Being an ER Nurse: what I wish I had known

A man falls off a ladder and is impaled on the branch of a tree. A woman skips a light and smashes into the car ahead of her; A two-year-old has a strange, blistering rash that resembles burns; A man is stabbed by his neighbor after an argument; Friends driving from South Carolina for Spring Break are involved in a crash wreck on an exit; A man is shot in the head in a road rage incident…These are not the latest scenes in a horror movie. Although there is never a typical day in the ER, these are some of the kinds of emergencies an ER nurse must deal with. It is a tough place to be.

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  1. Unlike most specialists, you need to know how to treat people of all ages and needs. Emergency nursing is considered a general nursing specialty. They take care of children and the elderly, pregnant women and psychiatric patients, as well as patients with special needs — you name it, they are expected to care for them. It’s essential to regularly brush up on medical information and keep current in your medical knowledge, because you must be prepared for any kind of patient to walk through the door.
  2. Deciding who to treat first is probably the biggest challenge. Apart from the stereotypical emergencies — heart attacks or trauma victims — there are also those patients who are not able to get care from a primary care physician. A triage nurse will then do an “across-the-room survey” to see who needs to be seen immediately and who can wait a little longer. In most emergency departments, only experienced nurses with advanced certifications can perform triage.
  3. Multitasking is a vital skill.You have to think on your feet and your reactions have to be fast because you never know what will be expected of you next. One minute, you might be drawing blood or starting IVs; next, you’ll be checking on someone’s vital signs; then you might have to perform CPR on someone. Fortunately, there are safety mechanisms in place to safeguard against potential errors. For example, before we give a patient medication, we scan both the patient’s ID band and the medications to make sure it’s the correct medication for the correct patient, and a full medical history is done along with a review of current medication and history of allergy.
  4. It is not as simple as it looks on paper. Traditionally, nurses work 12-hour shifts, three shifts a week. Even though it is less than a 40-hour workweek, it is still exhausting: There’s hardly any ‘downtime’ and the physical demands on one’s body and mind, are huge. A good idea is to wear a FitBit to measure just how many steps you take in a day. It will shock you. At some institutions, you are also expected to sign up for a certain number of on-call hours every six weeks.
  5. You’re a nurse no matter where you are, even when you’re off the duty.It doesn’t matter where you are or with whom, you will always be consulted about a rash, or a recurring headache or some or other ailment.
  6. You will become fanatical about your loved ones’ safety.Seeing loss and worst-case scenarios can make you paranoid about your own family and friends. A lot of the injuries occur as a result of carelessness, and often as an ER nurse, you will be hard on relatives about taking necessary safety cautions, wearing safety belts, and not taking unnecessary risks.
  7. Emergency departments don’t always hire nurses straight out of school. Acceptance into an Emergency room is not automatic. The reason is that new nurses take six months and more to get oriented so that basically means six months of training before a newly qualified nurse can start working. Some ER nurses start off in intensive care, telemetry, or maternal child health to gain experience before applying to work in the emergency department. Another way to be accepted is to start as an ER department tech, which offers on-the-job training and will provide you with the experience you need to be an ER nurse. Some nursing students also do a preceptorship, where you can ‘shadow’ a nurse for a few months while you’re still in school. It is a good way of making connections and proving that you are capable.
  8. Sometimes, you will be on the receiving end of patients’ abuse. There’s a lot of “violent verbal abuse” in the unit. Patients who are in a state of shock, or frantic about their condition, might call you names, or take out their frustrations on you. You will learn not to take it personally, but initially, it can come as quite a shock when it happens. 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. This kind of support is crucial.
  9. You will have to learn how to deal with death. These days, especially with medical technology, more and more peoples’ lives are being saved due to the advances in healthcare. But you will still see the cardiac arrest who cannot be saved, or the person who has such bad trauma that they bleed out. Death is part of the job, but very little can really prepare you to watch a patient die. The hardest cases are when the patient is still young. It is during these times that the support of the nurses around you is needed and comforting.
  10. Just being there with a patient, or patient’s family can be healing. A visit to the emergency room is never planned. Patients and their families are dealing with building anxiety and stress, and as a nurse, you are present with them at their most vulnerable. Just being there, holding a hand, sometimes even just your presence — can be comforting.

The ability to be calm whilst all around you, chaos reigns.

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