ER nurses have the opportunity to become Board Certified in Emergency Nursing (BCEN, CEN). This certification adds credibility to their skillset. Some facilities will provide merit increases for these certifications. Also, Advanced Practice RNs can function as midlevel providers in the ER as Nurse Practitioners.

Start your ER Nursing Adventure

ER nursing can prove to be a career that fits nicely into travel nursing. We know that emergencies will happen daily, so why not choose where you will provide that nursing care?

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If an ER nurse is from a rural ER, they can opt for an assignment in a larger trauma center where they may have the opportunity to learn new skills and understanding. Also, some critical access hospitals and facilities are paying impressive incentives for experienced ER nurses to staff those facilities with limited resources. None the less, ER nurses must be flexible and ready to hit the ground running.

Traveling as an ER nurse can help nurses make a difference no matter the destination. If you are ready to add some diversity to your life, travel nursing may be ideal. The key is to find a company or recruiter that can assure you are valued and a good fit for assignments. All around the world, ER nurses are needed to be the comforting hand and voice of calm in all situations.

Get started on your Travel Nursing Adventure today. TravelNursing.org

By Jennifer Petrea, RN Jennifer Petrea

Jennifer Petrea is a Registered Nurse from Concord, with clinical experience that includes critical care, ER, trauma, hospice & palliative care and case management. Jennifer is currently pursuing a Master’s Degree in Nursing and certification as a Clinical Nurse Leader. Jennifer also works as a freelance writer for various medical, health and fitness projects. Learn more about Jennifer on Google+