So You Want to be an ER Nurse?
Advice for New ER Nurses, From a Veteran ER Nurse
The ER (or, ED, as those in the know refer to it) is an appealing department for many prospective and established nurses. Fast-paced, unpredictable, and filled with many disciplines (theoretically) working in harmony to save lives, it is a bucket-list unit for sure. Yet, it’s still a job, it’s still work, and having a realistic sense of what you’re in for can save you from eventual disenchantment down the road once the grind sets in. Whether you’re about to set foot on the floor fresh from orientation, or have finally gotten your transfer request approved, here are a few guidelines to help you on your way towards a successful ER journey.
Yes, there are stupid questions:
Yes, this may seem an unpopular and bold tip for tender, young newbies, but in the ER it is possible to ask stupid questions. (Or rather, perhaps the more forgiving, unprepared questions.) It’s like this: once you are paired with your preceptor, it’s time to prove to them that you are ready for this role. That includes doing your homework (literally). It’s best to carry a notebook for the million and one things you’re not going to know/understand; once home, you can study up with the real-life example fresh in your mind.
Of course, that’s not to say you shouldn't ask skill-based inquiries in context. Repeat—never lay hands on a patient unsure about anything you are about to do. Think of it this way, if you really want to impress your preceptor, try not to ask the same question twice. If you’re not understanding something, make the time to find out why.
Always remember, you were hired onto this unit for a reason, and part of that reason is that someone saw in you a glimmer of “go-getter-ness.” If you find that your preceptor is responding to your inquiries with any sort of “that’s a great question—let me know when you find the answer to that,” than that probably means you need to challenge yourself a bit more. You’ll be a better nurse for it. This heightened level of insight leads to better questions that produce more meaningful answers (not to mention, cause your preceptor to brag about you in the med room).
Lean into your assertive self:
Working in the ER means being around BIG personalities. Add that to the go-go-go pace and there’s bound to be some kerfuffles. Expect to be tested as the staff sizes you up. Now, this is not an endorsement for hazing or any “nurses eat their young” BS; rather, think of it as a head’s up that your future teammates are keen to see what kind of nurse is joining their ranks.
Can that be intimidating? Heck yeah. Add that to the fact that you can be bantering in the break room one minute, only to be running to assist with a code the next, and your mental state can take a hit. You’ll do well to learn to push back at the push back. Setting boundaries includes speaking up for yourself—if you think you are being treated unfairly, nip it in the bud immediately. The staff will only respect you for this, trust me.
The other aspect of being assertive is placing yourself in learning’s way. Catch wind of an obscure procedure going on? Invite yourself to observe and/or assist, where and when appropriate. There’s no other place in the hospital where learning by experience is so valuable. The myriad of illness and injury that rolls through the front door means you won’t want to miss any opportunities to add to your rolodex of first-hand knowledge. Initiative is rewarded in the ER.
“Always remember, you were hired onto this unit for a reason, and part of that reason is that someone saw in you a glimmer of ‘go-getter-ness.’”
No doubt, the ER idles high. There’s not a lot of downtime, and breaks can be few and far between. The level of relentless physical labor on top of the misfortunes you’ll find many of your patients in can lead to burnout on a whole new level.
Prioritization-fatigue is definitely a thing here…you may find yourself getting home and bursting into tears trying to decide what to make for dinner, and then counting your perceived micro-failures of the day as you drift off to sleep. We’ve all been there, and you need to be proactive to mitigate this.
Fear not, you will acclimate to the crazy, I promise. But part of the acclimation process involves forcing yourself to leave work at work. Clock out and check out is a good strategy that is helped along by having something to look forward to once home. A dog-walk, a gym session, even a roll through the DQ drive-thru—whatever floats your non-nurse-related boat. Learning to compartmentalize is a tried-and-true strategy that seasoned ER nurses know well, and it will help you to cope with the inevitable days that threaten to spill over into your downtime.
Be the nurse you want to work with:
There’s no better feeling than arriving for your shift and seeing looks of relief and joy on your co-worker’s faces. Yes, working in the ER is tough, but you’ll never again be part of such a tight crew—saving lives has an indelible bonding effect on teams. This kind of nursing experience is awesome, to be sure, but it only happens when everyone pitches in.
On the days that you are drowning, when your patient load feels insurmountable, it’s your co-workers that will come to your aid. The only way to ensure that? To have kick-ass coworkers, you must be a kick-ass coworker. You’ll step into many roles in the ER and it’s a good idea to gain the respect of all staff there—from the registrars, to the EKG techs, to the patient transporters—you will need them each and every day. Helping to make their job easier will only makes yours easier, too.
Some more non-negotiables: arrive on time, offer to cover your fellow nurses for breaks, be ready to jump in to assist whenever you know an extra set of hands would be appreciated, and take the time to get to know your new family—because that’s how we roll in the ER.