Emergency Room

I have been working in the ER with a preceptor for the past 5 weeks. I have learned a great deal about Emergency Medicine, valuable lessons about acute care and a lot about people.

The ER that I work at is comprised of three zones, red, blue and green (which is rarely open) and Minor Emergency Care (which I shall never deal with being a RN.) There are a total of 40 rooms all together. On one given shift there are 3-5 Medical Doctors, an Emergency Nurse Practitioner, and at times Physician Assistants. Additionally, there are 10 RNs who have 4 rooms each. Working with the RNs are nurse techs (who are nursing students) they are an enthusiastic member of the team and do everything legally possible without a license. The other team members of the ER team are unit clerks who manage orders and take phone calls, housekeepers, and CT, Xray, and Respiratory Therapists.

An RNs job is to do an initial assessment, draw labs, start IVs, give medications, and monitor the patient. Most importantly they serve as advocates to the patients. We are the eyes and the ears, the first line of care. If we believe the patient is about to cease from breathing or their blood pressure is dangerously low, we go to the MD and let them know. We review medication orders and if we believe that the drug will cause more harm then good for the patient we relay our concerns with the MD, we double check their math on dosages and compatibility. We also anticipate treatment and labs needed, and most of the time we already have blood drawn, urine collected, cultures obtained and EKGs done before the doctor even orders them. We just know. This makes your stay at the ER a shorter amount of time, good nurses who know their jobs.

I mainly deal with the RNs, needless to say most of them are girls. One of which being my friend and classmate India. She would also agree with me that infiltrating the RN emergency nursing room has been tough, these girls have formed cliques and resent new people. They are mostly Associate Degree Nurses, and they wear their degree with pride. For this reason I keep my Bachelor Degree a secret, I don't want them to resent me more or cease to assist me with my questions that only experience can answer. There is one or two BSN nurses, they somehow managed to put white out on their badge and write in dark pen next to their name, 'BSN.' I believe that all the BSN nurses are charge nurses too. I refuse to flaunt my degree having very little experience on the floor. The male nurses, which I have only met 5 of them, yes one of them is gay, very gay. The other 4 are former EMT guys who had the brain to see that they could get paid more as a nurse and went back to school. They are probably the most competent nurses on the floor and the nicest, they are nowhere near as judgmental as the female nurses.

The patients we receive are various. I have noticed that there are several categories of patients. There are the really old people. They seem to really enjoy being in the ER, they see it as a social visit. I imagine they are very lonely people. For the most part the really old people love the attention us young nurses give them. It is almost like they get depressed when you have to discharge them. Then there are the several patients we get that have chest pain, only about 25% of all chest pain patients actually end up being a heart attack, but we take the necessary precautions regardless with nitroglycerin, morphine and aspirin, the rest of the cases is pneumonia, bronchitis, pulmonary embolism or a pulled muscle. These patients, about 75 % of them, are easily irritated, they get annoyed at the length in which we keep them in the ER. Let it be known that if you go into the hospital for chest pain you can expect to be their no less than 4 hours, and that is if you are lucky, most likely you will be there for 6-8 hours. The other group of patients we get is abdominal pain for females, I have noticed a lot of these patients. Females with their female reproductive system, whether it be an inflammation caused by an STD, a pregnancy, ectopic or normal, or a urinary tract infection. These are usually younger women, many of them you know are permiscous just by looking at their slutty faces. haha ok that is harsh but it is so true. Another group of people that come in are the ones that have colds, flus, pneumonia or bronchitis. Many of them children brought in by their paranoid parents. Most of these people could easily be treated at their family doctor's office but overreact. Then of course we have the people who have freak accidents, bug or snake bites, allergic reactions, broken bones and dislocations and suicidal patients (we get a lot of those.)

My first week in the ER one male nurse 'Bob' (not the gay one) told me that the ER is comprised of scum bags and real emergencies. He then told me 90% of the people who come in the ER do not need to be there, only 10% are real actual emergencies. I didn't realize how right he was until I started working on the floor. Most people who come in to see us could easily see their primary care provider, BUT in the ER if they don't pay us the hospital can't do anything about it nor does it reflect on their credit score. The ER is filled with the poor class of our society who can't afford a doctor or insurance in the first place. It is truly sad.

I love the ER. I thoroughly enjoy working. My nurse educator at the ER told me that Emergency Nursing runs in your blood and once you have a taste you are hooked, you will never do any other kind of nursing. I think that she is right, I can't see myself doing anything else in nursing. I found my place in this career field. Only 3 or 4 more weeks with a preceptor and I am on my own on the floor. I can't wait.