Nurses are lauded for their calm and focused manner when everything around them is erupting, but emergency nurses bring this laser focus to their jobs every day. Emergency Nurses Week (October 9-15) calls attention to this specialty as a career and to express gratitude for nurses working in emergency departments nationwide.
Emergency nursing is, by design, performed quickly and carefully to help patients who may be experiencing a life-threatening trauma or even those who visit the emergency department for a routine health issue. Nurses who work in this environment need rapid-fire assessment skills to help prioritize critical cases, particularly those where an obvious cause of the issue isn’t present. This particular work may not be something every nurse enjoys or thrives in, but for those who do, it’s particularly satisfying.
Emergency nurses work within a specialty, but that specialty encompasses nearly every possible area of nursing. Because anyone can come to the emergency department with virtually any symptom, and they depend on the medical team to treat even symptoms that are vague, emergency nurses have to know about many conditions, symptoms, medications, and injuries. They might, in a typical day, treat an infant or a 90-year-old, see multiple victims of a car crash or a worker who fell from a ladder, encounter someone with pregnancy complications or a person having an undetermined medication reaction. Emergency nurses frequently help patients who are in a psychiatric crisis as well. And many patients who come to the emergency department are stressed and agitated so emergency nurses must develop an approach toward patients that is both compassionate and in control.
If that sounds like an appealing challenge, then emergency nursing might be a terrific career path. After academic preparation, emergency nurses should gain myriad skills by working on different units. They should try to work with patients of all ages and with different health conditions to build a good foundation of skills from which to draw when needed in any given situation. Talk with emergency nurses to ask questions and look into the Emergency Nurses Association for resources about this field.
Gaining more experience will be a benefit–both because it helps nurses decide if this career path fits their interests and skills and because it will build the skills they need to help others. They will need to know how to treat catastrophic injuries or a heart attack one day and a person experiencing intense pain with no apparent cause the next, so an emergency nurse’s critical thinking skills must be sharp as they will need to triage patients constantly and in accordance with changing conditions.
After being in the field, gaining emergency nursing certification through the Board of Certification for Emergency Nursing will equip you with the additional knowledge needed to be a leader in emergency nursing. Although it is recommended that nurses who sit for the certification exam have two years of emergency nursing experience, it’s not a requirement; however, experience boosts your ability to pass and score well on the exam. And be sure to take the practice exams online as part of your study and preparation schedule as it will help you become familiar with the process and the types of questions.
And if you’re already an emergency nurse who is helping patients every day, thank you for all you do! Take some time this week to reflect on the people you help and the lives you have touched–and even how each of those people have touched your life as well.
Nursing can be stressful, no matter what area of the field you’re working in. But working in the Emergency Room (ER) or Emergency Department (ED) carries with it its own kind of stressors. Silver Powell, RN, at the University of Maryland Medical Center Midtown Campus Emergency Department, took to time answer our questions about what nurses regularly deal with in the ER/ED.
What follows is an edited version of our interview.
As a nurse in the ER/ED, what does your job entail? What do you do on a daily basis?
As an ED nurse, my duties tend to change. The majority of the time I circulate as either the charge nurse or the triage nurse. On a typical day as the charge nurse, the shift starts with taking reports from the night shift nurse on all the patients in the department, including the patients that are roomed as well as in the waiting area, and issuing assignments to the nurses circulating on the unit. From there, both charge nurses count the narcotics in the medication room and reconcile any pending discrepancies.
My next responsibility is to ensure that the nurses circulating have the support and supplies they need to properly care for the patients. This may include delegating tasks to other nurses or techs or being a liaison between the nurses and the physicians on the unit or the nurses on the other units. Responsibilities also include triaging patients that are brought in by ambulances and assigning rooms to all triaged patients. Often, the rooms fill quickly, yet it’s pertinent to initiate a work up on patients that are not roomed to eliminate any delays in process of the patient’s care.
In the meantime, I am also responsible for ensuring the cleanliness and the safety of the department.
As the triage nurse, my responsibilities start with checking the functionality and presence of the emergency equipment. The next priority is to triage all patients that come through the main ED waiting area. The charge nurse relies heavily on the triage nurse for support; therefore, I am responsible for aiding the charge nurse with all duties whenever possible.
Why did you choose to work in the ER/ED? How long have you worked there? What prepared you to be able to work in such a stressful environment?
While in nursing school, I applied for a student nurse position here in the ED at Midtown and fell in love with the excitement of the department. I immediately connected with the staff and felt honored when I was offered a position right after graduation. I gladly accepted and have been working here at Midtown in the ED for 5 years. Although working in the ED is very stressful at times, my student nurse position prepared me well. I made a strong connection between what I was learning in school in my critical care course and put it into action.
How do you keep yourself from bringing the stress of the job home? What do you do to relieve your stress?
Many times, after having a stressful day, some of the other staff and I get together after the shift and have a debriefing. This allows us to express what we think contributed to the stress of the day and discuss what we could do differently in the future—so we can possibly alleviate having to face some of the same stress repeatedly.
What are the biggest challenges of your job?
With so much autonomy as an ED nurse, one of the biggest challenges of the job is being able to recognize the priority problem for each patient and being able to meet their needs. With the population that we serve, patients often are experiencing multiple priority problems, which at times can make it difficult to meet all of their needs.
What are the greatest rewards of working in the ER/ED?
The greatest reward of my job is to know that I have helped someone, no matter how large or small their problem may be.
What would you say to someone considering this type of nursing work? What kind of training or background should he or she get?
I would tell anyone that is considering working in an ER/ED that although stressful, it is a very rewarding job. Each day is different, and there are so many things to see and to learn. In my opinion, there is no definitive training that completely prepares one for life in the ED, yet taking as many critical care courses in as many different areas as possible is always a plus.
Working in an ED entails working closely with many people from so many different areas of the health care spectrum; team work is incredibly important. We rely on others from all specialties to aid us in the care of patients to ensure optimal patient outcomes.
With dozens and dozens of nursing specialties, some nurses take varied paths to end up in the specialty that is the best fit. Many try different health care situations or medical training before deciding that one area of nursing is the career where they will make the impact they want and will satisfy their professional goals.
Jose M. Maria, MS, FNP, RN, CEN, director of emergency services at Brookdale Hospital and Medical Center in Brooklyn, New York, says he came to emergency nursing after gaining training and experience as an EMT and paramedic. “Emergency medicine was the next logical choice in starting my nursing career,” he says. “I haven’t looked back since.”
Maria, a native of the Dominican Republic, says his specific EMS experience really gave him a solid foundation to know what he wanted and provided him with the essential capability for any emergency nurse. “It allowed me to develop the skills to adapt to any situation while keeping a cool head,” he says.
But emergency nurses also benefit from having more than a cool head and a great skill set, says Maria. The flexibility to move from one situation to another one that is entirely different is essential for a successful emergency nurse. And then there’s the part where you work your tail off. An emergency nurse who doesn’t complain about the task (or 20 tasks) at hand and does what’s needed will have a much easier time working in such a fast-paced environment.
And when it’s time to transition a patient to inpatient nurses, challenges remain. In fact, Maria says that transition point is one of the most challenging aspects of emergency nursing. “This is a common challenge at every organization I have been a part of,” he says.
Preparation and planning, as with any part of the emergency nurse’s job, can help. And finding out how other nurses work also helps inform your own practice. “I try to stay current in practice and use resources like ENA CONNECT and to speak with colleagues across the states,” says Maria. “Like many professions, preparation is key for success in the emergency department.”
But with those skills and responsibilities, emergency department nurses encounter a lot of critical and crisis situations to adapt to. For Maria, those situations reveal why he does what he does. “The most satisfying and most important part of my job is to save lives,” he says. “It’s a powerful and overwhelming feeling to have brought someone back from death and see them walking out of the hospital.”
Anyone considering emergency nursing as a career path can follow Maria’s advice to rotate through other specialties before deciding on the ED. Each area offers you a new set of experiences and training that will be useful in the emergency department.
“Because we see a wide range of complaints, we can actually help our patients,” he says. “Working in psychiatry for example, helps you build conflict resolutions skills, improve communication techniques, and builds patience needed in the acute psychiatric emergency. Working in the ICU, with their attention to detail, improves your documentation. Working on a medicine floor helps in time management skills. Working a surgical unit, improves your teaching techniques with patients.”
And while the emergency department is intense and fast, emergency nurses do find a way to offer each other the kind of support and camaraderie that is distinct. Their humor might even be considered dark, says Maria.
“People have a hard time understanding that even in the darkest of times, humor helps us deal with our internal anxiety about the cases we work,” he says.
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