It is a bit of a cliché that experienced ER personnel are no strangers to strange incidents. Work long enough in the ER and you, too, will likely be able to say, “I have seen it all.” Whether it is the alleged influence of the full moon, or just another crazy busy Friday night in the big city, the ER seems to be the place where just about anything can and will occur, sooner or later.
It can be a great place to work for nurses who enjoy high stakes, fast pace, and the luxury of passing stabilized patients along to other teams—or, even better—the satisfaction of sending a satisfied patient home with a solution to a once-pressing medical emergency.
Not surprisingly, the ER is often ground zero for life-threatening emergencies. At any given moment you may be tasked with dealing with problems as mundane as an indigent child suffering from a common cold, or a senior experiencing cardiac arrest right in front of you. You have to stay sharp, be on the lookout for potential life-threatening situations and symptoms, and keep track of multiple unfolding emergencies and responsibilities.
To suggest that a typical day in the ER can be hectic, or nerve-fraying, would be an understatement. There is no denying it: Things can be downright crazy at times. But the work is also rewarding. How often does a nurse get to intervene and potentially save a life on the spot? On the medical wards the answer would be seldom. In the ER it can happen more often than you would imagine.
The Starting Huddle
After clocking in for your assigned shift, the typical ER nurse will join in a brief team conference in which outgoing personnel will provide thumbnail sketches of the status of current and incoming patients. The charge nurse will make assignments and you will receive critical information about the status of current patients. While you will ideally be responsible for no more than four to six patients at a time, the reality is that there are no such guarantees.
By law, hospitals cannot turn away patients, regardless of their ability to pay, so many indigent and/or underinsured patients turn to the ER as their primary care giver. Thus, you may be evaluating small children for sore throats, while juggling a patient in another room who is in cardiac crisis. Your job is to take it as it comes and go with the flow, while keeping a watchful eye out for signs that any given patient may be experiencing symptoms indicative of a potential crisis.
Different nurses will be assigned different roles, from screener, to triage, to room nurses, to trauma specialists.
Sharing Information/Making Assessments
ER Nurse Report involves sharing of pertinent information regarding the patient’s immediate needs and their plan of care. What may be considered pertinent is often quite different than what you will encounter in other areas of nursing. Remember, the chief goal of the ER is to assess, triage, treat and/or stabilize. Sick patients who require additional care are often transferred to other units. Some patients will be discharged home, after successfully receiving sutures for a simple laceration, for example.
And All the Rest
Obviously, there is far more to a given shift in the ER. There is no way to cover everything you might experience in one article. Suffice it to say that you will be doing assessments, monitoring, transferring, caring and discharging, often on multiple patients. All the while, you will need to make triage-related decisions. Some tasks will be able to wait, others will be extremely time-sensitive. Figuring out which is which is all part of the challenge—and the fun—of being an ER nurse.