What I Wish I Knew Before I Became an Emergency Department Nurse
October 10, 2021
Insights on the joys and challenges of emergency nursing.
With Emergency Nurses Week October 10-16, I sat down to write some attributes of emergency nurses that I’ve observed in my career. If you’re an emergency room nurse, you have no doubt experienced these and will have some to add. Anyone who is in school or looking for a specialty change may find this helpful.
ED nurses remain calm in chaos
A recent visitor to our ED shared her experience with me. She was amazed at the composure of the ED nurses and the way they handled the chaos around them. It was a busy time, and she said one patient was constantly complaining about how long the wait was. Every nurse was kind to him anyway. She saw that every nurse was professional and focused. Emergency rooms couldn’t exist without the expertise, professionalism, attention to detail, and compassion of the nurses. What the upset patient doesn’t know is that it’s actually better to have a longer wait: that meant he was stable. If we’re rushing you back, it means you’re having a medical crisis!
The ED nurse needs to know how to treat people of all ages and needs
Emergency nursing is considered a nursing specialty, but we’re also pediatric nurses, orthopedic nurses, neuroscience nurses, labor and delivery nurses, psychiatric nurses — you name it, we do it. It’s essential to regularly brush up on medical information and keep current in your continuing education, because you have to be prepared for any kind of patient to walk through the door.
Deciding who to treat first is often very difficult
Most hospitals use a triage system, which means the patients with the most serious conditions get seen first. We do get “true emergencies” — heart attacks, strokes or trauma victims — but we also see patients who just feel bad or can’t get in to see their primary care physician. We do this triage assessment when patients check in, but also a triage nurse will do an “across-the-room survey” to see who needs to be seen immediately and who can wait a little longer. Signs that a patient is very sick or getting worse as they wait can be subtle, so in most emergency departments, only experienced nurses with advanced certifications and training perform triage.
Multitasking is essential
You need to think fast on your feet because you never know what you are going to be asked to do next. One minute you might be drawing blood or starting IVs; next, you might be performing CPR on someone whose heart has stopped beating. Going from such a traumatic event to your next patient is challenging. They won’t know your own heart is heavy because you quickly put a smile on your face and give that patient your undivided attention.
It’s way more work than it looks like on paper
Traditionally, nurses work 12-hour shifts, three shifts a week. It’s less than a 40-hour work week, but it’s exhausting. There’s virtually no downtime and you’re physically on your feet, running around during the entire shift. The flow of patients never stops so you never actually catch up, you just pass your patients on to the nurse who arrives to relieve you and the cycle continues. We also have on-call shifts, so you have to sign up for so many hours of on-call every six weeks — beyond your regular shifts — and be prepared to go into work at a moment’s notice.
You’re a nurse no matter where you are, even when you’re off the clock
When people know you’re a nurse, everyone wants to know if you can take a look at their rash or help them heal a cut or tell them how to get over a cold. Anywhere you go, whoever you are with, if there is a medical issue – from a splinter to a heart attack – you’re the one everyone looks to for help.
You will become fanatical about your loved ones' safety
We’ve seen a lot of things come through the ED doors, and a lot of injuries could have been prevented. For instance, we treat people who were in car crashes but didn’t have their seatbelts on, or children who were not in their car seats, or bicyclists and motorcyclists with head trauma who weren’t wearing helmets. All of those injuries can be prevented. If your mother is a nurse, you’ve heard her say, “This car isn’t moving until you’re buckled in!”
Emergency departments rarely hire nurses straight out of school
The reason is that new nurses take six months or more to get oriented and start being productive. Some ED nurses start off in intensive care, telemetry, or mother-baby units to gain experience before applying to work in the emergency department. Another way to get a foot in the door is to start as an ED tech, which offers on-the-job training and can give you the experience you need to help you transition to an ED nurse after graduating. Some nursing students can get their senior practicum in the ED and can train with an ED nurse for a few months before finishing school. We’ve taken students for their senior practicum and several of them have been hired in the end, so it’s a good way to make connections and prove you can do the job.
Workplace violence in the ED is unfortunately relatively common
There’s a lot of what we call “violent verbal abuse” in the ED. Patients might call you names or take out their frustrations by yelling at you. There is “violent physical abuse” – scratching, spitting, biting, and kicking are unfortunately all too familiar to the ED nurse. A bond is developed with coworkers as it helps to be part of a professional association where you can vent to other nurses at the end of the day, or just talk it out with somebody who understands the environment.
ED nurses have to learn how to deal with death
These days, especially with medical technology, we’re saving more people than ever before. But you will also see the cardiac arrest who can’t be saved, or the person who has such bad trauma that they bleed out. Death is part of the job but nothing can really prepare you to watch one of your patients die. The hardest cases are when the patient is young. When you see something really upsetting, that’s when you lean on your network of other nurses. It’s so helpful to talk about what happened with someone else who understands.
Just being there with a patient or patient’s family can be healing
Most people, when they come to the emergency department, are not making a planned visit. Patients and their families are dealing with a lot of anxiety and stress, and we have the opportunity to be there when people are most vulnerable. Just being there, holding their hand, listening — that can go a long way.
Most emergency nurses would never want to work in any other specialty once it’s in their blood. It takes a special person to be an emergency nurse, a person who possesses the ability to rapidly organize thoughts and prioritize tasks, a master multitasker with a bladder of steel, a compassionate person who can hide her emotions well so that patients feel her warmth and empathy – no matter what just happened in the other room. If that describes you, you’ve got what it takes to be an ED nurse!