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Wednesday, September 21, 2011

plum tuckered

I really wonder who is going to work in the ER in the coming decade. As time goes on ERs are becoming more and more difficult to work in. The patient acuity has skyrocketed. There are more people living into their 90's accompanied by all the things that can go wrong by then. Medicine and technology are keeping people alive longer and longer. So the people with a myriad of medical problems present over and over to the ER.

A lot of people think ERs are places where you come if you have an accident, a heart attack, stuff like that. That's true, however the vast majority of our patients are people who are already chronically ill and now they are having some kind of other problem. Here is a typical ER patient these days: non english speaking immigrant with cancer with mets who is failing and the family presents with the patient. The family barely speaks english. There is confusion in the family about how much they want done. So they decide to do everything: labs, IVs, UA, xray. THis is the kind of person it is impossible to get an IV on. They really have no urine when you cath them because they are so dehydrated. The cultural divide between hospital staff and the family is wide, even with the assistance of an interpeter.

And that's just one patient of many with similar complex presentations. The days of sprained ankles and lacerations seem to have fallen by the wayside in ERs, my ER anyway. We have become mini ICUs. The thing about us is there is no staffing that takes acuity into account, ER staffing is based on volumes.

My days in the ER are numbered. I just don't want to work this hard under these kind of conditions for much longer. It is too exhausting. I had a nurse who just graduated from school tell me that she knows she won't last over the long haul in the ER because the acuity and the stress is too much. My advice: Don't stay for years and years. Its not worth the toll it takes on you.

7 comments:

Nurse K said...

You've been saying your days are numbered since I started reading your blog, dear. Maybe you should go up to the ICU and just have one patient the whole day...Sit there and write your titrations on a flow sheet, Q2hr turns, change your drips, suction...

Gabe said...

This is a very timely post. You have been doing this a long time and I respect your opinions and views of ER Nursing. I have reached the same conclusion in a shorter period of time. I have enjoyed my time in the ER and it has provided valuable experience, but I could never do an entire career in emergency medicine based on the same exact reasons you stated.

Jaedpact said...

Burnout syndrome SUX. Bail before it's full blown.

EDNurseasauras said...

I say the same thing but wonder how I can PHYSICALLY do this for the next 10 years until I can retire, never mind the stress. People are sicker, less compliant, and have more complications, yes; but they are BIGGER than ever. No signs that this is going to change.

beadnik said...

yes. I did 23 years, night shift. Small town ER, I saw a bit of everything over the years. About 10 years ago I started to realize that anything was good as long as someone wasn't handing me a dead baby. Sigh. I've been doing office nursing for a little over a year now and am beginning to see how insane those 2 decades of my life were. I'd say 15 years is really all anyone should put into ER nursing.

girlvet said...

ICU= been there done that. I am out in 1 1/2 years. This is my 22nd year of ER nursing. I have a right to be tired.

Rachedy said...

34 yrs as a nurse, 25 in the ICU.
I got bored to death with titrating and all the OCD BS. In the 3 yrs I've been in the ER I have to say it's been fun and I'm exhausted. I'm tired of the seekers, I'm tired of the fact that I've become non caring and generally don't give a shit about anything anymore. I'm tired of running my ass off all day long while charge nurses sit on their asses and pile more crap on while they cruise the internet and talk on the phone all day. I'm looking to work at a walk in clinic.