We have created this form specifically for ER discussions, topics and stories. We hope you find it useful. Be the first to share your stories and experience.
Ok where are all my fellow ER nurses?? I hope we can get a lively ongoing bunch of topics being discussed here & I'm going to check daily, so come on & pop in!
I love ER nursing. After NICU, ICU, teaching, being a flight nurse and a DON, I can honestly say ER is my love. (not the TV show... well, on second thought that Dr Kovak is good looking.. but... ahem)
So how about introducing yourself as you post...
like how long you've been an ER nurse, are you at a trauma center or regular ER.. a teaching hospital or whatever.. ok?
OK I'll go first...here's the problem and I'd like a few thoughts...first a little background.
I'm a female nurse, have been for years and my significant other is a male nurse for the past 7 years. He recently ran into a situation that I'm sure a female would never encounter and when he first told me about it, I was ready to blow it off as stupid....but it's not....here goes.
He works in a large,trauma ER. A female nurse (fairly new grad with little experience) recently came to him and asked for help disempacting a female pt. She'd never done it and didn't know how to.He went to the room with her, demonstrated the procedure and thought all was done...
The following shift, He was notified that the patient called adm and complained that she'd been sexually violated by the male nurse! Fortunately, the female nurse had remained in the room beside him and can testify otherwise, but...
If she notifies the police he can be arrested....if she purseues the allegations he will be suspended from the hospital until it's settled and will be unalbe to work...
I can't believe this whole situation...he says it can even happen several months down the road...now every time the doorbell rings or he goes to work he feels like this is hanging over his head...
Hi, I guess I should register. I am an RN, ER Coordinator of a small hospital.
As far as your dilemma goes, I wouldn't think that they would arrest him--especially with the nature of the problem, an order was given, and another nurse was in the room with him. I wish I had some words of wisdom, but I don't. Hang in there.
Thanks for your support! Actually everything is OK...
The hospital stuck by him. The director of ER and risk manager spoke with the female nurse who was with him, then contacted the patient.
She said she must have been mistaken if the female nurse was with him.
A real load off of our minds.
mercynurse I've been tied up working on Medi-Smart the past few days from dawn till dusk and missed your post until just now. I'm so relieved the hospital handled the situation the right way! Is your husband still feeling rather shaken up about the whole thing?
Actually, he was so relieved that the hospital took pro active measures he feels very positive about the entire thing. Thanks goodness they did! it's nice to know the facility was willing to stand behind him.
Thanks for the support we appreciate it!
our emergency department is going to be taping traumas. does any one else do this?? what is done with tapes?? they say they will be destroyed in 3 days, but what if they aren't??? can they be held as evidence in a legal issue. we are not excited about being on tape at all,and the legal issues are very real to us. the admin. tells us not to worry, but that is small comfort to those of us who will be seen and heard on tape. any thoughts??????????
Hi ellen & welcome to the ER Nursing Forum!
What reason did your department give you all for taping the trauma cases? The ONLY reasons I can think of are for teaching purposes.. (are you in a university teaching hospital?).. or for legal purposes to cover their tushes. I can't imagine them just taping & then "destroying the tapes in 3 days" and heck yes, those tapes would be excellent evidence in case of a malpractice suit. They might be excellent protection for the nurses & other staff too though you know? What are the powers that be saying their purpose is supposed to be??
Hi! I work in a somewhat busy ED that had 30,000 patients last year. I must say this is the greatest place to work! We have great teamwork and a lot of fun. I am also an instructor for the ED Nurse Residency Program for newbies and a S.A.N.E. But my greatest love is being a mother to my 6 yr old son! This is a great website, keep up the good work, we need a place to vent!
Juanita
I have been an ER nurse for 17 years. I recently left the ER because of on-going problems with the general mood and atmosphere in the ER where I have worked the last 15 years. I now work as a clinical resource nurse. It is a small hospital with a 34 med-surg unit, 6 bed ICU. We don't do trauma..as least not the come in an ambulance type. Losts walks in the door. We don't admit peds either. We stabilize and transfer..same with people who need interventional cardiac treatment. We give clot-busters and ship. In an 8 hour shift I go where I am needed. Give breaks, help out in a code or a crisis, do conscious sedation etc. I spent 5 years in Icu before moving to the ER. I am a ER nurse at heart and will always be. Does anybody else have problems with the whole department being just a real downer?? Granted the ER can be stressful.. We don't see the most intelligent or better sides of our patients.. Most of what comes in is not really an emergency. But if they didn't come see us we wouldn't have a job. And no one else is going to take care of them. So suck it up, deal with it and try and have a good time while doing it. Some of our docs are so burned out...the nurses aren't much better. It's hard to go into a patient room and hear them say "you're the first person whose been nice to me". How do you deal with it?? I finally had to quit the dept before I became conpletely burned out.
Laura
Laura, I understand what you are saying about burn out in the ER. I have been an ER nurse for two years now. It is true the ER see's the worst of the worse for abuses of the system. Lack of insurance, poorly educated, and lack of other resources creates a growing problem for ER's. In our facility we do not have a fast track area. So we can get a large number of clinic cases, drug seekers, and true emergencies. It is frustrating when you are in the midst of trying to keep someone alive and clinic pts are standing in the hall frowning and complaining. Our facility has no control mechanism's (ie key locks)for limiting who walks back into the ER including into other pt rooms. This is very frustrating to managing pt care and privacy.
AS a result of these problmes I think ER nurses do face burnouts at a higher rate than other fields. I often tell myself check your attitude when a clinic pt is reporting in as if they have an emergency. It is difficult to drum up compassion sometimes for the cold sores, flu, ear aches, pimples, back pain X 2 years, I missed work last week I need a work excuse pts. I have no problem producing compassion for the truly sick who belong in the ER. I have to constantly go home and check myself and my attitude so it does not continue spiraling down. I love nursing. I love ER nursing. I just get frustrated with the abuse that is throwing our system into further debt. My fear is that it will lead to crack downs to the ones who need it most.
Sherry
It is difficult. I pride myself on not showing my attitude to the patients. When I started..I knew it was time to move on. The sad thing is that the patients who come in with the little things sometimes have no choice. No office will see them without money or insurance. So they are forced to come to us...the most expensive place to go. It is such a cycle...The ones who manipulate the system are something else. Keep your attitude up and enjoy your job. ER nursing is very special...I think we end up with the broadest base of knowledge...I feel I really got to use my clinical judgement in problem solving, triaging, prioritizing. Cute story...I now work as a resource nurse.. I float the entire hospital in an 8 hour shift. I was doing an admit for the med-surg unit. She was a 94 yr old Nun..came from the office..being admitted for weakness. While undressing her..she had on five layers of garters, slips, dress, mylons etc...I caught just a whiff of that gi bleed smell..Her clothes were clean..her skin and undergarments impeccable...I walked out and asked the MD if she could be a GI bleed. He kind of looked at me and I explained what I smelled. He just shook his head. My shift was over so I left. The next day I found out that he was goodnauturedly making fun of me...made a comment like "hmmm..must have missed that class in med school, gee, smells like a....MI!!! Well, about 20 minutes later her admit blood work came up. Her labs showed an H&H of 6 and 18. They shipped her to the unit and transfused her.. Ha!! Last laugh was on him...Moral is...always trust your instincts and you will never go wrong.
I hope you enjoy your time as an ER nurse...I did
I'm a 29 year "vet" of the ER.
Traveling and working per diem at my home has kept me from burning out. I was close to total burn out before I decided to travel.
The trend towards putting new Grads in the ER without further education/training is growing. What thoughts does anyone else have?
Traditionally I have been against this concept for ER and CC...however, they are so desparate for help, I guess if the new grad gets enough internship and orientation, it's working....I know 3 new grads who have done this....but after less than 2 years they are all 3 burned out as they work in a trauma unit
I think it depends on the nurse. I have seen some nurses dive right into the ER as a new grad and do great. Most have had hospital experience or field experience either as an EMT or an ER tech. I have seen some just shrivel up and die too..The worst part about being a new grad in the ER is dealing with the ER nurses. Depending on the department and how big or small it is, if the newest nurse isn't keeping up the pace or carrying her load the other nurses will just chew her up and spit her out. You have to have a strong enough personality and enough confidence in your ability to know when to ask for help and be able to handle criticism and direction not handed out in the kindest manner. If you can do that, then you'll make it. I usually encourage most nurses who want to do ER to get a couple of years of ICU under their belt. That way when they do move to the ER they already have the critical thinking skills they need...they just need to learn the things specific to the ER like lacerations and pelvics and other fun stuff. I'm not burned out on the ER, I'm just burned out on the specific nurses at the ER that I used to work in. I still pick up shifts, and I float down there as resource...I will always be an ER nurse at heart..I do hate to see people burn out though...
Hi Sherry & Jill..
Jill, we all need a change of scenery every now & then. Who knows... perhaps you'll decide to return to the ER someday after you've had enougb time away. If not, then it means you're happier with what you're doing now & that's a good thing too.
I've been an ER nurse since 1988- with breaks to teach, be a DON, and run Medi-Smart.com.. I started out in NICU first, then moved to adult SICU, then to ER.. and I'll always be an ER nurse at heart too.
I've never understood the attitude some ER docs & nurses have towards the patient that presents with minor problems. Some of the folks I've worked with were just plain ugly to those type of patients- or their parents in the case of the 3 a.m kid with the week old earache... Why??
I guess I just think differently. I've worked in some pretty intense situations-- level one trauma center, trauma team leader.. on active duty in Desert Storm- I've worked horrendous cases, ungodly hours, in unbelievable circumstances... and had a wonderful time every second of it. Every now and then a simple earache is a relief! Isn't it sweet to get to see & treat something so easily taken care of once in a while? I looked at it like this as well- that mother didn't really want to be out at 3 am with her kid at the ER.. the fact that they were there told me the kid was so miserably nobody was getting any sleep. If we can fix that isn't that a good thing?
As for frequent flyers.... well.. try not to become so jaded that you believe every person coming in with low back pain wanting something for the pain is a drug seeker. Sometimes they really are in that much pain.
For example: I had a next door neighbor who had broken her back in an on the job injury years ago and had had a fusion. The fusion has snapped and her spine is unalligned and shifts causing her excrutiating pain sometimes. Her orthopedist is 60 miles away and sure isn't around on weekends or late at night so on occassion I've had to take her to the local ER when her spine would shift and she'd be on the floor crying. I've had to convince her to go because she had had such horrible experiences with ER docs and nurses thinking she was just after pain meds in the past.
She has osteoporosis as well and is on Fosomax. Has to have that for a full year to build up bone density before they can try another spinal fusion.
When I got her to the ER the young ER doc on duty started right out with that "attitude" -- the smart ass started treating her as if she was a crock and roughly started doing SLR testing etc.. she was in too much pain to explain her medical history but at least I was there and stopped him & had him get the other hosiptal to fax her records & films.
So.. what good is that attitude towards "pain seekers" -- or towards the simple cases? In my way of thinking- we're there anyway... whether we see multiple trauma patients or we see simple ear aches... why not enjoy the simple when it comes?
Hi! I've been following this forum for some time before deciding to sign up. I work in a fairly busy ED (40,000+ pts per year); I've been there about 8 months, first job as a new RN. (I'm what you'd call a non-traditional student, or maybe it was just mid-life crisis!) I have found that the moral level in my dept. changes depending on who's working that night. Moral is low to begin with, but some staff just seem to bring it down further. Pity.
Laura, Is'nt this the truth! I can smell that" GI bleed smell" too.I have been an ER nurse for 18 year's,and get frustrated at the DR's.They might learn a thing or two if they would listen to the seasoned nurses and our little gut feeling's about symptom's etc. I have learned to put my ego aside lately and just take care of my patient's ,work hard,go home and leave it at the hospital.It is hard to do but is called survival in ER nursing. This is something that comes with time and experience -Humility. As long as the patient does not suffer, I have learned to not let it affect me,what other nurses and doctor's think about me. Trusting your instinct is very true!!!I have alway's had"a feeling"before anything bad happen's to my patient's,regardless of their symptom's sometimes. It is real important to listen to this inner warning. I actually worked with a doc.last assignment that valued all of the nurses input in all crashes and trauma's ,He would ask for any suggestion's from all of us involved and if indicated,we would do it.It was very fulfilling to work in a group effort,and good for self esteem as well.We also learned from each other like this and nobody was put down for any input. This was Comanche Co.Hospital,Okla.Dr.Hall.Great asset to his profession!
Do any of you have any great ER JOB'S to recommend in California?I am on the hunt for next assignment.I will appreciate any input from you more experience travelor's.I also value any recommendations regarding any ER'S.
I was the type of man that would gag when changing my kids dippers. Any ways, I had a little old lady with a SBO. She was vomiting copious amounts of stool that stunk so bad and crying. I started to gag and gag. Well I finely just looked at this poor old ladies face and started to cry with her. I hugged her holding the emesis basin under her chin as she cried.
You know ever since that episode, I no longer gag with fowl smells
Hello everyone! This is my first time here, sounds like an interesting place. I'm an RN and work in a level II trauma center. I've been a nurse 22 years, some on med surg, some ICU, some home health (BORING). I've been in ER going on 11 years and I love it! I can't see myself doing anything else! Well, anyway, just wanted to say hi! Thanks!
Susan
I work in an ER that sees an average of 70,000/year. I know all about burn out. I left my ER for a year to work overseas and when I came back I couldn't believe the mood of the place. People were snappish, looked tired and rarely had positive things to say about anything. The sad part is it didn't take me long to get sucked into that mentality regardless of how hard I fought it. I love ER nursing but the frustration level gets to a point where you want to say really bad things!! Right now I'm trying to figure out what I want to do as nursing is no longer my passion. I even tried teaching at the university affiliated with my hospital but the instructors there were even worse. I think that when the thought of going to work makes you feel tired it's time to get out. I've travelled a lot and am thinking about relocating permanently overseas. I feel for the new grads entering the ER field - it's a lot to adapt to and if you don't have the supports in place it's more than overwhelming.
Regarding legality and trauma tapes. If the attorney finds out your hospital made the tapes they can supoena the tapes and use them during trial. Even if the hospital tells you they are destroyed BE SURE THEY ARE !!! I am a legal nurse consultant and there was a case I was involved with where the husband taped the delivery of his son....one which went horribly wrong..and there the whole thing was on tape for his attorney ! I would ask the hospital/ER director for some clear written guidelines and policies regarding the tapes and their use. Even if they are used for QI or educational purposes, they are discoverable by an attorney.
Hi Jill...the problems I am having are...#1 New Grads/Baby Nurses hired and staffing the ED. (minimal or no experience) #2 The lack of retention of senior nurses. (lose the experience and what do you have?) #3 Poor morale-feelings of frustration with the increased numbers of patients (multi-issue of non-insured, illegal aliens, use of ER as Primary doctor) I recently began a career as a traveler just so I don't have to get involved in politics that won't change anyway.
Hope some of this helps.
i worked in an er where they did this taping also. i thought it was the best thing , i have even suggested it to other hospitals where i have worked since then, my understanding is ONLY the medical director of the er sees them, and this is sort of like incidents reports they are ONLY to educate and assist in performance of the next time you are involved not to punish you , they are only in the "code" room they also help out if the nurses say certain md's or nurses arent qualified or are ugly towards their collegues during such episodes, i love the idea if i dont do anything wrong and it is used as planned (to educate not punish) then they are great...i just wish i could have seen them then i could improve if needed,,,
Just surfing and noticed the discussion re new grads in ER.
I was a RPN(LPN) for 14 yrs in geriatrics and psych, and am now working on a medical surgical floor as a RN. I have to respond to a call tomorrow re an open ER position. I'm afraid if I get too comfortable where I'm at, I will never have the courage to try something more. My kids are grown, I single parented for 16 yrs, 4 of them, 2 adhd sons....so have had some stress management going on for quite a while.
How can I decide if I am cut out for this kind of work? without making a huge mistake?
Hey guys i know that this discussion is far beyond my head because im just starting nursing school in August of this year and i would just like some good advice and encouraging words for when the load gets heavy....if it does...
i am 23, im married and have a 1 year old son....give me all the necessary info that YOU GUYS think i will need. Thanks!!!
hello everyone, I just found this website is cool :)
I am a new grad LPN and RN, I like ER and I am tinking to get a job there. I have been told that is too stressfully for a new grad...any comments will be helpfull
hello everyone. I have been a cardiothoracic ICU nurse for the past two and a half years..I was fed up with the commute (50 miles one way) and the night shift..sick all the time etc.,, and felt the pace was not fast enough..I need action! I interviewed today for a job in an emergency room in a hospital close to my house on the day shift. This hospital er sees 88,000 patients a year..ver busy...i am excited as well as nervous as this is a whole new field of nursing for me..any advice from you er nurses at heart??
I am a nurse in a fairly busy 6-bed ER that sees 22,000 pts/yr. No traumas or big stuff, but a ton of cardiac and copd cases. I have been in the ER for a year and prior to the ER, I spent time on Med/Surg and Psych (adolescent, adult and geri). I completely disagree with letting new grad's work in specialized areas. If I hadn't put 50 NG tubes down before my first OD in the ER that was about to crash, I would have been a nervous wreck. I am currently in a situation where I am working with another great RN and we are training a new grad GN. He is not nearly as smart as he thinks he is. He is a nice person and tries to do right, but he refuses to ask for help. I am afraid he is going to end up hurting someone. He about hung TPA the other day without consulting anyone...WHO does that? He has also tried to hang dopamine, diprivan, and insulin drips without asking a soul for help. We have told him and told him to ask, but he assures us he knows what he is doing and keeps on...He also gets WAY too excited when "real" emergencies present. LIke, to the point of screwing up royally...We are constantly having to look over him, thus making our job twice as hard. I have never been one to be hateful. I am generally the peacemaker, but what can I do to stop him from these behaviors?
Please help....
Discuss this with your manager, if he is still on orientation, they may decide that ER isn't the right place for him. If you catch him trying to give meds without orders or making other big mistakes, document it by writing up incident reports. It's not the ones that ask a lot of questions that are the problem... It's the ones that refuse to ask for help or think they know it all that are truly dangerous (like this guy).
AmandaWIRN wrote:Discuss this with your manager, if he is still on orientation, they may decide that ER isn't the right place for him. If you catch him trying to give meds without orders or making other big mistakes, document it by writing up incident reports. It's not the ones that ask a lot of questions that are the problem... It's the ones that refuse to ask for help or think they know it all that are truly dangerous (like this guy).
We have been so short staffed lately that our manager has actually worked several shifts with us. She knows how he is. I think she is giving hime time-and us time-to get him in line. Thanks for the advice.
I currently work in a community ED in the PEDS ED. It's really like a fast track or "urgent care" for peds. I came from PICU which I loved the work but hated the hours and lack of flexibility. I love the flexibility of the Ed and I have contemplated learning adults but probably not @ my currently hospital. The adult side @ my current ED has certain issues with the work environment that would place unnessesary stress on me. My first priority and heart lies with my 2 young children but I am completely bored @ my current job and I am ready to learn and feel challenged. We are all aware of the difficulties of nursing but those of you with families what is it about the ED that makes you love it and stay. I am in the process of deciding whether to try another ED or return to the PICU and just deal with the difficult hours.
