A day in the life of an ER nurse

A day in the life of an ER nurse

As soon as your feet hit the pavement in the parking lot you begin chanting your mantra, “I can do this. It’s going to be a good night.” In the back of your mind there’s some hope that the ER gods will be looking down upon you. For some reason you think it can’t be that bad. Right? Wrong. As you hit the department doors you see fellow nurses who look as if they will be reduced to tears by the next voice they hear say, “Nurse”. As if you needed confirmation of just how busy it is your eyes hit the patient boards. Confirmed: chaos is upon you.

You head to the break room where you unload and take your last few breaths of freedom. You take patient report from the distraught dayshifter who informs you of all the things she didn’t have time to do. You spend a few minutes just letting the nurse vent to relieve some stress from the day.

It’s now time to hit the floor running.

You attempt to prioritize and meet with the most critical patients first. On your way to do rounds you are stopped by the ER doctor who sees you as fresh prey. He begins questioning why things aren’t done and all you can do is patiently wait to interject.  “I just came on shift.  I’ll get to those things ASAP.”  You hope this is enough to calm him for the moment until you actually can get to those things.

After finally making rounds and finishing up tasks, you consider for a moment you will have time to chart all the things you have done since starting your shift 4 hours ago. No chance.  A code blue is en route and just so happens you have the only available room. You scramble to at least chart on one person and then you’re off to prepare the room for your code. Surprise, surprise, you have no suction canister or tubing and no defibrillator pads. Good thing you checked. You hurry down the hall to the stock room avoiding eye contact with everyone so you can get there and get back.  During the resuscitation of the 92 year old male from a nursing facility where they were unable to provide a code status, you hear the neighbor patient screaming out in pain for more dilaudid for his chronic back pain x 3 years.

After the code is called you’re back at it full speed ahead. You decide it’s time for rounds again. Check on the patients you left and meet new ones, one of which includes a 2 year old with a fever of 104.5F that the mother states she didn’t give Tylenol/Motrin because she “wanted you to see how high the fever was.” You assist all your patients with every need and insure them the doctor will see them…today.

You finally get to sit down after leaving an elderly lady’s room where you performed an incontinence change and dewrinkling of sheets. As soon as you’re hiney hits the seat the family from the room you just came out of requests additional warm blankets and a position change.

On your way out of the room for the 10th time in an hour, EMS dispatches a psych patient that is combative and in 4 point restraints. You take a deep breath and a happy thought creeps in your mind. You’re thankful this isn’t going to be your patient. However, being the kind-hearted person you are you help the other nurse with this patient.

Before you know it you’re 11 hours into your shift and you realize you haven’t taken a bathroom break at all. The only food and water you’ve consumed was while standing and in between changing an incontinent patient and cleaning up someone who vomited everywhere.

As your shift nears the end you try to do everything you can to help the oncoming nurse.  You let out a sigh of relief as you see day shift begin to roll in. You know at that point you have survived. No one died on your account….that’s a good night.

You drive home thinking I should stay up and get my grocery shopping done this morning, but by the time you near home you can barely get yourself inside. You shower, struggle with strength to brush your teeth, and then finally get yourself dragged into bed. For the next 30 minutes wonder if you charted this or that. Once you drift off to sleep you dream of call bells you can’t find. You wake up startled after 6 hours of sleep realizing it’s your phone ringing. Your mother apparently forgot you work nights and called repeatedly to ask for a recipe. You decide to stay up and get some things done.  Even though you know at 1830 the vicious cycle begins again.

As the dread of another shift floods your thoughts, you know in the back of your mind you really do love your job.  It may sound slightly crazy to those who don’t understand what we do every day. But in the end, in the grand scheme of things we have helped at least one of those people. We love and crave the chaos.

Did I miss anything? Please leave a comment below on anything you would like to add.

  • TerryAnn

    You left out the never-ending search for charts, the constant interruption of calls with admission orders that you take for someone else on a patient you never met “because the doc can’t be left on hold”, and the visitors with the endless stories of their own ailments that delay delivery of care to those who need it now. Keeping your composure and your smile is a test every day, only to go to monthly staff meeting and the staff be reprimanded for “low customer satisfaction”. I remember when they were patients, not customers. I also recall that bac then, we were treated like medical professionals, not waitresses. Oh how I miss those days.

    • an old nurse

      amen terryann–that’s the exact moment when nursing went to hell in a handbasket–when patients became customers

    • sedunning

      the best thing about electronic charting….never having to look for the chart again. I used to waste so much time, only to find that one of the residents was sitting on it until the attending came back around.

  • Stasha

    I definitely feel like a waitress most days! I hate that people expect their ER visit to be like McDonald’s drive thru, out in 90 seconds. Oh and standing outside your door glaring at me, doesn’t make me move any faster. :)

  • Marilynn Caulder

    Thanks for the help with the combative psych patient, lol. I would be the nurse to take him, except, i’d have up to 7 more in the pod with him. Very accurate report, and right about loving my job. Can’t even begin to count the days that I’ve thanked God, as I was going out the door, that no one died on my shift.

    • Stasha

      Oh yes, when it comes to psych patients …when it rains it pours! I do love my job. It’s challenging at times, but being able to manage in those situations is making me a better nurse.

      • Uncle Steve

        I love your notes…I loved the ER and I loved all of you who helped us ! I don’t do it any more ’cause I have retired but I do miss it !…and miss all of you who worked with us. I used to stop at accidents to see if I could help but don’t anymore …they tell me they don’t want me anymore ! God Bless all of you and know that there are lots of us that miss you !

        • Uncle Steve

          Uncle Steve is Dr. Steve Giman…love you Cindy …it was fun reading this.

          • Laura

            Sometimes we wonder why we do what we do……then there is that moment…when we’ve saved somebody…..that we know why….

  • Patsy Downer

    I am retired now…however, I really miss those nights . May God Bless EVERY Nurse that is till working.

    • Stasha

      Patsy, it’s good to know that one day I will miss these nights!

  • Adam Bowles

    I recall 7am my dad coming home and waking my brother and I for school sometimes cheerful sometimes exhausted with blood spatter on his shoes, I could never understand why he always said he loved being an ER nurse it seemed so hard, frustrating and they never seemed to be credited for their work. He is in administration/clinical work now but only because he is getting older and needed to slow down. He spent years as a paramedic then an ER nurse and then a flight nurse. I can see now why he loved it, he will shine in any moment of chaos or emergency we have ever faced together. Even now if the opportunity presents itself he reverts back to the Trauma Junkie! Thank you nurses you are all amazing!

    • Stasha

      That’s a great story! It’s a hard job, no doubt. Many years of the fast paced, high stress environment can certainly wear you down mentally and physically. Nursing is programmed into your brain. Once a nurse always, a nurse. No matter what job your doing!

  • duff

    Very well said! It is true! Nurses and doctors do work hard at their jobs and are not always appreciated for what they do…so I am here to say I appreciate you my sis-n-law! Love ya, Monique Moss McFarland for what you do! God bless you! :)

  • Jacqueline Gilmore Estrella

    I’m so proud of my daughter, Joleen Quevado, because she chose to work in night shift ER, and is a extremely competent person to have when you are in crisis. Her compassion is only eclipsed by efficiency. If I had a medical emergency, my prayer would be to get a nurse like her.

  • Mary Beth Casey

    I was recently a patient in an ER, I signed myself out to treat myself…I was having an allergic reaction to scopolamine patch after surgery. I removed the patch because my uvula was the size of the Adirondaks, and I was fearful my airway would become occluded.
    I signed in stating my problem (oh yeah I work for the HMO that the ER is freestanding too, and I know most of the patient population), the patients were taken back first come first serve. The first patient with a gouty toe, I realize is very painful, but not life threatening, the next patient missed her blood transfusion in the infusion center and was going to have her transfusion in the ED, again not life threatening, next patient said she was so happy they were taking her she had such bad cramps and didm’t know what to do. It was at that point I decided I could better care for myself than whoever was making the decision of priorities. I stopped at a drug store and picked up Benadryl and went to my sister’s house to use an epi-pen.
    I had my husband check my vitals every 1/2 hour.
    The rationale I was given when I complained that there was poor triage and that nurse needs retraining, I didn’t have stridor, yet REALLY.
    I LOVED working in the ED, but I don’t think I could tolerate the nurses who don’t do their job.

    • Stasha

      Unfortunately, you do come across the occasional nurse who has lack of skill or training. Some are new and starting out, of course, and some drift to the land of laziness. I’m sorry you had a bad experience. Glad your ok!

  • Eileen D

    How sick am I? I read the opening with the full board and the evening shift and thought, “Oh, yeah, fun’s about to begin.” I’ve been out for a while, and I miss it. You’re right. You have to be born to it, or you won’t last. But oh, lord, did I love the madness, the loudness, the circus atmosphere. And my friends, who were the best people on earth.

    • Stasha

      It’s funny how you get so anxious to see the patient board. You instantly start preparing yourself for the worst shift ever or tell yourself “it’s probably the calm before the storm.” if it doesn’t look like madness. No matter what we are handed we always pull through. We are all a strong breed!

  • Martha

    Bless all of you for doing the ER job, I know in this world now people aren’t so kind, Do know you are appreciated~~~

    • Stasha

      Thanks, Marsha! We all need to hear that from time to time.

  • Terri Wallace

    The words of gratitude just aren’t available to properly stress my appreciation of all sincere, loving, honest nurses and other medical personnel. My daughter works in the medical field and is excellent at her job. It is sad to hear the restraints that the system and the poor attitudes of co-workers put on those who try so hard to help others. I love you all and am very proud of you! I fully believe there is a special place in Heaven for you!

    • Stasha

      Thanks, Terri! Knowing that there are good people out there that really do appreciate and understand what we do, really means a lot!

  • pb8991

    You forgot about going to get the supplies to find out there aren’t any because par levels haven’t been stocked yet. And the endless trips to get box lunches for the homeless patients or the ones who just didn’t have the money for a meal today. It’s just as bad on day shift, except we ALSO get the random roving inservices which are mandatory, drop everything you are doing to learn how to do something a 4 year old could figure out on their own. At least where I work, they finally gave up on forbidding us from eating in the work area – what, exactly, IS a lunch break?

    • Stasha

      Oh my gosh, you are so right! They should be required to offer night shift in services and mandatory meetings. Day shifters don’t understand how much night affects your life.

  • Scott G.

    Just a few night shift food for thoughts. I’ve always worked night, from the time I was a tech until now, 12 years later and I would have it non over way. I don’t like to divide days and nights as we all have our hurdles to face…but on nights when you are constantly downsizing staff instead of up staffing as the shift goes on, it makes us reach past the limits we thought we had. Our 5 patient assignment suddenly becomes 9 because the mid shifters are leaving. We may not have the inflow of patients that says does…but we are still tying up the loose ends that couldn’t get done before. We are holding multiple patients of all acuities because of poor staffing and what gets us through? A lot of prayers, some duct tape and if you’re luckily enough, an amazing team of nurses, techs, doctors & ancillary staff that know that when you say you need help, you seriously need help…NOW! Night shifters learn quickly to grow thick skin, to embrace that gut feeling that something just isn’t right and have a backbone that can absorb the never ending stress of double patient loads when acuity doesn’t count! Yet when we realize that we can thrive in such a warlike environment, we continue to come back…for our patients and our amazing coworkers!

    • Stasha

      Love this. Being a travel nurse I’ve worked all shifts. I prefer nights even tho the ratios are always worse. Night shift nurses know they have to work as a team. There is a sense of cohesiveness.

  • chuckles

    oh and having to explain to the doc that their is a shortage of the meds they ordered and he throws a fit that you don’t have it.. or on top of it all the docs/residents that do nothing but demean you all shift :(

    • Stasha

      I have developed a “take no attitude” attitude during my career. I have found that if I stand up for myself then their response changes. Not always, but sometimes. We work hard. They simply write the orders and we have to carry them out. Big difference.

  • Betsy J Hatler-Kern

    You pretty much nailed it. However, you forgot the “lifesaving” turkey sandwich, graham crackers, and apple juice to the patient who came in with abdominal pain/n/v, and the extra pillows because the ER stretcher “isn’t comfortable”.

    • Stasha

      Betsy, this made me laugh out loud. So funny and so true! If only we used craftmatic adjustables the ER would be perfect! Who would ever want to leave? :)

  • Kimberlee Hogerson-Gulick

    Oh, how about you go to get a Foley and when your ready to do the job, you open the package and notice it is a new one, hmmmm wondering when did they change this? Did I not notice it yesterday on that code that lived?

  • Audrey Shaw

    Wow, Yes, Thanks, that sums it up, especially the part about trying to get the groceries done before you go home, I have 2 little girls so that’s the only time I can do it without them!
    God Bless you and all the other nurses out there!

  • nicole

    It is even more fun when you are caring for the nonsensical patients only to be more sick than they are.You go vomit, than give zofran because a young girl is pregnant for the 3rd time and she is having nausea. You redose with motrin for your fever than go give tylenol for an ear infection. Or the best is you redose with motrin and tylenol for your shot out back than give dilaudid to the person who stubbed there toe. When you are a patient, remember as much as we really do love our job, we may be more sick than you.

  • Michele

    Am blessed everyday that I, the ER nurse am not lying
    on that stretcher and have the will, know how, ability and opportunity to be Gods hands and feet and take care of the ones unfortunate enough to be on the stretcher!

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