Deciding who to treat first is so, so hard. 1. Unlike most specialists, you need to know how to treat people of all ages and needs. Emergency nursing is considered a nursing specialty, but we’re also generalists. We take care of children and the elderly, pregnant patients and psychiatric patients, patients with special needs — 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. 2. Deciding who to treat first is really, really hard. We do get the stereotypical “emergency” cases — heart attacks or trauma victims — but we also see patients who are not able to get care from a primary care physician. 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. In most emergency departments, only experienced nurses [with] advances certifications perform triage. 3. Multitasking is essential. You need to think fast on your feet, because you never know what’s you’re going to be asked to do 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 many safety mechanisms in place to catch 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 one, [and] we’ll do a targeted medical history, and review current medications and allergies to make sure there are no problems. 4. 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 workweek, but it’s still exhausting: There’s virtually no downtime and you’re physically on your feet, running around during the entire shift. I wear a FitBit and I can easily put on 5 miles in a single day. In my institution, we also have on-call times, 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. 5. 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. A couple weeks ago, I was on an airplane and wound up taking care of a passenger who was having difficulty breathing after the flight attendants asked if there was a medical professional on board. 6. You will become fanatical about your loved ones' safety. I’ve seen a lot of things come through the ER doors, and a lot of injuries could’ve 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 who weren’t wearing helmets. All of those injuries can be prevented. 7. Emergency departments don’t always hire nurses straight out of school. The reason is that new nurses take upward of six months to get oriented, so that basically means six months of training before a brand new 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 get a foot in the door is to start as an ER department tech, which offers on-the-job training and can give you 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. I’ve taken on students for preceptorships 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. 8. Sometimes, patients will treat you like a punching bag. There’s a lot of what we call “violent verbal abuse” in our department. Patients might call you names, or take out their frustrations by yelling at you. I think everybody just has to put on their armor before coming to work but it does affect you. 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. 9. You will have to learn how to deal with death. These days, especially with medical technology, we’re saving more and more people due to the advances in healthcare. 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 territory 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 where you lean on your network of other nurses. It’s so helpful to talk about what happened with someone else who understands. 10. Just being there with a patient, or patient’s family, can be healing. Most people, when they come to the emergency department, it’s not 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 — that can go a long way. Kathleen E. Carlson, MSN, RN, CEN, FAEN, is an emergency room nurse and the president of the Emergency Nurses Association Source
