Confessions of an ER nurse.

I’m an RN. I recently completed 8 months of ER nursing, and every time I would tell someone in the community about my position, I would receive one of two responses.
Example One: “Wow, that must be so tough. I could never do that.”
Example Two: “You know, I was in the ER a couple months ago. And I waited 8 hours to see the doctor! It’s ridiculous!”

In response to example one, I always say that yes, it is tough. It’s demanding. Working in the ER is busy, and there is never a dull moment for any of our staff. But I can confidently say that every single one of my co-workers loves their job. We do it because it makes us tick. It’s a beautiful thing when a passion and a career meet.

In response to example two,  I always say “I’m sorry about that.”
I know that people often complain about the amount of time they have to spend in the ER.

Most often for patients and family members alike, the complaint concerns time spent waiting: waiting to see the triage nurse; the primary nurse; the doctor. Waiting for lab results, waiting for the IV fluids to finish infusing, waiting to hear the prognosis for the father they see lying on the trauma room stretcher.

Over the past 8 months, I’ve spent over 1500 hours in the ER.

Only a tiny portion of that time was spent waiting.

As an RN, my time was spent receiving or giving report, phoning family members, applying defibrillators, inserting IVs, making toast with a little girl, documenting, reading cardiac rhythm strips, calculating medication doses, bringing the cancer patient another warm blanket, holding an elderly woman’s hand during an exam, triaging hundreds of patients a day, bringing concerns to doctors, coaching a young boy into swallowing his first pill, putting on isolation gown and mask and gloves, assessing a middle-aged man’s chest pain, washing the blood of the hepatitis patient off my arm, injecting analgesic, preparing a body for transport to the morgue, teaching a young boy’s parents about his new diagnosis of diabetes, fixing stretchers, pumping in IV fluids, discussing drug use with a college student, assessing lacerations and pupils and broken bones, patiently receiving “feedback” from irate patients, listening to a young woman cry about her heartbreaking week, interpreting doctor’s orders, researching rare conditions, getting a sugar packet for the homeless man in the waiting room, trying to find out a patient’s identity by going through their wallet, rushing a newborn baby into the resuscitation room, determining if a little girl has measles, hearing the cries of a small child having blood drawn, meeting with my manager about staffing concerns, mixing a Pink Lady for the man with heartburn, running to a “code” up on one of the floors, paging lab and respiratory, administering oxygen, obtaining health histories and medication lists, suctioning the airway for a man during his seizure, emptying catheter bags, sending samples to lab, catching early sepsis in the single mom who had a cough last week, helping a patient understand what the doctor just told them, advocating for an elderly woman who had a stroke, interpreting lab results, hugging the family whose father just died, fetching apple juice and toast for the drug dealer, pushing stretchers, changing bedding, and maybe finally sitting down to write down a couple notes before rushing off to the next thing.

Even though it feels like forever, times spent waiting represent only a fraction of what really goes on in the ER.

The thing is, an emergency room sees patients on a needs-based system. Those who require critical care receive it on a critical basis. They are the ones who do not have to wait, those who are rushed in and immediately surrounded by a gang of nurses. It is those people who often end up with CPR, central lines, catheters, defibrillators, arterial lines, warmed fluids, intubation, mechanical ventilation, rapid blood administration, countless wires and tubes connecting their body to various machines, orthopedic consults, CTs, surgery, or eventually… either a glad nod or a sad frown to their family member in response to the question “How are they?!”

I always say that I’d much rather be the person in the waiting room than the one lying on that stretcher, surrounded by all those nurses and doctors and support staff, connected to all those machines, with my life in the balance.

If you’re waiting, you can wait. Even though it’s tough and likely painful (one way or another), waiting is actually not a bad thing.

So please be patient with us as we care for those who need it most. Because someday, that might be you, and when that day comes you will want your nurse’s undivided attention.

Trust me, I would know. I’m a nurse.

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263 thoughts on “Confessions of an ER nurse.

  1. Great article!! I am also an ER nurse and you hit it on the head!!
    I’m guessing you probably meant “over 1500 hours” instead of 15000?

    • Leila, you’re indeed correct. Thanks for letting me know so I could fix that typo! Glad to hear my colleagues feel the same way. We’ve certainly talked about it lots in the break room and around the desk; this is just my way of expressing it. :)

    • After reading about 3/4 of the comments on this page it has become very clear that this is just a bitch page. I have had both experiences in the ER at my local hospital and was not put out either way as I know that there is always a wait. Last year in June my youngest daughter was in a very serious car accident, it took 20 minutes for the ambulance to show up but once they got her to the ER there was no waiting and she was taken care in a timely fashion. The ER team was great, the SICU was a great experience, even step down was good. The ward is another case, they are understaffed and over worked. I tend to agree with the part about going to a GP instead. I want to thank all nurses and aids as without them we would be no where.

      • As a ER nurse for 18 years and a flight nurse for 10 years, I think this was very well written. Patients don’t understand what is going on out side their own emergency and many don’t care. This page was not “a bitch page” it was a chance to let people know what goes on in an emergency room. People now days want everything done immediately, they don’t want to wait and many don’t care that you are trying to save someone’s life right next to their room. They want their pain meds for their dental pain, chronic back pain, sore throat or whatever the non-life threatening illness that they could have gone to their GP for but chose not to because they wanted their quick fix NOW. You want less waiting in the ER then convince people to go to their doctors or urgent care clinics for minor stuff and the people who should really be in the ER will get seen quicker.

      • I took my husband to the ER one evening when he was confused, after waking up from a afternoon of sleeping. I assumed he had had a slight stroke. He was short of breath and coughing. We waited, in a full waiting room , for about 5 minutes before seeing the doctor. We waited about 10 minutes before a nurse came for him to take him for a cat scan of his head. Within less than 30 minutes from our arrival time we learned he had NOT had a stroke.True it took a while to determine that he had pnuemonia and they decided to admit him to the hospital. If you are having to wait in ER , there is a very good reason for the wait. Be patient!!

      • I have been a paramedic for over 20 years and from your comment about 20 minute response time and nothing else about transport it seems that your child only got a taxi ride to er. If that was the case I do apologize for all that serve in the field. My job starts when the call is dispatched to my unit and goes on until I am no longer needed and all reports are given as well as documen

      • Kevin, as an RN of 26 years, I will tell you that I have dealt with many like you. Fortunately, I don’t work in the ER anymore. It is because of people like you, commenting on things you know absolutely nothing about, then running to administration and creating an even tougher work environment, the I left. So when you take your child, wife, or your own rear end to the ER again, and you wait, or look around and can’t figure out why all your nurses are 23, remember that people like you are a classic reason why experience gets sick of bullshit and moves on.

    • I totally understand the need for triage and the need for most people to have to wait in an emergency room. I have only experienced this once when my daughter broke her arm. We got to the emergence room at around 6pm, it was not until 6 hours later that the arm was temporarily set (she required surgery the next morning) and we were able to get a bed in the hospital. I am sure that this wait was due to all of the factors that you mentioned and that absolutely none of the emergency personal weren’t incredibly busy. The single thing that would have helped, however is something that you didn’t mention in your list of activities – Communication. If we had been told what to expect instead of just told to Wait, it would have been a significantly better experience. It doesn’t seem like it would have taken long for someone to simply say to us, “it will be 2 hours before we can get the X-Ray done” or to say, “the doctor is currently with another little girl with a broken arm, he will be here in 45 minutes”. Instead, we were just left waiting and not having any idea of when the wait would end.

      • A very good point, Jeff. We strive for clear communication in our practices but it isn’t always the best. Like all things, improvement is always possible. Hopefully we can keep improving and your next experience will be better.
        Also, I’m sure you know this, but just because I didn’t mention it, doesn’t mean it wasn’t done. Guess communication is something I think comes inherently with what I do. :)

      • You can’t give someone a predictable wait time because you never know who is going to roll in the door after you. When you arrive you may have an hour wait, but during that hour any number of patients could come through that door extending the wait time further. Like others have said, if you are in the waiting room and in good enough shape to “wait” count your lucky stars.

      • As an ER nurse. I always try to give an estimate of the current wait time. I’ve even been accused of trying to deter someone from checking in because I told her it would be about 4 hours before she’d be seen by the doctor.
        Also there are times when there aren’t a lot of people waiting and the wait is relatively short when a cardiac arrest arrives. That adds at least an hour to the wait time.
        We try to keep everyone informed, but unpredictable things come up.
        If you go to an ER with a non-emergency, you will get bumped by more serious cases. The more people use the ER instead of their own doctor, the more everyone will have to wait.

      • Jeff, you make really great points. When I used to be a restaurant server, I always had great relationships with my customers because I communicated well with them: “Sorry your food is taking so long, a group of 15 people placed an order right before yours and it’ll be another 30 minutes or so”. Now I’m an ER nurse, and while I try to use the same communication strategies, it’s more difficult…mainly because I don’t always know how much longer you’ll have to wait either. I may think you’ll get a bed in 30 minutes, but during those 30 minutes several people who are sicker than you might show up and end up being seen first. I may think the doctor will see you next, but then one of my other patients might decompensate and need his attention immediately. So it’s very, very hard to pin things down to specific times in the ER, and sometimes it’s even worse to attempt to give a time that ends up not being accurate. I generally try to explain to my patients what’s going on if there’s a long delay, but the ED environment is so unpredictable and constantly changing that sometimes we need people to just trust we’re doing the best we can.

      • Jeff, unfortunately we don’t always know those things. If a CPR or a trauma comes in, you can sometimes be caught up for an hour before you come back to the rest (yes rest, you are not the only one) of your patients. And we are not allowed to share information about other patients’ conditions or complaints. And aside from that, it isn’t fair to the patient we are seeing to bring the issues from another room into their room. You deserve 100% of our attention while we are in that room, and despite all the chaos, we are very good at giving it to you. Also, we would love to give you an estimate. Unfortunately, we may not know ourselves sometimes, and trust me, this is frustrating because you just have to stand there and get yelled at by angry (rightfully so) family members. Maybe radiology is understaffed, a machine in the lab had to be calibrated, the OR had an emergency from the ICU so the on-call team has to call the back-up on-call team to come in for your appendicitis or orthopedic emergency. We have streamlined wait times in our department, and everyone gets seen rather quickly, but the issues I have mentioned are left to the powers that be…and we email those powers a lot!

      • You see you must not understand. I am an ER nurse in a dept. that saw 417 patients the other day and if you understood you would not expect to be given a time frame. You see this is why we love what we do. You never know when that stroke, MI, MVC, or broken arm or GSW may come in. We don’t know time frames. If we did it would not be called an emergency room. It would be called a doctors office.

      • Jeff Im not in the medical profession but unfortunately have had extensive experience on the patient side. The reason you are not given a time is that in an ER anything can and does happen. If you are told the Dr will be here in 45mins and he doesnt get there for 3hrs are you going to consider that hes rushed to a more critical patient and be thankful that he will get to your daughter as timely as possible and that your daughter ,as uncomfortable as she is can physically wait or will you be more frustrated that “they told us 45mins, 3hrs ago”? I can assure you as a parent watching your child in pain the latter is all that will be on your mind.

      • Jeff- I’m sorry about your daughter- BUT please understand that running out to the waiting room to try to give people updates about the wait time takes TIME!!! Something we often don’t have. In addition, I hesitate to tell people that the wait will be X-minutes- As soon as that happens, I will get back to back codes that will take up the X-Ray techs, as well as several of my Nurses. Nobody wants to be in an ER, and It boggles my mind that people don’t understand that most of what we deal with is not a true emergency. It’s that stuff that we have to wade through, all the while reshuffling our priorities.

      • Jeff,
        You are exactly right. I’ve got 22 years in the ER and the lack of communication is one of the things we can do better. Jenn-this was very well written and reflects the daily life of an ER nurse. This goes a long way towards educating the consumers of our business to what we do. Until we figure this out-keep fighting the good fight! The following link is from a physician I work with. Please consider reading it.
        http://billingsgazette.com/lifestyles/health-med-fit/physical-brokenness-can-come-from-a-deeper-spiritual-brokenness/article_97f83c34-ca0d-57b6-98c8-e251f619a993.html

      • That is a very good point. There is a big initiative in my hospital (I am an ER nurse in a children’s hospital) is to improve communication. It is amazing how placated a patient’s family can be if you start them out expecting “This lab result usually takes about an hour to result, but let me know if you need anything while you wait.” The Catch-22 is that if something goes wrong and you underestimate the wait time, the patients who probably should never have been there in the first place get doubly irate. The kicker is that, in this era of pay-for-performance where hospital reimbursement is influenced by patient satisfaction surveys, the majority of people who fill out said surveys are the disgruntled. But a little communication goes a long way.

      • I am an ER nurse as well and I couldn’t agree with your comment more. I have, myself, waited in an ER for HOURS. With me knowing what goes on in there made me especially irritated. I just kept saying to myself, “I will never not go in and see a patient just to let them know we didn’t forget about them.” When I’m in triage and it’s very busy, I will tell people it will be a long wait. We’re not allowed to be specific on times because we get held to that. I could say it will be an hour wait, but we have no idea what is going to happen in the ER. If we get a code, it takes up every nurses time and throws things back a long time. The best thing I’ve ever heard a doctor say in response to a patient yelling about how they were in line first, he replied, “Ma’am! The last place you want to be first in line is the ER!” Couldn’t have said it better myself!

      • Jeff~
        As an ER/trauma & ICU nurse for 11 years and a son, brother, uncle, step dad, friend & patient, I have spent more than my fair share of time in a hospital, both on and off the clock. I learned very quickly that even if you are in a treatment room, there is no rational way to give time estimates to patients. To say “the doctor will be in in ____ minutes” or “your blood tests will be back in 45 minutes” is giving false hope. The nature of emergency medicine is to expect the unexpected. Would we like to conform to the drive-thru mentally that “your order (Dilaudid…because its the only thing that works) will be ready in 50 minutes”? No. Because we know that as soon as the alotted timeframe is up, we start to get daggers threwn at us by the stares of family members standing outside the door. Even if we are running past them with a crash cart. Although nurses have a unique gut feeling about that middle aged chest pain patient that keeps saying “Don’t let me die” or grandma that came in who “just doesn’t feel well”, we cannot predict when those 3 drop offs at the EMS bay door will happen, when those 2 patients with “just a fever” decide to no longer be “stable” at opposite ends of the department or when the 88 year old with dizziness decides to go into full arrest during the resuscitation of 4 back to back level one traumas. The balancing of time in an ER is such a delicate, fragile art that most of us are rarely accurate. Yes, lab work may be back in 40 minutes but who can determine what the attending doctor will be handling when they are resulted? Yes, your xrays were taken a half hour ago but we might not have the time to tell you that your films have been bumped for the stroke patient that needed an emergent CT scan & the trauma patient that needed scans done before emergent surgery. When we give approximate times, please understand that they are given with the pretense that nothing serious happens. As much as I try to keep my patients and families up to date with the progress of their care, sometimes other patients needs must come first.
        Oh, and this posting was definitely NOT a bitch posting! And thank you for shedding light on the challenges that we face every shift, everyday.

      • I myself am a nurse, I completely understand how communication would have eased the wait. However I find it very hard to give the type of communication you are talking about. I feel that nurses learn to be vague in communication regarding time to protect not only themselves but their patients from disappointment. When starting out as a nurse I often did give my patients and family members, “a time the doctor will be in,” or “a time the lab results will be back”. After doing this, those times were not met and I was left with distraught and rightfully upset patients, families. I would get upset too. I hate to see my patients wait, wonder, worry. I care about everything that happens to them from the moment I meat them. So be it wrong or right, I have learned to be very vague in regards to time.

      • We would love to be able to communicate how long of a wait time you will experience, but that’s the thing.. we don’t know!!! We have no knowledge or control of:
        the schedule of the Radiology dept, how far back you are in line, how long it will be before they will call for you. How long it will take for a radiologist to read it.
        The speed with which lab results will be processed.
        How quickly a Dr will be able to get to your room, how many people they are seeing before you or how long they will take in any given room.
        Even if we could estimate, all of these things are subject to change on a moment’s notice if someone comes in after you and is more critically ill. So, it’s almost like setting people up with an expectation that we can’t meet… and unmet expectations cause more frustration that waiting on an unknown. Nurses don’t KNOW how long things will take! How are we supposed to communicate it to you? We are in the same position most of the time.. waiting on this or that!

      • I agree 100%, as an ER employee, that communication with the patients who are waiting would improve patient satisfaction. I was an ER patron long before I was an employee. Having NO idea how an ER worked … and with a child who swallowed bleach….I honestly thought that they left us in the waiting room and then forgot about us. No one told me why we were waiting or how long we would wait. It was my first visit to an ER and I was a scared mom. Just a brief explanation..ex. “I’m sorry but all of our room are full right now..we will sit you in the waiting area until a room opens up” would have been appreciated. I got nothing…just an escort to the waiting area with my 2 yr. old who was vomiting black mucous. Oh…and then I had a tech explain (not very kindly) that I could have saved everyone a lot of trouble and just called poison control. I felt like a complete idiot.
        The part that THEY didn’t understand was that I was 8 months pregnant with my 4th child….I was supposed to be on total bed rest….and my daughter had managed to pry through our “child-proof” locks on the cabinet (in the 3 minutes that she was out of my sight) then she drank Clorox and started vomiting. I couldn’t find the number to Poison Control….I had two little boys who were crying as they watched their sister vomiting black stuff up….and my husband was working late. I probably panicked too quickly. I realize that. HOWEVER – my fear and my reaction were reasonable reactions. I came to the ER for help.
        Now that i work in the ER (for the last 9 years)…I share that story with any new nurse or tech who complains about scared parents rushing their child in for something that is not necessarily an emergency. I am a respected employee, an educated woman and a mother of 4. If I have that reaction/fear/response….why wouldn’t any parent? I think that part of the problem is that, when we work in the ER, we tend to forget that WE get comfortable with scary situations. We get desensitized to violence, blood, body fluids, orifices, exposed body parts and traumatic injuries. These are things WE see every day. For the general public – these are very scary things. These are not a part of their every-day-norm. They come to US for reassurance, for help, for comfort. We owe it to them to provide that….whether we understand their reasoning or not.
        If we didn’t go into this field to provide comfort, healing, reassurance, compassion and help…..we are in the wrong profession. We don’t have to be complete martyrs…but we do need to do our job to the best of our abilities and we need to remember that every patient deserves our very best.

      • This is a great point. I’m an ER nurse and just like the rest, I’ve juggled my share of angry patients/family members who have been waiting for treatment and information. Under normal circumstances I find that people who are upset about waiting respond phenomenally to contact, communication and nursing care. As a consumer I’ve spent 5+ hours in an ER waiting room; I recall the anxiety approaching panic as I saw the borders of my toddler’s cellulitis extending by the half hour. I worried they didn’t realize the seriousness of our problem or that her doctor SENT us there to be ADMITTED, I worried we’d been forgotten. I should have known better as an RN but that was my baby and I wasn’t thinking like I was on the clock.
        In my practice, I check in on patients all over the department. In the waiting, triage and treatment rooms. I assess them openly, acknowledge them, engage in open 2-way communication and provide nursing care while they wait for the doctor…I’ve knelt beside patients in the waiting room and put my stethoscope on them to assure them they’re not getting worse while they wait and that I care and am keeping an eye out for them. When patients are in triage or treatment rooms I order X-rays, labs, start IVs, give fluids, zofran, tylenol, oxygen, EKGs, nebulizers, warm blankets, compassion,education,respect, assessments, accu-checks, VS, ultrasounds and review available results with them…all per standing or verbal orders before the doctor even sees them or knows they’re there. This decreases their perceived wait time to receive treatment because as an ER nurse I have a lot of tools to provide legitimate care throughout the whole process. I establish this trusting relationship and tell them ‘I can’t say when the doctor will be in but we look busy/not so busy right now.”
        Now of course we don’t always have the time to be perfect communicators but a candid conversation and quick check in every now and again goes such a LONG way. Its good customer service, humanity- what have you.

      • Jeff you are exactly right! Communication is everything! Some people might still not completely understand but it takes just as long to give a simple short explanation as it does to tell them they have to wait! I have been in the er for 21 of my 23 years at the same facility…still there today. It is a constant battle to try to help the community understand and be aware of wait times…but it will always be our job and practice to assist , educate and care for patients to ensure a better visit to our dept. each time.

    • I have been an RN for 16 years and up until 4 months ago I spent the majority of it in the ER..
      I agree that waiting is the largest complaint. Patients and families want immediate response, care and results. As ER staff, we never waste time waiting because we are constantly pulled in many different directions at once. God forbid we get adequate breaks or take 3 minutes to run to the bathroom. 30 mins. That’s it for lunch in a 12 hour shift. The rest of the shift we are in constant motion.

      Unfortunately the ER is overused by many who can not or will not go to their PCPs.. We all know this. We can not turn anyone away irregardless of their ability or inability to pay, so why can’t pcp’s be held to the same standard? Oh wait!! They also direct their patients to go to the ER instead of treating non life threatening conditions in their offices.

      While communication is something that we can all improve upon, and giving some time frames is helpful, ER acuities and volume are constantly changing so any time frames set will also change. I recently had a discussion with one of my patients who was prepped but late for CAT scan. Why the delay? The 50 year old woman having a massive stroke needed it at that time.. My patient who had to wait, and not patiently I may add, could not or would not comprehend that the other patient needed to go first.. ‘I’m sick too. Why should I wait?’ Sad, very sad.

      • … do you honestly not understand why people go to the ER instead of a PCP? Is it really that hard to figure out? Lack of insurance. Lack of healthcare. It isn’t really rocket science, here. If the ‘unwashed masses’ are too much for you, maybe it’s time to reconsider your career. Or at least move to a private hospital that simply stabilizes then transfers patients instead of treating them 100%, since those of us who are forced by the healthcare system to rely on ERs are such a fucking problem for you? Jesus Christ, so much for nurses being ‘caring’ and ‘compassionate’ – I pray to God I never wind up at your hospital, lady!

      • I tell my patients that complain about the wait to reflect back to their wait in the lobby and ask them to tell me how many people actually looked sick out there. There my dear partient is the reason for your wait.

      • Hello all,
        I haven’t read all the responses, however I did read the initial story. I think you are all very understanding nurses who have sounded out. I personally have been in the ER for about 9 years now, and I am sickened daily by the attitudes and words of my patients. All I have to say is that I only continue doing my job because I do still get to take care of sick people. However, as far as I’m concerned, anyone and everyone who wants to bitch about wait times should go home…and should be escorted out when they decide to start cussing at staff. Hospitals allow entirely too many non-emergent patients to behave in a way that would get them arrested at an airport. And, although I give time estimates as best I can, doesn’t mean you are ENTITLED to get it. If you don’t like waiting, go find another ER that has NO wait times. Good luck with that.

      • this is so very true I have been a ED RN for many years and even though we try to communicate and doing it quite well, we still have critical patients walk through the door, when these people come in, and we deal with them straight away , people don’t understand why they get in first . also we have people use our ambulances as taxis because their loved ones don’t drive them, or they wont pick them up because they are drunk or they are in bed go figure . we also don’t give information about anyone inside, privacy act . You are always stating to patients that they are not too sick to go to the main area they go through to the clinic . and as you said GPs forward their patients and don’t deal with non critical issues . and don’t refer them to the appropriate specialist they send them to the hospital . I would say if you have to wait you are very lucky it means you are not dying and that your life is good . I enjoy my job and love dealing with people .

      • I have been reading the threads relating to this article for the last hour or so with great interest. Every department in a hospital presents different challenges. However, the ER experience appears to fairly universal.

        I am also a nurse, but in an ICU, not the ER. I have been a nurse for over 17 years and I’m sure this is what I am meant to do. The reason I like the ICU is the same reason I can’t work in the ER. There is an element of predictability and a sense of controlled chaos where I work. That is exactly what was missing for me in the ER. However, I don’t remember working harder and going home more physically exhausted or emotionally charged than when I worked in the ER.

        Even though I rarely ‘post’ or ‘reply’, I just could not resist in this case as it is so near and dear. I have a few thought of my own I wanted to share.

        I think one of the most absurd thoughts I have read here is making any comparison of the ER to a restaurant. Period. If you don’t believe me, try getting treatment for a stroke, heart attack, or life-threatening infection at your local eatery. They may have an AED but likely nobody with the training to use it.

        The subject of ‘communicating’ or ‘estimating the wait’ is a close second. If you choose to use the ER as your primary care provider for non-emergency needs do so at your own peril. You will have to wait. Ever heard of triage? Please look it up. Triage is the reason you don’t know how long the wait will be. The fact is: anyone can come to the ER for anything. Anybody not breathing, having symptoms of a heart attack or stroke, and/or profuse bleeding will typically be treated ahead of coughs, colds, scrapes, abdominal pain, or ‘just not feeling right.’

        The ‘Patient Experience’ is another curse which was put on the healthcare industry. Instead of critical thinking nurses are expected by the administration to memorize scripts. Linking patient satisfaction (not outcomes) to reimbursement comes from the hospitality industry. Just because the word ‘hospital’ is in it does not make it appropriate when helping the ill. Just in case you are not familiar with this fiasco, here is a quick summary. Each hospital sends discharged patients surveys asking how satisfied they were with their ‘stay’. Hospitals with favorable satisfaction scores get better reimbursement from Medicare. This is a hospital, not Disneyland. Truthfully, I already do everything possible to anticipate and minimize patient discomfort and needless suffering. But chances are, a certain amount of discomfort has to be a normal expectation to healing. You will have to: get out of bed after surgery, cough and deep-breathe despite some pain, possibly breathe during a trach-collar trial despite some anxiety, endure nasal-tracheal suctioning, or have your arms restrained to prevent dislodgement of invasive tubes and devices. When is the last time Goofy or Mickey at Disneyland gave a patron an enema, inserted a Foley catheter or a peripheral IV, or made them walk while wearing one of those attractive patient gowns with the opening in the back? We seem to be losing focus on why the patient is here in the first place.

        Lastly, my favorite line from all the threads (I’m paraphrasing)…This is the one place where being first is not desirable.

        I could go on, but this is getting dangerously close to a rant. Jenn, thanks for sharing. Hope all have a happy and healthy 2014!

        Nurses work hard everywhere. ER nurses work hard under the worst of conditions. Their job description is to accomplish the impossible and ask for more on a regular basis.

    • Great article! I guess this is why I love working e.r. so much! People baffle me so much! They will spend 4 hours camped out at the closest Wal-Mart waiting for the next ps4 to go on sale but god forbid wait an hour to be seen for some end stage fibromyalgia!

    • i worked in an ER in a rural area of Arkansas for several years in the admissions area and have seen it all in my 13 years there. Waiting at our ER is very seldom over 15 minutes but people still complain. We have the best ER staff anyone could ask for and everyone of our nurses truley care about the patient first. We are only a 25 bed critical care facility so we treat and get people where they need to go for treatment if serious, the less serious we can admit to our facility for treatment. When people complain about waiting I would tell them the story about my brother was a kidney transplant patient with the University of Texas medical center in Galveston, Texas. When he went there on an ER bases he got directly in because of his conditions but other people had to wait. We took him there one time and while waiting for him to be admitted I was sitting nest to a man who had a bad leg injury and I just ask him how long he had been waiting and he said 13 hours. I almost passed out!!. I could not believe my ears, He said that was very common and I could believe him as there had to be 100 people waiting in the waitng room. As you know, so many people that come into the ER are not an emergency and that is what makes it bad for everyone else who truly have an emergency. Your message was right on and bless you for what you do as a nurse. Kevin, that is not a bitch page it is the absolute TRUTH.

    • Absolutely! Waiting in an ER is actually a good sign. Unfortunately most people equate the ER” line”, like buying shoes at Macy’s….. complaining, “I was here first!” I was always happy to explain to impatient, patients the short version of what you said.
      Also, if a patients condition worsens, the ER waiting room is a really good place to be…. seconds aways from the doctor. I have always tried to explain this to my patients, along with making myself available to them for any concerns/needs. I believe it deferred some angry feelings toward medical staff and put it back where it belongs….. the realization that it is just that busy.

    • I have been in the ER for 19 of my 21 years as a nurse and your article was shared with me today by one of the crew. It hit home and put things into perspective for me. People just don’t understand what we go thru. I am in an 8 bed ER in rural America with 2 nurses a HUC and 1 Dr. we are so abused by the public it’s pitiful. Most of our clients expect everything for nothing and expect it right now. That being said I love what I do and still after all these years find great satisfaction in what I do. Most rewarding is seeing the fear and panic in peoples eyes and knowing that we will be the one’s that calm that fear and reassure them and watch them get better, alot of times I feel we actually take care of the family as much as the pt. To all my fellow Nurses, my hats off to you, you do things for people everyday that most people couldn’t do so keep up the good work.

  2. I am an RN x 6 years. What you say is true BUT I have been in the ER for myself and my kids and it is always the worst service ever. I know you’re busy but that shouldn’t excuse absolutely horrid communication. Why not tell someone waiting on labs it will be awhile and they might as well go home? Why not stop and ask “how are you doing in here?” Instead of ignoring non emergent patients for 4 or more hours. I have a really hard time accepting the way ER staff seem to think there is no room for improvement. It’s not all about life saving measures, it’s about good patient care and advocacy too.

    • Rose, I hear you. I’m sorry you’ve had some bad experiences. I’ve been on the patient side and been frustrated too. You’re right, being busy is not an excuse for a lack of communication. Patient care and advocacy should always be our priority. I hope those ER nurses are doing the best they can, as I would be trying to. Trust me that some people actually have really awesome ER experiences, but they unfortunately are rarely mentioned.

    • If it was you family member coding in the trauma room would you like if I stopped his chest compressions to check on the lady next door with abdominal pain who is laying on the stretcher eating cheetos. You obviously have never worked in an ER. It not a matter of ignoring its prioritizing.

      • I am an RN in a 32 bed ED that sees regularly over 350 patients a day as you can guess we are very busy. We have employed the use of many things to keep our patients informed of what is going on such as cards they get at the begining of their visit where the RN can mark down what tests have been ordered that have an explination of average time frames to complete those tests and have the doctor review them. There is also a real time television tracking board with coded patient identifiers that update the patient as each item comes back so they can know where they are in the process of their stay without having to track someone down to ask. This is helping to empower the patient and give more time back to the nurses. There is always the disclaimer given that patients are seen on an acuity basis so the sickest go first but this has helped our patients not to feel so in the dark. That also being said when a code does come in unless things are absolutely crazy there is an RN who stays out to watch the other patients. When it is a small ED this is not possible but larger ones should be able to flex staff to have some one round on the patients and let them know that their RN and doctor is tied up with a critical patient and is there anything that you can do for them. You will be amazed at the responses you get when you so this. Many will only show concern for the other patient. Sometimes having a brief conversation or giving information on whag expectations will be at the beginning of thier visit not necessarily with exact time frames but with the steps that must be accomplished to complete their stay at the ED gives the patient something to check off so they can at least feel they are making progress…. it seems to be working for us….. and yes many days I have no breaks and finally get to lunch 11 hours into my shift and realize I have not gone to the bathroom all day either. Being an ER nurse is truely a labour of love.

    • I am disappointed in you response as you are an RN. I would offer this for all who have to sit and wait – you are not being ignored. Others are being assisted. As adults , we should be able to look about and see if an ER is busy, then follow a logical thought process to, ‘I will have a long wait.’ As an ER nurse, we are never thinking we have no room for improvement. The opposite is true. We study, attend classes, adhere to core measures, and attempt to analyze all the criticism we receive in order to get better and better at our jobs. I had a director once who Often said, ‘ it isn’t the patient’s concern if you are busy.’ Nothing could be further from the truth. It is everyone’s concern. The next time you put you name on a list at a restaurant with a 1-2 hour wait and are gracious and patient, vow to take some of that to your next ER visit.

      • I think what people are attempting to point out is not that they don’t understand that they are likely to have to wait in an ER, it is that it would be better if there was some communication about the wait. To use your example of the restaurant, a customer is not just told to “wait here” for an indefinite period of time. They are given an idea of how long they should expect to wait. It would be nice if the same courtesy were afforded in ER rooms. Instead of being told, for example, “wait in this room for the doctor”, it would be nice to be told, “wait in this room for the doctor, he is seeing 2 patients before you and it will be approximately 1 hour”. It doesn’t take that much longer to set expectations of the wait and it makes a huge difference to the person doing the waiting.

      • I think one big difference between a restaurant and an ER is that an ER’s patient acuity and priorities constantly change. Clients in a restaurant are seen in the order they arrived; ER patients are seen based on priority. So those two patients mentioned might become eight patients if there is a big car crash, or something like that. I see the point of communication to the patient, though. It’s imperative to continue to keep our patients in the loop, and to continue to care for them as best as we can, even when they’re waiting.

      • In response to those comparing ER wait to restaurants…. we DON’T KNOW how long the wait is…. Ever! Several times I’ve told a patient he should be the next one seen by the doctor but then 2 chest pains walk in and EMS tones out on a major trauma and he doesn’t see the Dr for a few hours. It’s not first come first serve. We cannot ever predict what will come in. We always treat the most critical patient first. After a few patients get mad at you for estimating a wait time incorrectly you quit trying.

    • wait your an RN? and you want blood to be done and go home and then what? wait for a call for the results? If going home and spending your time elsewhere then I am 110% sure your issue isn’t an emergency. Go to a walk in clinic or your GP. I’v worked on the ward before i went to ER. I’ve never been so satisfied using my nursing/critical skills in the ER. Again it’s not ignoring its prioritizing…

      • Amen Brother. I couldn’t agree with you more. If only emergencies went to the emergency room, no one would have to wait. It’s about prioritizing and just filtering out the noise.

      • Jeff, when you come to the emergency room, sure you think you get right in, maybe wait and hour. Not so in many er’s. If we came in and told you to expect the doctor in 1 hour, that would be great. In that hours time, cardiac arrest comes through the door. Your episode of vomiting, just got pushed back, then we say 45 more minutes, and that is out after the overdose comes through. now we say 45 more minutes, but OMG, an effin stroke, another hour!!!.. Now you are jacked, BIG TIME….. What the hell is taking sooooooo long???. 3 hours ago they said an hour. As you can see Shit happens in the er, I’m sorry your supper came up, but now Mr cardiac arrest is still alive and being packed up and sent to the cath lab. the overdose (God love them) is still here for another day, but we now have to fight with them and keep them there as they are sometimes not ideal patients when they “wake up”. That stroke patient is having a complete workup with neurology and we have to treat that critically, time is brain, just like time is muscle in the heart. Here’s some Zofran. Thing is, that the Er relies on other parts of the hospital to help them move patients too. An those other department also serve the entire hospital as well. So when they say you are waiting to get an x-ray or CT, or lab work, hey were servicing those other CRITICAL patients FIRST, and squeezing in the I had a pain in my belly scans, when we can. While we try our hardest to move fast, it is not always possible to scan 5 er patients in 10 minutes. We have in-house stats as well. As many have said, we are sorry you have to wait, but you are just going to have too. If it’s more tolerable to wait graciously 2 hours for food than for EMERGENT CARE, then your time priorities are a little off. I for one could not wait 30 minutes for a table, my time is more important than over priced food, being that I just had a hard day/week at the “office” and would rather chill at home or just can’t stand the people sometimes.. Sorry to be so passionate about it, but sometimes working in healthcare can make you go grrrrrr.

      • Yes, you are being asked to wait for an unknown period of time. Come work with me 2hours and your view will completely change. Please, unless you walk in someone else’s shoes and do what they do. Keep your thoughts and requests to yourself. Nothing is any more degrading than for someone who has no idea what you do to request something almost impossible. Work with me and I’ll send you in to give these people a time frame then back in when it is not met.

    • Rose, you must have accidentally thought you went to the “Convenience Room”. Believe it or not, you actually went to the “Emergency Room”. In theory, there should not be a single test performed in the ‘Emergency Room’ that we can just ‘send you home and call you later’. We are testing for, well, “emergencies”.

      Can you imagine: Ring, ring… “Hey, Rose? … Dr. Smith here. … Yeah, so the tests came back. … You are, in fact, dying. Rather quickly, actually. … What?. … I know, right?! … Yeah, so, an-tee-way, do you mind, like, coming back in?… Great!…. Also, please stop by Arby’s and have a double roast beef and supersize curly fries before you come back. Thanks! Drive careful! … Of course you can have a work note. See ya in a bit! We’ll get the Demerol ready!”

      The reason you are waiting so long is people have lost sight of what the emergency room is about. ED staff are overwhelmed with noise and trying to pick out that signal in the noise is becoming even more difficult. That includes PMD’s, specialists, nurses and especially patients.

      Seriously, last shift I worked these were some of the chief complaints: ‘vomited once 3 hours ago’ … ‘no complaint- car accident yesterday, wants to get checked out’ …. ‘no complaint- had positive pregnancy test at home and wants to confirm’…. ‘bloody nose in a 13yo *yesterday*; mom read on internet it could be cancer; wants cancer testing’- at 3am …. ‘rash for 2 weeks, called PMD answering service at 2am, Told patient to go to ED’

      The reason we ignore you is the same reason you turn the radio down when you are following directions. We need to concentrate so we don’t get lost. I say this about 10 times a shift, “If you are waiting in an emergency room it is a good thing.” You don’t want to be the person that doesn’t wait. Trust me.

      The average stay for an ED visit is 4 hours. *Average*. So half of all ED visits will be over 4 hours.

      God forbid you call your primary, wait 1 or 2 weeks and then to go to your primary, then wait another 2 weeks for results. Honestly, your problem will most likely be resolved before you get to the appointment. You can then cancel your appointment then BAM! Money in the pocket.

      50-70% of what comes through the door does not even need to be there. Remember the Great Runny Nose Epidemic of 1746 that killed 17 million people? Exactly, because it didn’t f’ing exist. Colds just go away after 2 weeks. So does most everything else.

      Also, when did fever in otherwise well appearing children become an emergency? And vomiting? Geez, when I was a kid I didn’t even wake up my parents. I would just get a trash can and vomit all night. By the next day gone.

      Wait, you don’t have a primary? If only they could invent something, like a book that would have phone numbers in it– we could call it a “phone **book**”. We could even separate businesses from regular people. Perhaps, a different color of paper, like green, red… no! How about yellow?

      Wait, you have no money? How can you then possibly justify a $1500 ED bill for cold like symptoms vs a $300 office visit? Don’t forget the $700 ambulance since you couldn’t find a ride.

      BTW, No, I will not give you a work note; i need you to go to work and pay off your *&%$-ing bill so everyone else doesn’t have to pay double on account of your lazy ass.

      Also, don’t tell me you don’t have $300, when you spend $2098.76 a year on cigarettes. What? Oh, you just bum them off of everyone else and don’t ever buy them? Ah, Just like your healthcare.

      ED doc for 15yrs.

      • To Derek,
        Thank You. I LOVE this reply! Our job in the Emergency Department is like nowhere else.

        Too bad most people reading and responding to this are nurses, not patients!
        Merry Christmas and Happy 2014 to all!

      • Ditto, Derek…THANK YOU!
        …what we see now is at least 70% non-emergencies with pts demanding better/faster “service”…it’s not MacDonalds. It’s a medical facility. If you’re waiting ‘too long’, it’s time to count your lucky stars that you’re not the person everyone has to concentrate all their attention on…also: HA!! to the notion of getting labs and then going home to be called later. If that was possible, your problem was not an emergency. That’s what your PCP is for.
        — ED doc for 27 years.

      • Freakin awesome! High five! It’s people like this so called nurse that shouldn’t come to the ER. She obviously couldn’t handle working with the all-stars in the ER!

      • angry ED doc, with a chip. Take a deep breath, maybe a vacation.
        RN for 30 years, 24 hospital, ER, Med/Surg, ICU, Ortho, etc. I used to be angry too. Thought no body got it, until I stepped back from it and saw how much we missed, especially when we get caught up in our feelings.(Not just ER)

      • Er doc of fifteen years, i think i love you…haha…you just said everything i am thinking while i check patients in, assign an esi level and triage them…

      • Totally agree!! I have been an RN for 36 years and the reasons most people use the ED are ridiculous! Thanks for your commentary!

      • I had a patient register and when I called her name she was not in the lobby so I assumed she was outside smoking but 5 minutes later I got a phone call from her. She told me she felt sick waiting in the lobby and went outside for air so when I asked her where she was calling me from, she said “home”!! Then she asked if she should come back!

      • Well stated Doc!. Most ER’s now are not much more than clinics with emergency capabilities. If you are waiting, you are not emergent. Period. Chances are, the longer you wait the less emergent your complaint is. People, the ER is not a restaurant. It is not a place where you go for convenience. It is not a first come first serve cash register at a Wal Mart. It is a life saving facility staffed with dedicated professionals who are trying to alleviate pain and suffering physical, mental, and emotional, while trying to keep from getting hit, spit on, or attacked. To whine about communication when we are barely able to keep up with the full work ups, the codes coming in the ambulance bay, WHILE watching the patients we have because anything can happen at any time, is to have absolutely no concept of the word EMERGENCY. ER’s are on the front line of battle categorically. Take your complaints that usually amount to “my hair hurt yesterday” as compared to what we are dealing with and GO TO A CLINIC. Go to your doctor. Go to your grandmother. And while you are at it, look up the words “selfish” and “narrow minded”, then look in a mirror.

      • A friends OB GYN called the ER and told them to expect a ruptured topical pregnancy (hemorrhaging) coming in. The MD then called the police to get an escort since no time for a ambulance and only a couple miles away from the hospital. All I knew was he said get to the hospital NOW and knew none of the this until later. I went to pull out of her street and a police blocked me and told me they were escorting us and we hauled ass to the hospital with me chasing a police car (only funny in hindsight) . The ER was waiting for her when I pulled up. Totally went above and beyond to save her life. So I can’t apologize for jumping ahead of you with a sniffling cold, broken finger, sore throat or back ache. A sing saying “If it isn’t gonna kill you, you’re going to be waiting a minimum of 2 hours” should be posted in every ER.

      • That’s great. Dr. I do the lovely diagnostic assist, CT. Many a pt’s come through with abdominal pain for 1 hour. Vomiting started three hours ago. Seriously people, wait it out like he said. Stay home. If you are not gushing blood, seriously . REALLY dying, broken in half, go to your GP and find one if you don’t have one. The general population that run to the ED is REALLY taxing on the healthcare providers. It puts a damper on why we are there, making it what the f&*^* am I doing here?, why did I go to school for this? Don’t come in with intractable abdominal pain and eat Cheetos and ask for a dinner tray, act like you can’t move and we have to hoist you, while you skip out of the er 2 hours later with constipation diagnosis.

      • You hit the nail on the head, love it… I don’t work in the ER but I am a nurse, have done some work in the ER and much prefer Med-Surg…there is a reason for that.. you just said it all……thanks for laying it out there!!!!

      • Be careful there. My 2 month old had a 103 fever and I was told to go to the ER. Luckily it was a weekend day and I went to urgent care as it was open. Another time, my 3 year old had vomited every 20 minutes for about 6 hours and diarrhea as well. Good thing I took her to the ER as she was totally dehydrated and STILL vomiting. I am just saying that some of the things you dismiss in your comment can indeed be true emergencies and life threatening. By the way, I have no complaints about my ER visits and my mom was an ER nurse when I was younger. So I totally get it. Unfortunately I have been one of the no wait brought in by ambulance patients and I don’t think I waited. I wasn’t totally with it enough to know as I was having issues with anaphylaxis. So thank you to all of the fabulous nurses out there.

      • Awesome reply! I’m an oncology nurse and have tons of respect for anyone who works in the ER! Thanks for doing what you do!

      • Well said!!! And don’t forget the SUV, designer clothes, nail tips, gold teeth and more jewelry than a rap star!! But they can’t afford to buy Tylenol to treat that fever in their 2 year old!

        —ERnursedi

      • Hey ED doc, AAAAA-Men!!!!! I’ve worked med/surg, ob, icu, and ER. And never have I ever seen more ungrateful, entitled, impatient, rude, know-it-all, people as I’ve seen in my years in the ED. Except for those patients who have needed the ER (true emergent cases). They are always so thankful. You wouldn’t believe the “nausea and vomiting” pts that stink of cigarette smoke bc they smoked before coming in. Or they are texting as you are documenting their chief complaint. If you can smoke a cig on the way in or text during triage, you don’t need to be there. And, rating your pain a 10/10 does not get you better drugs. We literally only hear 10/10 or “it’s like a million!!!!” I want to say so badly “sir, I know pain assessment is supposed to be what you say it is. But if a 1cm superficial laceration to your arm is a 10/10 you are a pu$$y”.
        It is so frustrating that my number one concern in an ER full of non-emergent pts is crowd control. Telling rooms full of sore throats that they’re strep test should only take 15 minutes to come back only to be pulled away 13 minutes later into a respiratory arrest room. And 40 minutes pass and you can hear the sore throat person huffing loudly “what’s TAKING so long?!?!” I always want to say “I’m so sorry. I was literally breathing for someone else. Good news is, you were yelling so you apparently got your voice back!”
        Anyway, go to your pcp. Pay the $15-$30 dollars to be seen. You’ll have an actual appointment and can be upset if it’s 3 hours later than when you got there. If you go to the ER with something that is not life threatening and only mildly annoying, bring a book and take the time to relax while we run our butts off.

      • Completely agree. ER nurse for 8 years, you see so much abuse of the system. Fevers for one day will not kill you and you won’t become dehydrated for vomiting 3 times.

      • Ooooooo doc, you’re gonna get a bunch a whiners saying that you’re being mean……hahahaha! Don’t forget arrested folks that suddenly develop serious cases of “incarceritis” and our local drunks that rest on carts in the hall pissing and crapping themselves! You really feel like you’re helping people in their time of need! I am an NP in the ER and I frequently run the “fast track” area. Examples of emergencies: 2 yo that vomited 2 days ago. Parents wondering if it will come back? 26yo that gets migraines when he smokes weed. Do you have a headache now? no, why?
        Everyday I do feel like I make a difference in people’s lives, but the constant abuse and misuse of the ER really grinds on a person. Hoping our government can someday make steps towards fixing our sad system…. How bout starting with a $10 mandatory copay for Medicaid and self pay patients? My copay is $150, that sounds fair! Maybe some of the douchebags we see would think twice about their non emergency when their clinic is less than a mile away????

    • my question is this….. if it is non emergent why are you in the EMERGENCY room? Tired of people using the er as a rapid treatment center. Go to your primary, go to an intermediate care center… emergency rooms are for life or limb threatening situations. As an RN you should know better.

    • John, you’re so right. Sending sick patients home is never a good idea. If they are well enough to go home, we usually give them a requisition for outpatient labs and instructions to follow up with a family physician. You never know what the bloodwork is going to show. I had a fellow who came in, only complaint of shoulder pain and wanted to go home for a bit. We kept him cause we had a hunch, and turns out he had a trop of over 5 and thus a massive heart attack. Good thing he didn’t go home.

    • Then perhaps you should be an ER nurse and make that difference. Once you live it I am certain you will understand it better. I know it’s easier to degrade an ER nurse than to actually see all that they do. Our lives are often filled with angry, ungrateful people because many people aren’t concerned with anyone but themselves. ER’s are priority based. Non urgent medical problems are often best taken care of by your primary care doctor and the wait could be done at home instead of an ER LOBBY. You would only be waiting for an appointment then. Just a little food for thought

    • If you can go home to wait for lab results, you don’t belong in the ER. That’s why wait times are so long – people like you clogging up the EMERGENCY room with stuff you could’ve gone to the doctor or a walk-in clinic for.

    • To be fair, I think Rose has a good point. Everyone just ganged up on her, for one silly little comment about going home while they wait on results. Yes, if that were an option, then it probably wasn’t really an emergency. However, I think she does make some very valid points as well. I was in the emergency room a few years ago. I was having a miscarriage. At the time it was my fourth, so I was not alarmed, I went through the process at home, as I had done three times prior. I followed up a NP, who refused to do an ultrasound to make sure I had passed everything. I explained I had a history of not passing everything on my own, but she did not listen. So, Long story short, I did NOT pass the fetus, my body went into shock, and I lost an insane amount of blood. My husband rushed me to the emergency room, explained what had happened and also told them I have a brain aneurysm incase that was need to know. The took my BP, with was of course off the charts. Put on that pretty hospital gown, and gave me the corn cob pad to absorb the blood. Yet, I laid there in the hospital bed, not really able to respond even to my husband, for 4 hours. I soaked through the pad, through my gown, through the absorbent bedding, and into the actual hospital bed. BP spiked and all. Not one time in that four hours did anyone come in the room to explain my wait. Not one person came in to tell my husband what was happening to me. It wasn’t until my husband (who is a very quiet and shy man) got up, went out into the hall, an grabbed the first nurse he could find and demand that someone help me, that anything was done. Now while I realize, that poor nurse was probably on her way to another patient, and had a million things to do besides come in my room, maybe is someone, anyone would have helped me or calmed my husband in the four hours prior, he wouldn’t have been so frantic. After a few hours, some meds, a blood transfusion, a D&C, and change in clothes & quick wipe down I was fine. And you know what the discharging nurse has the balls to me to say as she handed me my paperwork on the way out? “Oh, look here. It’s so funny, the registration nurse wrote down crapping and bleeding on your admitting paperwork, instead of cramping and bleeding.” and had herself a good chuckle about it. Wow!

      Keep in mind, it was the same hospital that I myself worked at for 7.5 years! I left very shortly after that. I say all of that to make a point that while, yes a lot of the patients in the ER do not have an emergency, and yes maybe some of the things Rose said aren’t practical, she does also make some very valid points. Communication is key. I think there is always room for improvement when you’re talking about real people.

      • I’m just a little curious as to how your BP was “spiked”…”off the charts” from blood loss and/or sepsis which are the two concerns in your situation. Both of these conditions would cause a very low BP if you were as critically ill as it seems you thought yourself to be. Anyway, I doubt anyone here is attempting to address every poor experience anyone has ever had in an ER, and denying that sometimes things can be handled in a better way. This is about the general trend of people flooding the waiting room for reason’s that are NOT emergent. It is not about individual cases of poor customer service. Those are two different issues. Sorry for your loss, and for your crappy experience, but since you couldn’t simply “phone it in” you clearly aren’t the demographic being discussed here. you are obviously someone who desperately needed emergent care and you ended up with a really poor care team. Apples and oranges.

      • First, my BP spiked because my body considered the fetus/miscarriage an infection, and was trying to fight off that infection. When my body was unable to fight off that infection, and I had lost too much blood I went into shock.

        Second, I’m guessing the nurses took the same approach to my care as you have in your response. I’m not dying from blood loss from a gun shot, my aneurysm hasn’t burst yet, so I must not be “as critically ill as it seemed I thought I was” right?

        Third, to the apples and oranges comment. That was exactly my point. There are several reasons people come into the ER. Some require immediate attention, others can wait. Regardless, communication can be better. If someone is waiting, explain the wait to them. Don’t just leave them in a room for 4 hours to freak out. Or worse, leaving the spouse or family member of a patient who is not very coherent, for four hours with no communication.

        Fifth, the article is not only about the general trend of ER’s being flooded with non-emergent things, it’s about people’s wait time, and trying to explain that wait time. Non-emergent patients are just a portion of that problem. So anyone and everyone who has ever been in and ER is part of that demographic.

        I apologize if my reply comes off as snarky, but your response was literally to belittle what I went through, try to call me a liar, and then dismiss my points on communication because I didn’t fit into what YOU were talking about. This is exactly the attitude, and lack of compassion I was met with that night & morning.
        Now trust me, in 7.5 years I saw plenty of patients and their families freaking out over things that were not what I’d consider to be an emergency. I get it, sometimes you want to shake them and say, “Get a grip!”. But I always repeated this sentence to myself, “This may not seem like an emergency to me, but this is a huge moment in their life, and I will treat them with the same compassion and care as I would someone with a true emergency.”
        Communication is key to patient care. Always.

      • I’m sorry but after reading your story….you shouldn’t have been waiting for 4 hours. I work in a busy ED. There’s no way in the world you’d have waited that long for anyone to see you. In 4 hours time you should have had an OB consult, a transfusion started (if necessary) d&c discussed (again if necessary) BP control, and pain management. As an ED nurse of almost 9 years, I’m sorry. That was not right.

      • I’ve been an ER nurse for 26 years. Even though your chief complaint said “crapping and bleeding”, that’s something that requires immediate attention too! I’m sad to say that a lot of hospitals (in an effort to keep costs down!) hire unseasoned nurses, I’m talking just got their diploma! Of course if you had been seen quickly it would have costs down. When your hubby grabbed a nurse and he/she realized that you needed a doctor right then, he/she charges by the acuity of the patient. The higher the acuity, the more the doctor charges. Please don’t make the mistake that I’m saying a doctor would twiddle his/her thumbs at the desk while you bled out, I’m not saying that at all. Before you’re ever seen by an MD, DO, PA or CRNP you’re seen by a triage nurse. If your triage nurse doesn’t connect all the dots and sort you out right, then you wait for 4 hours. It does happen to all of us, everyone makes mistakes. I suppose that’s why they call it “practice”.

    • “…ignoring non emergent patients for 4 or more hours.” That statement alone makes me question the validity of your claim to be a RN. It’s an Emergency room, and generally its filled with EMERGENCIES! If a loved one of mine was in a serious emergency I’d be super pissed if I saw a nurse placating a non-emergency person because they can’t figure out that customer service if for retail stores. By the very nature of what you said you should be the first person to not be a non-emergency gumming up the works in an ER!

      • A good 80% of patients in the ER aren’t emergencies. They are patients who could have been seen at their doctors office (if they had one), or urgent care center (if they had the money). The ER is the only place where it is illegal to say no (emtala). Do resources are limited as most hospitals see the ER as an expense rather than the first view the patient has of the hospitals. The nurses are almost always understaffed. Caring for those who feel they are entitled to the best for free can easily clog up the system.

      • I worked as an RN in the ER for more 12 years and never, ever ONCE did a patient in our ER wait in a room unchecked for four hours, nay even one hour unchecked. Some one from the ER medical care team would have come into the room to make sure you were all right, ask if you needed a blanket, check your IV fluids, ask if a family member needed to be contacted, commiserate with you about the length of time it was taking to get blood results or wait for your doctor call back, something. Even if you were given a med that would relax you or reduce your pain and help you nap for a bit, still within 30 minutes or so, a team member would poke their head in to check on you. And I am talking about an adult and pediatric emergency room in the fourth largest city in the United States. The only time I can even imagine this happening is during a hurricane, earthquake or other disaster. It just isn’t done.

        However, when you are miserable, scared, hurting, losing a baby, expecting a baby, waiting to hear about a loved one, time as we/you know it changes perspective. Minutes become hours, hours turn into seconds. Worry, love, fear, concern all change the way we perceive time.

    • Rose, I hope you like being a nurse. I wonder if YOUR patients ever have to wait on you? Wait to get a bedpan, up to the BSC or bathroom, wait for pain meds, wait for a blanket or pillow, wait to go to xray, wait to get their food and then wait for someone to come set them up and help them eat; wait on the doctor to come give them the news you already know; wait on YOU to get them what they need or come back with an answer. Yes, it is very hard to “wait.” But as Jenn stated, if you’re waiting, you’re likely not critical. If you can’t give some slack and understanding to your fellow nurses for trying their best and possibly being hamstrung by the system, then you are not someone I’d like caring for me or my family–you have no discernable compassion. I have been a nurse for 38 years–ICU for 7, ED for 7, Flight Nurse for 24. I’ve had to do my share of waiting, too. But I know what goes on “in there” so if it’s too hard to wait, then go home and take care of it, or go to a walk-in, or your own doctor. If you are “non-urgent” you CAN go home–please DO!

    • I’d just like to make a note about the “non-emergent” comments. Technically, here in Canada we use the Canadian Triage and Acuity Score, and there is a section on it for “non-emergent.” Patients are classified by the triage nurse, and it is these “non-emergent” patients who are still important to us, and we still care about them, but can wait the longest prior to seeing a physician or receiving treatment. It is these patients that often end up waiting hours and hours, which is tough but obviously these patients are not our highest priority when there are other patients whose airway/breathing/circulation are compromised. That’s just how an ER works. Our patients are always asked to please let us know if their condition changes or worsens in case we can’t check up with them in tmie and something changes their acuity. And, technically, these patients could be seen by another health care provider, as their concern is non-emergent, but sometimes the ER is their last resort.

    • Are you an ER nurse because I have learned over the years that being a nurse and being an ER nurse are two totally different animals. When the floor is full, they don’t get more patients, but when the ER is full we start stacking people in the halls. There is lots of room for improvement in the ER and on the floors. I can’t tell you the number of times a floor nurse won’t take report because “they aren’t ready, they didn’t know they were getting a patient, or a variety of other reasons.” We don’t have that luxury. If you are an ER nurse I find your comments strange but if you aren’t maybe you should come walk in our shoes for a day.

    • Rose,
      I am really sorry that your experience was so horrible and that you feel you weren’t given information adequately. But if you feel that u were able to leave and get your results at a later time why was it an emergency? While I value my patients concerns and fears, there are times when I need to physically be with the patient who is infarcting, coding or otherwise unstable. Hence my ability to communicate in a timely manner is also delayed. As a RN you should understand this. It is not about ignoring. It’s about prioritizing and being where u r needed immediately first.

    • rose, as an ED nurse, there is NO set time for when things happen. If I come in a tell you it will be 1 hour before whatever is supposed to happen, it will surely not be an hour, and you want to know.why? Because it is an EMERGENCY DEPARTMENT and emergencies change the order where you are in line. We cannot tell you how long for this and how long for that because WE DONT KNOW! If you have better things.to do than sit and wait, by all means, please do and see your PCP. And btw do they tell you how long you have to.wait? Mine can be up to an hour and thats with an appt. So before you go throwing your RN around, maybe you should realize and understand what you are talking about.

    • Try it first, then judge. Communication is almost always the first casualty in an ER, and it is the responsibility of the staff to be more considerate of the time of the patients and family. But sometimes there just isn’t time, sometimes there is simply too much to handle. Its easy for a floor nurse who handles maybe 3 or 6 low acuity patients to judge (that job is stressful in its own right, no question) without realizing that I may have 12 other patients to keep track of. All of whom I just learned the briefest of history on and are all deserving of my time. To me, the issue lies with people utilizing an ER like a PCP office – things that can and should wait for normal hours bog down the system to the point where it is near impossible to handle at times.

    • Rose, you say your an ER nurse…and this is your attitude about the dept you work in???…from the 20 yrs I have been an ER nurse, I can say emphatically, this is not the dept you should be in…you need to be in a doctors office where it is OK to have blood work done and go home…and you would be better able to communicate with the few pts you would see on a dly basis…I personally hope the hospital you work at keeps you in the fast track so no critical pts would be harmed by your inability to prioritize…and as far as life saving measures go…they are #1 at any ER…I would certainly hope you would not stop CPR on a pt so you could walk next door to the person waiting on lab results to let them know the time frame/wait time…as far as room for improvement…it should start with you.

    • Because as an ER doc, I’m there to make sure nobody dies, not to perform Press Gainey surveys. They can feed you all the “i’m there to serve you” BS you want, but my 2 missions are: #1. Make sure I don’t send someone home or admit someone and they die, and #2. In the US, make sure I don’t get my ass sued so I can continue to perform #1. I make fun of my colleagues when I see them leave the bathroom after taking a piss, it’s so damn busy. Now that your country has gotten rid of it’s primary care health system, we are all you’ve got when your sick, and I apologize, but I don’t have time to coddle you. If you want “patient care and advocacy”, maybe you’ll need to pay for it instead of expecting your “Obamacare” to cover us babysitting y’all in the emergency room.

    • Rose, you must not be an ER nurse. We never drag ourself or kids in to the ER unless we have a limb hanging off. And it is ALL about life saving measures. Without saving that one life, we would be lax at good nursing care.

    • Thanks! I always tell people that if they feel it’s an emergency, go to the ER. They know themselves best. But I always add that the nurses and docs see a lot of emergencies and will treat those first who need it most. So if it’s less of an emergency, always good to be prepared to wait a little bit. ;)

    • I’ve had to take my child to the ER twice for reasons I did not think we should have been there.

      The first, he had croup. I took him to his pediatrician’s office during the day and asked for a steroid shot (we have been through this many times with my other child). He refused and decided to check for pneumonia instead (it was not our usual doctor). At 9 o’clock that night, my son was having difficulty breathing due to the croup. I called the after hours number and the lady refused to page the doctor and have him call me back. She would only have some on-call nurse call me back who told us to go to the ER. We were there for about 4 hours for a breathing treatment and the steroid I had asked for 12 hours earlier in the day. BTW – when my husband went back and talked to our usual doctor, he let him know exactly what had happened and that we were not pleased about it. He wasn’t either.

      The second time, he fell and busted his chin open and needed a few stitches. The pediatricians office was closed so I took him to an urgent care place because I did not consider it to be ER worthy, even though I knew he needed stitches. The doctor said he was not comfortable doing it and sent us to the ER. The ER doctor thought it was silly we were sent there, but the staff was very kind. The only thing that really bugged me about them was that we had to go back to the ER to get the stitches removed, even knowing we most likely would not see the same doctor (we didn’t), instead of just going to his regular doctor to have them taken out.

      I know a lot of people up and decide to go to the ER when it is not life or death, and I’m not sure why, but sometimes they feel that there is no other choice because they are sent there as we were.

      • I am proud of the ER Doctors& The ER Nurses! Living in the country twice I had to carry my Dad to ER by car cause there just wasn’t time to wait for the ambulance! When I was 5 minutes away I called our ER told them his age problem & asked they meet me at the entrance of ER with wheelchair which they did! Once he was admitted once life-flight to a bigger hospital! Believe me I didn’t care if all they did was ask questions about him that’s what we were there for! BIG THANKSTO ALL!

  3. I have great admiration and respect for ER nurses. They do a wonderful job. However, being a person with epilepsy, I would like to correct one thing that you said in your description of what you do while you are performing your duties in the ER. Please, DO NOT HOLD DOWN A PERSON WHILE THEY ARE HAVING A SEIZURE!! You can do more harm to them than good, (break their bones, etc.) This may sound trivial to you, but it is important. Thank you.

    • Thanks for your input, Carole. In this case, the fella did need physical support as he surprised the staff and was falling off the stretcher. But you’re right, for 99% of situations, the person seizing should be kept safe without physical intervention if possible. :)

    • True, I work Neuro now,we have a seizure unit and do 24 hour video monitoring where we are wanting our patients to have a seizure so the doc can either do surgery or adjust meds. I have had to restrain the families from trying to hold hem down or shoving things in their mouths. They don’t understand how dangerous it is. Just protect them from injuring themselves- pad the side rails and have suction set up, oxygen ready and just monitor them is all you need to do!

  4. I have had great experiences in emergency! Of course, I only go there if it’s a real emergency. I recall seeing a little boy about 6 or 7 that had a “boo boo” on his finger. Give me a break! A kiss would have been fine, along with a bandaid. I hope the doctors tell these people that they shouldn’t be in emergency? And of course there is the flu…which will run it’s course…so why bring it to the hospital to spread it around? I raised 4 sons and they have had a lot of stitches and a few broken bones…which were all treated quickly. I have never ever taken my child in for a fever. There is a bathtub, a wet cloth etc.. unless of course it’s up into the dangerous range which is about 104? A cold? stay home and keep your kids home. Give them fluids, cough syrup etc.. Be a Mom!

    • Having worked in the ED myself, I found that I heard more noise and complaints from people with the flu, a cold or simply just wanting pain meds than I did from the ones that really needed the urgent care. There is abuse of ED’s all over the country. The problem is that the patients that REALLY need care are the ones that hesitate to find the help. Then when they come in as a critical patient, those whiners and complainers are the ones that have to wait while a life is saved and stabilized. Nurses, in my opinion, are heroes everyday. Thank you for all you do!

  5. I have been an RN for 37 years, strictly ER for 29 years. I appreciate ALL aspects of nursing! I’m now a travel nurse in the ER. I know how hard and how rewarding the carreer is! But seriously, 8 months and you are running to other floors for a code. I think you might be a HERO wanna be. If you stay in the true profession, I hope you take the time to learn what nursing is really all about.

    • Hi Debra,
      Thanks for your feedback. The hospital we are in has a system where one RN from ER is part of the code team. Unfortunately, we often had a staff mix that made me part of the code team, so running to codes on other floors was standard routine for me as well as all of the other RNs in our department when it was their turn to be on the team.
      I look forward to someday having the experience and knowledge you do, and hope that I’m still as in love with nursing then as I am now, and as dedicated to the profession and to people as you seem to be.

    • Debra, instead of putting your energy and experience into criticizing and name calling, why don’t you encourage and mentor those new to the profession! Don’t make assumptions about Jenn’s knowledge, experience or motivation in this profession! Calling Jenn a “HERO wanna be” makes you sound embittered, self-righteous and presumptuous! Maybe it is YOU that needs to “learn what nursing is really all about”…compassion, graciousness, and most of all, HUMILITY!!!

    • That is standard in our ER too. Each and every code on the floor, the ER MD, ER nurse, and a tech go to help out. I’ve been an ER nurse 8 months too and I routinely accompany them. As long as you are ACLS certified and feel prepared, you can go. Often the floor nurses are very thankful! We deal with codes on a daily basis and you learn VERY quickly how to run and assist the docs in them! You’re not a “wanna be”-just doing your job! :)

  6. Jenn,
    You wrote a great article. My wife, whom I love so much has been an ER (ED) nurse for almost ten years now. She is a great woman who puts herself through hell sometimes for her job (career). It always amazes me when I hear her stories from her previous shift. The crazy thing is that she rarely has the same weird stories because people are just that unpredictable. Y’alls job is very important and even though there are people who frustrate you to the point that you want to lay a hand on them in anger, you cannot because you are a better person than that ungrateful S.O.B. You have to be because you are a pillar that keeps day to day operations running smoothly. At the end of your day when you’ve saved lives and put band-aids on boo-boo’s you will only be thought of as “That nurse.” Just continue your day knowing that you are appreciated and its not always about those ungrateful people. Those who you work with on your left and right need you too. I understand most of what you go through, I’ve been a soldier for the same people for almost fifteen years.

    • Amen, Ray. You have no doubt heard so many unbelievable stories, and have many of your own too. Thanks for doing what you do, and supporting us in what we do.

  7. I know, that if I take one of my kids to the ER with a fever of 104* on a Saturday night that there is a good possibility that I will be sitting in the waiting room for a while. I accept that, still don’t understand why that is sometimes, because I have seen it happen and there was only one person in the back and no others in the waiting room but us. What is WRONG is when a person goes to the ER and tells the receptionist that they have been in another hospital over the weekend having their heart checked because there was something wrong. That they were released and told to go to the ER if they had anymore problems. So the person starts having horrible chest pains and goes to the ER. They sit in the waiting room for 5 hours without even being seen by a triage nurse, all the while feeling like their heart is going to explode at any minute. Never once in those 5 hours did another person from that hospital speak to this person. No one told them they would have them in a room soon, no one asked if they were ok, NOTHING. So after 5 hours of waiting, the person finally just left that hospital. They went directly to another ER, explained what had happend over the weekend and told the receptionist that they were having horrible chest pains. This time, they didn’t even have her sit down, they took her straight to triage. Her blood pressure was through the roof and all indications were that she was having a heart attack. She was transported by ambulance to a larger hospital immediately. She was given numersous asprin to chew on the way and nitro to try to stop the attack. She was sent directly to surgery upon arriving at the bigger hospital to have 2 stints put in. The heart doctors estimated that her heart had been “attacking” for over 8 hours and they could not believe that she was even still alive. This isn’t a story I read or heard about, this happened to my mother in 2006. Had it not been for God and the miracle of allowing her heart to create a new path through which blood could flow in her heart she would have died due to the crappy conditions and lack of any care of ER nurses and staff. AND YES, the nurses did know she was there. Her heart DR is the Chief of Staff at that hospital that she waited for 5 hours in, and when she became his patient and he found out how she had been treated there were nurses and other staff that received “unpaid” time off for their treatment of her along with other patients that had been left sitting for stupid amounts of time. So, yes I am sure there are times when it just isn’t going to move along quickly because of things that are happening to other people in the ER, but there are also times that things don’t move along quickly because the staff just doesn’t feel like it is a true emergency and they can just take their time because they don’t “have to” hurry.

    • Hi Jane, thanks for your reply.
      I’m sorry to hear about your mothers story. That is definitely disappointing. I obviously don’t know the circumstances surrounding this, but I do know that there are excellent hospitals and excellent receptionists and excellent triage nurses out there. I can’t speak for those who were working in that ER that day, but I know that as RNs we are taught and trained (both in the classroom and by experience) to prioritize based on what we see and know. I hope that your mother is now doing well.

    • That sucks that your Mom went through that, but you have no clue what was going on in the ER outside of the waiting room. My son at 2 years of age got a bad case of salmonella, he had a 105 fever and was BMing blood, real bad stuff. I rushed him to the local community hospital ER, and they told me it would be at least an hour before he could be seen. Well I uttered a few choice words, and took him a mile up the road to a university hospital ER that is known for its work with children who rushed him in and saved his life. I later went to complain about the first place only to find out that small ER had all the normal people with the flu and such, along with a 6 severe victims in a car accident, and 2 people that had been shot. As much as my son means to me, the people in the ER have to prioritize and deal with what is in front of them, and deal with being mobbed with problems. They often have no time to explain why they aren’t helping you or yours, and I’m sure sometimes they can’t help everyone, and that sucks. The point I’m making is your generalization that the ER staff ignored your Mom out of laziness is most likely untrue, and I bet a dollar there were issues more serious than your Mother behind the waiting room wall that you will never know about. That being said I’m glad your Mother is alive.

      • Well said. As with every business, profession and people in general you will find good and bad nurses, hospitals, doctors. You will find good and bad experiences within the same hospital and same nurse. As an ER nurse for 20 years I can honestly say that if people would learn to take care of themselves and their families for the minor stuff, the wait times would be extremely short the majority of the time.

      • An important point here is that the ER staff gave you an estimate of how long it would be before your child could be seen. As you point out the delay was due to extraordinary conditions. Again, communication was the key and it helped you make the right decision as a parent – take him to another hospital.

  8. I loved my time in the ER . But my specialty for 25 years was infusion therapy. Putting in Picc’s and teaching others how to access ports. Teaching families how to administer TPN, Antibiotics,titrating IV morphine to relief of pain.
    You need to post to a sign that says” Thank God you’re NOT being rushed back for treatment. That’s reserved for those sick enough to be near death!”
    Maybe now that people have the chance to get insurance under ACA they won’t have to use the ER as their Primary care site.
    Keep on doing what you’re doing since it is a specialty and you are always learning new things.

    • Thanks for the encouragement, Laurie! Learning new things and constantly being challenged is definitely one of my favourite things about this job. And I’m still looking forward to a whole career of discovery and teaching others!

  9. too many people use the er as a primary doctor. most do not have a dr. andwhen something comes up, go to the er. don’t understand this kind of thinking, and of course, don’t pay.

  10. Merry Christmas all,and thank all the caring and diligent nurses out there….
    as an RN of 32 years..28 in emergency it is very clear that the system is not perfect. there are nurses working in emergencies that need further education..we are short staffed due to government cut backs, nurses doing so much overtime that doing updates and further training such as advanced cardiac life support, paediatric advanced life support, NALS,TNCC,ENCC..to stay current can be expensive and time consuming, as well as missing out on family time. Nurses work thru every holiday…..
    people come to emergency for lots of reasons..a lot of communities do not have urgency clinics or family MD’s to go to and so have no option but to come to emergency for care.
    I have spent many years supporting grieving families,to go out to triage and be verbally assaulted by some one has waited for many hours..they had no idea we had just finished unsuccessfully resuscitating someones loved one…same token I was given a hug by a patient waiting for IV antibiotics who had seen us working unsuccessfully resuscitating a young child who had been in a mva.
    Nurses must remember to communicate well, and patients and family must be patient and understanding..if you are not life threatening you will have to wait…
    the old adage treat others as you wish to be treated applys to all
    shelley

    • Thanks for this, Shelley. You’re so right, the basics of communication go a long way in the ER, from both staff and patients and families. So glad for those who understand that some things take higher priorities than others, and extend that compassion and understanding to others.

  11. From a floor nurse to an ER nurse, thank you for what you do. Our ER and our units have been jam packed the past few days! We ran out of ICU and PCU beds so our Obs department has turned into a mini unit pulling RNs and aides from every part or the hospital.

    I’m sorry that some people still cannot accept your explanation of wait times and priorities in EMERGENCY care. While I’m sure these people are in the most pain they’ve ever been in, they don’t realize that if their airway, breathing or circulation isn’t in immediate danger they will have to wait.
    In response to the hero wannabe comment I say shame on you seasoned nurse commenter! We also have a code team and depending on the staff we get an ICU or ER nurse in the group who has to respond to the codes. Those nurses are always top notch so in those times of need, you are a hero. Cheers.

    • Lia, I love floor nurses. Glad we can do what we do and you can do what you do and it all comes together in a mix of excellent patient care. I worked obstetrics for a year and a half, and I would have been quite out of my element with ICU and PCU patients. So good on you for being so flexible! Kudos, and thank you.

  12. Having spent a lot of time (unfortunately) in emergency rooms, I understand the procedure and what is being done and that it takes time AND there are other patients; but when I take my mother there at 11 a.m and they don’t put her into a room until 2-3 a.m, it’s a little hard to keep that in prospective. Especially when the people from the business office visit her before the doctor does.

    With that being said, I have had the good fortune to have experienced some wonderful ER nurses who give us an update and listen to my mother and me (her caregiver) to those who are literally looking at the clock. To tose who care, I aplaud you and you dedication and the care that you give your patients despite the fact thet you bear the brunt of the wrath.

    • Thanks, Cilla. On behalf of those ER nurses too, we appreciate your patience and understanding. I hope you continue to meet those wonderful ER nurses, and we’ll do our best to be them.

  13. I work in a small ER and my view point is that if you have time to complain about the wait, you should question why you are there. I have had patients leave without being seen, but this indicates to me that the reason was not an Emergency. There are times when it is 1 RN and 1 Doctor in the ER. I have to call in respiratory and radiology from home, so you better be thankful when you come through the doors that the nurse knows what is going on. The rush to this setting is that no matter what walks through the doors, You got it! I love nursing and the situation I work in. I think ER nursing is a calling and not every RN able to do it.

    • Justin, sounds like a wild job! I worked a few months in a hospital that had 2 nurses on at nights and no other staff, and it was always an adrenaline rush when those doors opened! I’m confident you have that calling. Enjoy!

  14. ER nursing IS a calling, and also a curse. I did it for years, then worked on a helicopter for a few more years after that. After doing both in a war zone, I decided enough was enough and I got out of nursing all together. Nursing isn’t something you do, it’s something you are. Hats off to you for the work you do, and for all the crap you have to put up with from administrators, bean counters, non-emergent indigents, and family members who went to med school on Google. I also apologize on behalf of the inventor of the Press Ganey. If I ever find him, no one else ever will. Peace and sleep well at night. If you can’t, there’s always Xanax.

    • I’ve been reading all the comments and I have a different perspective on things. I am the mother of an ER nurse. I’ve watched her while she studied from college and university to get her degree. She has been in the ER since day one as that’s where she felt her calling was. As a person that has brought people in to the ER for different circumstances, some minor and some major, I knew there would be a wait time. Like people have said, be glad you have to wait. I’ve listened to other people in waiting rooms whining about waiting and told them that if it’s not a true emergency to wait. More than a few times I had to hold back what I really wanted to say! My kids learned to toughen it out, build an immune system and didn’t grow up on antibiotics for every sniffle and fever. Yes, there are people that need to go in there, I agree. Another perspective is I’ve spent many a holiday without her as she’s been scheduled to work. I couldn’t be prouder of her for the many times she’s volunteered to work for someone with a family so they could enjoy the holiday with their children. She’s a wonderful nurse that’s had the experience of being on the other side of an ER waiting for results and was not impressed by their lack of concern or the way she was treated. Her experience is always in her mind as she is dealing with other peoples families. In closing, thank you to all nurses for a great job being done. Not many people in their life can say they truly touch so many lives on a daily basis.

      • Heather, I’m sure my mom would echo what you just said. Thanks for your story, and for supporting your daughter and the rest of us. We need that!

    • Yancy, thanks for what you did, for what you do, and for who you are. It is so tough, and certainly not for everyone.
      Also, I had to look up Press Ganey, never heard of that in Canada. Interesting. “Patient care experience” is important, but a little less important than the ABCs. ;)

    • Yancy,
      I have been a nurse for 38 years. The past 20 in level one trauma centers both Peds and adult. In fact just had a very exhausting day 3 of 5 in a row 3p-3:30a.. May I please be on your find the Press Ganey inventor team. I would like to give him/her a huge adjustment as well. This has changed nursing and medicine into a business versus a healing , caring, prioritizing health care system. The bottom line is the bottom dollar. May I add this, the CNOs and directors now are being paid huge salaries and even larger bonuses according to what the Press Ganey Scores are. The more satisfied the CLIENT is with the services provided , the better the score , the higher the bonus! These bonuses are huge as per many articles I have read. Need I say more? I am so sorry you felt the need to leave Nursing for these reasons and sometimes entertain the thought as well, BUT I just cannot because I love healing and caring for people. I know I make a difference on a daily basis and that truly makes me who I am. I do not get a bonus , I practice safely, carefully, with compassion, skill and heart. It is the best policy Press Ganey or not……

      Jenn,
      You are a very articulate nurse who seems to have a wealth of experience in your past 8 months. Stay this way and keep up the strong work. Our profession needs young nurses with your attitude. Rock On

  15. Yes Rose , there is such a place……it is called the outpatient lab and the way to get there is via your PCP and he/she will give you a magical entrance ticket called a ” p r e s c r i p t i on” and indeed someone probably your PCP will call to discuss your results …..AMAZING! RIGHT?!

  16. Someone once was addimently complaining about a delay at the airport……..
    Sobody else responded – “if there’s a delay, that means that there’s either a problem with the plane, a problem with the pilot, or a problem with the weather. Either way, I’d rather not be on the plane until all are fixed”
    It’s all about your perspective on the situation
    Here’s you’v put things in the right perspedtive!
    Thanks for sharing this, and thanks for all your hard work!
    Woody

  17. A story on public radio today spotlighted the increase in for-profit emergency rooms in Houston. Some members of the public are confusing these for-profit centers for urgent care and only realize the difference when they get a bill that is 6 or 7 times what they would have spent at an urgent care center. The story mentioned the overuse of emergency rooms, with waits of 8 hours or so, and said the for-profit centers are capitalizing on that with 30 minute or less waits. The story said this is all at a tremendous cost to everyone because they are causing insurance costs to rise since (they said) insurance companies can’t refuse to pay for emergency room visits. I wasn’t aware of this myself, so don’t know if it is true.

    It’s a sad comment on our society that we require emergency rooms for minor ailments.

  18. I think your article was well written and accurate! To the ones complaining all I can say is walk a mile in our shoes before you judge. While I understand waiting is annoying, you never know what is going on behind the scenes. Until you have calmed the fears of a dying patient in one room , all while be cussed at by the drunk patient next door, then you have no idea what ER nurses deal with daily. I am a proud ER nurse!

  19. Excellent post!!! Waiting in the ER is generally good news. But there are ERs that are just terrible. I have been in with pancreatitis in extreme pain. I could see all the nurses and a doctor at their station standing around visiting and horsing around being quite unprofessional (which they deserve some time for stress relief). I was lying in extreme pain and later found out that they figured I was an alcoholic. Apparently this happens to alcoholics as it does diabetics which is what was my diagnosis after caring for my pancreatitis. So, yes people need to be much more aware of what ER staff are going through and doing. But some of the staff need to get out of there and find a place where judgement calls aren’t required. And maybe people who resent their patients, or people in general need to look for new careers (e.g. Derek).

  20. Amen! As a new nurse in the ER I can already see what you’re saying. However this may have something to do with my experience as a paramedic. The 2 AM calls for knee pain x3 weeks and able to walk better than my partner, may have had something to with it! I love what I do (both in ER and on the truck) but the abuse of the ambulance and ER have become ridiculous! The stubbed toes and rash x3 months need to learn to be more patient when we are dealing with the plane crash victim and the respiratory distress!

  21. Hi! I’m a telemetry nurse. To those who are wondering why the ED when emergent care would be more appropriate, here’s one legitimate reason: some insurance policies don’t pay for urgent care, which I think is a deplorable!. I suspected I had a UTI, as I was experiencing urinary frequency and pelvic pressure. I called my primary for an appointment. No appointment for 10 days, even when I gave my symptoms. (There’s something in there about primary offices no longer using RNs to triage patients, but that’s for another day.) Anyway, worried that the infection would spread up to my kidneys, I asked if it would be okay to go to an urgent care facility. I was told that my insurance did not cover urgent care, and I would have to go to the ED. I finished my shift, clocked out, and walked into my hospital’s ED. Every aspect of the system needs to be vigilant about cost savings, especially when the patient is fully willing to do it the right way.

  22. My complaint is my jealousy in that I grew up with a mother who supervised the nursing staff of the emergency room at St Francis Hospital for 25 years of her life, she was admired and loved and respected by all of her peers, my only wish is I could have spent more time with her, but she was right where she knew she was supposed to be. And know I am giving up time with a best friend who is also right where she should be. There are some very fortunate families who had the pleasure of these two women entering their lives. Thank you Claudia and thank you mom.

    Respectfully, Keely

  23. Jenn, thank you for this! My Grandfather was a GP, and my Grandmother, Aunt, and ex-wife were all RN’s I’ve been around it my whole life. Recently I’ve been thinking over changing my life, resetting, restarting at 42. Nursing was suggested to me, and I’ve found a university with a 3 year BNS program. I’ve researched it and I’d have to do a year or two in a community college first to handle the prerequisites. Things keep popping up that push me in this direction and enforce this decision. Your story has helped to cement it, I read about what you do with excitement, it sounds amazing, exhausting, emotionally draining, and fulfilling at at once. I hope I can cut it. :)

    • Thanks, Sean. :) Sounds like this might be your calling! Good luck! Just remember that you’ll get there someday, and it’ll be worth it even if it is really tough at times. Cheers!

  24. This was beautifully written. I’m not a RN nor am I a medical professional – I’m a counselor. However, I had to go to the ER the day I went home from the hospital after the birth of my third child. I ripped my c/s incision open when taking off my sock (crazy, I know!). Anyway, it was 11 p.m. I left my newborn son, along with my two daughters, home with my parents while my husband frantically drove me to the ER, which was hopelessly packed. I was in tears because I was breastfeeding and I knew my husband would have to go back home to get the baby so he could eat (no way was I going to get out of there before it was time to feed him again), but the last place I wanted him to be was in a germ-filled ER waiting room. When I told this to the ER nurse who was doing triage, she hugged me and promised she would do what she could so that I could get back home to my baby. She took me straight to a private waiting area, brought me water and a snack, and had a doctor in to assess me within an hour. She was an angel of compassion while I was frantic and she calmed me down. I wasn’t critical, by any means, and I’m sure there were others who were in worse shape than me. However, I appreciated her more than I could say and I was home in time to cuddle and feed my newborn son. Having friends who are nurses, one of whom is a pediatric ER nurse, I think this is the norm more than the exception. Nurses have a tough job, but handle it with grace and understanding. So, from someone not in your profession, I want to say thank you and God bless you.

  25. What I don’t see in most replies is what has been most important lately is: safety in the ER. As time has passed it is more dangerous every day I work in the ED. Not for just for me but for everyone including these poor young registration girls who are expected to make contact with these dangerous wackaloons that clog up the department with their psyco-social complaints. I, who pride myself as ever forward looking, never thought an ER nurse could be physically harmed in the ED at any moment when I chose this career. Really, you clock in at a place where you expected to know how to solve thousands of maladies in a matter of seconds, and some deranged individual wants to beat you to death and we have no defense plan that makes sense. No where else is an individual allowed to threaten or actually cause physical harm to a human being with almost no repercussions. If we just had tasters. That would be so sweet.

  26. Wonderful description of “life in the ER” … or horrific one, given that all of those things can & do happen, just hopefully not all in one shift! Having been a waiting family member a number of times, sometimes that wait can be overwhelming, unless you do realize that triage does mean to take the sickest first. My own experiences as an ER patient (in more than one hospital) have been few & far between because I have been fortunate enough (or maybe stubborn enough) to only go when I or someone else thought I really did have an emergency. In three cases, I was moved to the “head of the line” …. once coming in at 3 a.m. with BP at 198/120 & a severe headache; once being escorted by an occupational health nurse with elevated BP & chest pain & shortness of breath (& me protesting all the way that I could just relax a little & go back to work); also, coming from work elsewhere in the hospital, wheezing & struggling to breathe from an asthma attack, realizing later that I was put next to two patients who ended up in ICU. A fourth time, triage didn’t get to me right away, but once they did, my ankle the size of two softballs was moved ahead of everyone else waiting for an x-ray.

    Only once did I receive less than excellent & compassionate care: having had food poisoning on the last day of my vacation, taking care of myself in a motel room, & driving back home, then thinking that “something still wasn’t quite right” & going to the “Walk-In Clinic” next to the ER on a Sunday night … I waited for 8 hours, as suicide-attempts, car-wrecks, heart attacks, and who-knows-what-else went in ahead of me. The WI Clinic closed, and I was shifted to the ER. Finally in a bed in the back, I was stung by the nurse whose first response to my description of “why are you here?” was “Couldn’t you hydrate yourself at home?” “NO! if I could, do you think I’d have curled up out there in the waiting room for 8 hours???” Fortunately, the physician who came in (the head of the department) was much kinder & understanding, and after another 3-4 hours of IV fluids, I was released to come home, with clear instructions for home care, and follow-up with my own physician.

    Bottom line: I admire & respect all those people who manage to survive working in the pace & chaos of ER’s all around the country. THANK YOU!!!

  27. I am not nurse, but I am a tech in the ER. My job is to assist the nurses with whatever non-invasive care I can give. I play the middle-man at work– I hear the requests and complaints of both nurses and patients and try my very hardest to support both ends. In our Emergency Department, I’m the first person you’ll see in triage, taking your vitals and listening to your complaints. I’m the last person you’ll see, either assisting you back into your car or transferring you to an inpatient unit. I’m the one that’s answering the endless call lights, babysitting the violent drunk we had to restrain, doing endless rounds of exhausting chest compressions (talk about cardio!) and running up several flights of stairs with a 20lb monitor on my back for codes because yes, we too have a system in our hospital where one ER nurse and tech respond. I usually hear your dissatisfaction with our care (to put it nicely) before anyone else does because it’s primarily my job to regularly round on our patients. I’m the person designated to retrieve a patient from the waiting room so they can see the doctor, and let me tell you, walking into our waiting room sometimes feels like a suicide mission.

    But I LOVE my job. I work with some of the most amazing people, all for whom I have great respect. I am in a unique position as an ER tech. I’m still in college, studying to become a paramedic, yet I still get to work right in the middle of the chaos that is the ER. It is an amazing opportunity to get to actively learn under doctors and nurses who have years of experience, to get to participate, ask questions and gain their valuable wisdom and apply it to my studies. Plus, I’m getting paid for it! So yes, nurse, I will happily get that urine sample and yes, patient, I don’t mind retrieving you another warm blanket.

    This is the most difficult and trying, but best job I’ve ever had.

  28. I’m the mother of a paramedic of 10 years that is also a pre-med student. Her experiences are beyond anything that I could handle and yet she still wants to be an ER dr. She’s been attacked, cussed out, bled on, vomited on, spit on, accused of being a racist, name it, she’s experienced it. It truly is a calling. She has the same problem the ER does in that the majority of her calls are bs and a lot of times just a free cab drive. Free to them anyway since they usually don’t pay. She gets excited when they have a “real” call. Things that get her going make me sick to my stomach. Some of the Dr.s and nurses don’t seem too appreciative of what she does by the way they treat her. I always thought they worked on the same team, just different positions. If a dr. or nurse did not start out as a paramedic and did not go in the ditch, climb in the wrecked car, get covered in mud or drenched in the rain, or any of the many situations she finds herself in where they have to be accompanied by police for their safety, they may not appreciate what they do as they probably don’t know. That’s something I wish the ER staff would think about.

    As for me, I’ve had nothing but good experiences in ERs. We don’t go very often of course. My son’s emergency appendectomy, great service. My husband’s heart attack, fantastic service. Waiting is just part of the deal. Thank you to all the medical people that take care of us.

  29. Wonderful site! And thanks for shedding some light on the things that we RNs do every day, that don’t get seen. As an RN myself (Acute Care-Spinal Cord Injury), I understand the frustrations of patients that come in and have to wait, in my specialty, I deal with very demanding and dependent patients (they literally can’t do anything for themselves in most cases as they are paralyzed). I think the problem is also societal. We live in an instant gratification society, we want it and we want it yesterday, and anything that upsets our regular routine (especially not feeling well) causes anxiety, anger and discord. Sometimes it takes just a moment to sit back reflect and understand that ‘waiting’ is not deliberate but for a very good reason. I’m lucky in that I have patients sometimes who understand this. But then there are those that cannot be pleased, despite our best efforts. but hey in this job we have to take the good with the bad, so to speak!!

  30. If only emergencies came to the ER then a lot of us would be out of a job. We do such a good job at the critical part of medicine because we are so efficient at getting really sick patients up to the cath lab, surgery or ICU that we would be sitting around waiting for the next crisis and we all know as nurses it’s volume that determines our staffing. We need to appreciate the not so sick patients and realize that without them we would be out of a job. We just need to do a better job at communicating to them that they are important too whatever the wait and that we are doing our best to get them the treatment they need. Reality is, a lot of the not so sick patients make for some pretty good humor and conversation.

  31. I know all about the life of an ER nurse. My mother held that job until the day she came home and within two hours died from an anuerism. Her last night in the unit was spent trying to help treat people who were shot at a nightclub by a couple of God’s earthly mistakes. Her collegeagues were shocked they had to work on her only hours after speaking to her. She used to tell aboutthe good and the bad in the unit. Fortunately my knowledge of what she went through helped years later when I went in for a DVT and it took four hours before I was admitted. I was not thrilled about sitting along in a gown and my undies but I know what was happening. To eliminate ANY stereotypes, it was a male nurse that took me to my room. My only regret was not getting him to put the channel setting on ESPN since the remote was messed up. Nothing is perfect.To the nurses I say hang in there.

  32. I think it’s sad that you all get on the “stupid people who come in for a cold” bandwagon. Guess what? Some of these people don’t have healthcare. Guess what else? I’m sure they’d be happy as hell to not charge up thousands of dollars and see your faces. When/if healthcare becomes universal ED will finally operate as it was originally intended; for emergencies only. Until then though, your berating of patients only shows that you may be ready for a different pace. It’s not ok.

    Also, your quiet cases may be your real emergent ones but you’d never know because you’re too busy thinking the worst of the patient rather than the illness. Believe me, I know. With 3 wonderful ED visits to 2 different hospitals and the same wrong diagnosis at both I can tell no one was paying attention. No, it wasn’t miscarriage, but who cares once the doctor (who knows nothing of obstetrics)leaves the room with his (and her) diagnosis in hand. Ectopic pregnancies can be a real killer.

  33. In response to “communication”, being an ED RN, it is very difficult to give patients a wait time. When you come up to my triage window and ask how long your wait is and I tell you approximately 2 hours you expect that time to be 2 hours. When we get 4 ambulances in, one being a full arrest, that wait time is pushed back another hour. Then I have the angry patient yelling at me cause they were not taken to a room in “approximately 2 hours”. It’s a damn if you do and damn if you don’t situation. I have actually had a father of a “rash” patient tell me it only takes one person to do CPR when I explained to him the reason for their long wait time. Some people will never understand!

  34. People go the E.D. because people think they have emergency, real or imagined. These are your fathers, mothers, brothers, sisters, sons and daughters. A little kindness and compassion always goes a long way.

  35. Jen. Great article. I have been an RN for 23 years with 13 in ICU and 10 in ED. Most of in the US and now in NZ. The abuse of the system is a bit less over here but it is free here so people come so they do not have to pay their GP. I have admiration for any ED staff. I have to admit though I AM enjoying it a lot more over here where people more patient
    cannot sue.

  36. Undoubtedly the rigors of becoming and being an RN are tremendous and admirable. I am fortunate to have only been to an ER less times than I can count on one hand. As for my experiences it is not so much the waiting in the ER that is aggravating so much as it is the waiting in PAIN that can seem interminable. Is it possible to have someone triage a patient other than a seemingly untrained receptionist and perhaps administer something for the pain while waiting for actual treatment? I ask this out of honest curiosity.

    • It depends on the location. In the ER I worked in, an RN or physician was the first point of contact and triaged every patient who came through. There were also standing orders for analgesic or asthma medication for known asthmatics having an attack that could be initiated at the triage desk. Other departments have no such protocols. Truly depends on where it’s located and what is going on. However, ice packs are always handed out like candy. ;)

  37. Thank you so much for this eloquent and honest post. Emergency Nurses/Paramedics/Mds/Techs gave my family 4 extra months with my beloved Dad, a pancreatic cancer patient who presented with sepsis/pneumonia, he was fatally hypotensive and near death….Because of the unbelievable care he was given from the moment the paramedics arrived, to the moment the ER nurses transitioned him to ICU, my dad was able to go home and spend his remaining time with his family. He was an ER nurse of 20+years himself and I worked in ambulance and patient registration-admittedly I could never fully appreciate the job emergency nurses, techs and MDs do until they brought my Dad back from the brink. Even if you have a reputation for being “cranky” or “insensitive” I will always remind those critics that you are the ones’ who save lives-I will take a tough as nails ER nurse with a “no BS” attitude anyday, because you guys are tough for a reason! You save lives. I just want to say ER RNs are an amazing community and I take solace knowing that even if my Dad wasn’t ‘ours’ every other weekend/holiday, the Christmas’, Thanksgivings’ and New Years he couldn’t be with us were spent saving lives among the best of the best. I have nothing but love, respect and gratitude towards those who dedicate their lives to this field. Thank you all for all you do-big and small, every holiday, every weekend, and every regular day too. <3 Nicolette H. Worcester, Ma

  38. I have found myself on many occasions in the emergency room. Usually for broken bones or stitches and the like. However one time was particularly dangerous and life threatening. I had an allergic reaction to a lidocain (nah cant spell that) rinse for my mouth. The brought me by ambulance to the E.R. and then promptly up to intensive care. Guess who was the person who figured it all out? My niece who at the time was in school to be a nurse. She is now a R.N. and shes great at it. Her sister is a R.N. too. So proud of them I am because they put their heart and soul into every day.
    Nurses are angels. Its that simple. I am in no way a “good” patient. Hell most guys are not good patients. But if you ask any of us that seem to need medical attention that we will always seek out a nurse before the doctor themselves. Hospitals are drastically understaffed and sadly the majority of the work falls on nurses. Communication could be better but its not the nurses fault. I know i am not in that much trouble if I have to wait for treatment. I also know that when the doctor comes to see me he will spend 2 minutes with me but then a nurse will walk in with a smile on her face, bandage me up, and make sure im ok. Nurses are under rated, underpaid, overworked, but somehow some way just plain wonderful.
    They should of instead of being bullied, or reprimanded for things out of their control, thanked every day for everything they do.

  39. Ok my turn, I am an RN and I’ve done several years in the unit and ER. Both as the nurse and the patient. I do not go unless it’s an emergency! If I come in, I’m admitted I guarantee you, my ARNP has nearly freaked out because I’ve walked in her office with oxygen Sats in the mid to upper 60’s. Ok stumbled as opposed to walked! Before the naysayers jump in yes it’s it true, for some reason I will desat without confusion, I am very short of breath and limbs feel like lead but I do not get confused. I’ve fine this at the ER and I’ve had triage nurses literally look at me and write “stable” on the paper, they don’t listen to my lungs, nor checks my Sats. They take the lazy way out and assume because I’m coherent that I must not be that bad! Often times I can barely speak when I’m like this and this can frustrate and/or anger me making me worse, besides being short of breath makes you pretty irritable. After a few minutes of note scribbling and texting (I didn’t work at this hospital but I had several friends who did) to friends, I had RN friends speaking for me, the nursing supervisor in front of me personally checking my Sats (68% on room air as they’d left me). Next thing I know I’m whisked away, I’m stuck 6 times for an iv with no luck, so to make a long story short, I was put in the lobby to wait for an hour with a dangerous oxygen level due to a lazy nurse, I won’t say too busy because not checking sat of a respiratory patient in distress is careless and lazy. I had a pulmonary embolism within moments of being moved to the back, had I not contacted my friends to be my voice, I could have died. I was on a bipap and hospitalized for 17 days. But yet my triage nurse wrote “stable” and at no time was I stable! She didn’t even obtain vital signs. Which were incredibly abnormal bp 200’s/140’s pulse 130’s, resp 40’s, o2 68% temp was the only normal at 97. I had reactive airway to a chemical and it nearly killed me but yet I was stable. The hospital profusely apologized. No I didn’t sue, it’s a small town hospital and a lawsuit would shut it’s doors and it needs to stay open, the next closest is 40 miles. But the nurse was fired. She needed to be, but now when I go there, they listen if I say I’m short of breath and actually check me out immediately, I owe them my life a couple times, asthma is a bad bad thing!

    • Hmm. Sorry to hear your story. The “first look” is an important part of our assessment, but no assessment is complete without a set of vital signs, and no triage is complete without a proper assessment. We are taught to triage in a comprehensive but concise manner, and unfortunately your nurse that day forgot the “comprehensive” and just went for concise. Hope that your experiences are a whole lot better in the future.

      • I (just a very occasional and reluctant ER patient… ;) ) have had a similar experience, in that I went in with a dislocated shoulder, and because I just calmly informed the the doctor (who happened to be the first person I saw… weird set up there) that I had a dislocated shoulder, my notion of what was wrong was pretty much dismissed. At least until the x-ray tech read him the riot act over it. It wouldn’t have been so bad, if I hadn’t been wearing a bathing suit at the time, so that anyone in the same room could see what was wrong. It was worth it to see the doc get chewed out, but my point (there is one…) is that sometimes if you go in and calmly explain your problem, you get less attention than if you’re pitching a fit. I kind of understand it – I’ve known people who had screaming conniptions because they’d broken their little toe, or cut a tiny little artery – but dismissing someone because they’re responding atypically might be a mistake. In my case it didn’t matter – I was the only one there at the time – but the mention of “first look” struck a nerve. It wasn’t life threatening in that sense… but it certainly wasn’t anything I could have gone elsewhere for. Now, when they have urgent care places, maybe, but not back then.

  40. Thank you for listing all of the daily tasks and responsibilities for which you are being PAID to perform. I also work at a hospital with cancer patients, most of whom are in critical condition. There is no waiting time for sick patients, because we do not have that luxury; we wait and a patient may die. From my experience with staff in ERs, you are all there because it is an entry-level position offering clinicians a “broad” experience which helps you harness necessary skills needed for specializing in more difficult positions. The majority of employees in the ER have not completed a full undergraduate degree (excluding the doctors). Most of you don’t know what a specific condition is or what a medication is prescribed for. This is sad, but true. Also, the majority of ERs employ a younger population of employees, due to the lower pay and decreased expectations of performance. You should not commend yourself for performing the bare minimum of your expected duties as an employee and clinician. These are expected of you and this is why you get a pay check. You cannot excuse the poor and uncoordinated treatment of patients in the ER by listing the tasks you are responsible for performing.

    • Hey Tyler. Thanks for your response. I’m sure you do excellent work where you are, and are an important link in the chain of survival for those cancer patients.
      You’re right. I do get paid for those tasks, however challenging or menial they may seem. However, my point with listing them was to give the reader an indication of the things I am doing while the patient is waiting. It was not my goal to provide an excuse for a lack of care, because even if a person is waiting, I still provide the care that I can: communicate with those in the waiting room, keep patients updated on the status of lab results, poke my head in with the abdominal pain patient to check their pain score, etc.
      I didn’t enter nursing for the pay cheque. That’s a bonus for me. I entered it to provide excellent care for those patients I encounter, and that’s what I strive to do, whether they’re critically ill or just walking in with a stubbed toe. I don’t wait to treat anyone, either, but sometimes some people don’t need to be rushed in and/or isolated and/or treatment initiated this instant, and that was the focus of this article.
      I’m sorry you’ve had such bad experiences with ER employees. Every single ER RN I’ve met here has a bachelor’s degree and a wealth of knowledge and experience, and they are a delight to work with and learn with. And when we don’t know something, we do our research as part of our commitment to a profession where continuing competence, knowledge, skill, and excellence of patient care are pillars of what we do. Especially since all of those are expectations of my job, as you’ve said. I just want to do it well, and make sure others know what’s going on behind the scenes so that I can help those who need it most.

    • Serious question: what country do you practice in? Are you at a community hospital? Because where I work (large city, academic medical center), the ER staff are just as educated as everyone else. The nurses, for the most part, all have BSNs. At my hospital, the ER won’t hire new nurses; you have to have some experience, it’s certainly not an entry-level position. You might notice younger employees in the ER because the environment is absolutely brutal physically and emotionally…I work in an ER and an ICU, and I’m almost always more exhausted after my ER shifts.

      I suspect you think patients get poor and uncoordinated treatment in the ER because you’re used to working in an acute care environment where you have the luxury of knowing a lot more about your patients. I used to think the same thing before I started working in the ER. When someone shows up in the ER, we don’t have an admission history to consult, or doctors’ notes to read, or whatever. We don’t even have a diagnosis yet. We have really high patient turnover in an environment where the goal is to stabilize and dispo ASAP. Our job is to make sure that people don’t die in our unit (that’s why critically sick people don’t wait). For the most part, we’re really good at it, and it’s important work. Your job is to provide more complete, detailed care, and I’m sure you’re really good at it as well. You don’t have to hate on other departments though; our goals are different, so the care is different. Not better or worse.

    • I am also a RN (full degree), and worked in a cancer hospital for five years before switching to the ER this year. It was quite an adjustment for me going from an area I knew quite well, to having to learn/re-learn about the numerous issues that can present at an ER. All of the nurses I have encountered are incredibly knowledgeable and I’m glad to say I have learned so much in my six months in emergency.

      Why do you perceive ER nurses as dumb or unaware of what a medication or disorder is? For any nurse in any area, it is poor practice and unsafe to not know what you are giving a patient and why.

      Generalizations and assumptions are dangerous. Judgments about others in your same profession are just as bad. Nursing is great because there are so many areas to work in. Each area requires its own level of specialized knowledge. Another great aspect of nursing is that you never have to stop learning. There is always, ALWAYS something new.

      As always there is no black and white. You may have had one experience that was poor and caused you to believe what you believe, and that is unfortunate as you have now applied that narrow minded thought to all cases. I hope you don’t do this with your patients and co-workers as they deserve much more than dealing with a close-minded, judgmental person.

    • Tyler C.,
      It baffles me to no end that you work in health care and can criticize another medical professional. Jenn’s listing of all that she must do in her shift is an effort to let people understand what her position entails. Those not in the medical field may not realize just what an RN’s job requires–it’s not all bedpans and puke buckets. I have the utmost respect for anyone in the medical field…even you.

  41. Such a wonderful post, and I’m laughing at how all nurses are alike (eating their own). I have been an ER nurse for 6 years and three months ago decided to switch to home health. You know that saying, “learn from others mistakes”? Yeah well, I miss my ER. I miss the craziness. You are wise at 8 months. It took me at least two years to figure out what kind of nurse I was and wanted to be. Kudos to you for all your polite replies to some very rude, disrespectful people! (Although I did enjoy the laugh on your behalf) Thanks. :)

    -oh yeah… Derek, I love you. No, seriously.

    • Thank you :) Clearly not all nurses eat their young; it’s evident there are a lot of encouraging nurses out there cheering young’uns like me on!
      ER to home health would be like going 60 to 0 in an instant. Yikes. Still just as important, though. ;)

  42. You are indeed correct. As an ER nurse and flight nurse most people really don’t look past their own needs to those around them. It is a thankless job that is only appreciated by those of us in the medical field. I try and educate all my patients but has become clear that the ER is a primary care clinic that sees patients for free and we are supposed to be at every think to every one. Some days I don’t feel like a nurse but rather a waiter taking orders. I love my job but I have taken it back as a nurse. I will no longer be treated as a servant, waiter, etc. I will do my best to take care of your needs and wait for it “emergency” as promptly as I can. Just know that the sickest come first and unless you are bleeding out, can’t breath, or are in other words dying we will get to you soon!

  43. In spent 17 years as an RN in the ED, I left for day surgery 6 months ago. It took about 4 months to get over the guilt of leaving my fellow “soldiers on the battle field ”. I can’t lie, I am so much happier now. The stress of the ED takes its toll on you physically and emotionally.

  44. I am not a nurse, I am “the patient”.. I nurse my colds at home, my feverish babies I snuggle in the rocking chair, when a limb appears to be broken, we do the wiggle test and give it a little time, (just a sprain) we do not eat barbecue ribs until it comes out of our nose and then come to the ER saying our chest hurts, you see, that would embarrass me. Because we have class, and we know the ED staff is deep in the trenches and may have just watched a young family loose their mother in a horrific traffic accident, and go to the next room to be asked to bring sandwiches and coke along with a tirade on the wait time.
    No people, this is not a problem that only crops up in the ER. We the people have become demanding, entitled (especially if we live off the government ) angry, think we are the most important, and fatter then ever.

  45. Howdy all of you. I am the proud mother of a sjmhc er RN . I have seen both sides of the situation. Yes while I see how busy our nurses are. They ; OUR NURSES and one inparticular as a pct do their best to keep both patients and drs happy. Those RNs in my oppinion are great at bed side manners and careing but when our society teaches us to stereotype ALL patients who come in IT is not right. These RNs are rare now adays.I walk into a ER with real problems and the pain meds listed in my chart cause an immediate judgement that I am a drug seeker. As someone with medical knowledge who really wanted to be a professinal medical Pedetrician and by a auto vs ped accident who has been thru two surgries on my spine ( 1987) and need three more I do not appreciate (my daughter a great RESPECTFUL RN )needing to be called down from icu to bring me an ice pack 4 hrs. After holding up the hallway wall balling. But I am proud of my SJMHC RN. You make me proud. Allison too. Dawn M. Cole. Warren,MI

  46. I am not an RN nor have I ever worked in the medical field, rather just a simple patient with the extremely rare visit to the ED. I just want to say THANK YOU for all that you do!!! I believe you are more often yelled at than praised for the job well done that you do. And yes, I’ve met the occasional nurse who clearly is in a bad mood but I’m more than positive after reading other RN’s comments and your fabulous article Jenn that they may have just had a rough day, they may have just lost a patient moments before they had to compose them self before seeing you, so to all the other PATIENTS reading this… Have some patience!!! Because if you were that cardiac arrest or if it were your mother, daughter, brother etc. you would hope that the nurses and Dr’s jumped the line to save your life!!

    If any patient with non life threatening injuries expects to be seen right away at any ED then you are simply crazy and very much focused on you and your family only. Shame on you, all I can believe is that your parents didn’t teach you to have compassion for others.

    News flash the world does not revolve around you only!

    Okay so I ranted too from the patient perspective and although it does stink to wait… Oh well!!!!!!

    Once again a big THANK YOU to all of the nurses and doctors in Emergency and happy healthy 2014!!!

  47. I am an RN, and I went with my friends to take their baby to the ER for the third time. (He was admitted and discharged from the hospital and in the ER once more in the first 10 days after initial discharge from the NICU.) Anyway, they triage him and then send us to the waiting room. His mom said, “they’ve never done this before. The last two times they took us straight back.”
    I responded, “that’s great! It means he’s not as sick as he was last time.”

  48. I noticed the ER tech was ignored. I feel like they usually are. The nurses could barely function without an ER tech to do all the grunt work. ER nurses may have 3-5 patients at one given time. An ER tech could have 9-18 patients at any given time. And maybe 5+ nurses barking orders at them. Techs are over worked and underpaid. Not to mention under appreciated. KUDO’s to all ER techs out there. They are the silent hero’s. People are always praising RN’s and Doctors. (and that’s okay) but don’t forget the rest of the team. These people work hard and love their jobs too. And often bail the RN’s out.. They are the commode cleaners. The ones that run their legs off with little appreciation. I love RN’s too but they tend to pat themselves on the back and take all the praise without a word about the tech who was right beside them. The nurse isn’t the one sitting with their drunk patient most the night cleaning up their vomit, wrestling with them or being verbally abused. That would most likely be the tech where I am from. These people work very hard and maybe make a little over minimum wage. They clean the beds, take patients to their destinations, do patient care, stock, and sometimes draw blood, put on temporary casts, ekg’s etc. etc. etc. I would love to hear the nursing profession start praising the people that make their difficult jobs just a little easier. Not all of these nurses that are working so hard and being in difficult situations are doing it alone. Most likely there is a tech there that heard it all first. Or discovered that patient crashing and called it to the attention of the nurse. THANK YOU!! to all techs, and any of the other behind the scene people that are feeling forgotten and not appreciated.

    • Hey Gerrie, thanks for drawing attention to that. My ER doesn’t have techs to help the nurses out, but our LPNs are a huge asset to our team, as are all the support staff, diagnostic imaging, lab, registration, etc. It takes a village to run an ER, and it sounds like techs are a huge part of that in your ER, too.

    • We don’t have ER techs. I clean commodes, wipe up vomit and am verbally abused. We have a scant few LPN’s who are allowed to work in the low acuity fast track areas and we work as a team. I don’t and have never barked orders at someone. Some hospitals need to clean up their hierarchy if this exists. Proper patient care is best delivered as a team, not with perceived status or rank over someone. Everyone has a job to do, and a functioning ER or unit best runs when everyone works together.

    • Thank you, Gerrie! I am an ER tech and I do all that you mentioned except drawing blood. I do love my job, but it is exhausting! I can have anywhere from 12 to 29 rooms to look after (13 of those rooms are high-acuity) and the hardest part of my job is definitely balancing the requests of all the nurses, who aren’t usually aware that other nurses have asked for my assistance as well. It can get frustrating, especially when a few of the nurses whine about my unavailability to them.
      We are definitely underpaid at my hospital, but I’d rather be underpaid in the Emergency Department than fairly paid at McDonalds– we make about the same wages anyway.
      Again though, I love my job. I really do. It is a wonderful environment for me to learn and practice the skills I’m getting from studying Paramedic Science in school.

  49. I have worked as an ED RN since 1984. I thought this was a very well written article, and I have only 2 additional comments. First, I find that many people come to the Emergency Room after they are instructed to do so by their PCP. Whether office volumes prevent PCP’s from seeing the patient in the office, or after hours, PCP’s are concerned with liability ( so they tell the patient ” Go to the ED”) And second, ED’s need to develop a system to get the less critical patients in and out. Our ED has a mid level provider in triage/ intake. We draw labs, start IV’s, do EKG’s, x-rays, cultures. We can treat and discharge patients without ever putting them in a room. The rooms are reserved for the sicker patients who require a more extensive work up. ED nursing is certainly not for everyone, but anyone who has ever been to an ENA convention knows, there are many of us who can not imagine working anywhere else!

  50. OMG, I’ve worked in a ER and currently practice prehospital medicine. ED RN’s are so busy? Please, they pass most of the work on the techs because they are too busy gossiping, eating and complaining about something. I know not all are bad, but please next time you have time to shop on amazon while in the ED make sure that homeless guy gets his piece of toast!

  51. I’ll tell you now, if your waiting it’s for a good reason. We just want to clear the board. We certainly don’t want you there any longer than you have to be. Great em, Treat em, an street em!

  52. As an ER nurse, often assigned to triage, now I have a new way to respond when many angry patients come to find out….how much more I have to wait to be seen?

  53. I worked Triage last (Friday) night for 12 hours…I work every Friday, Saturday, & Sunday night ER/Trauma, before that ICU, before that State Mental Hospital…RN/NP for a long time always night/weekends…last night was steady, mostly routine–I decided to give 2 Norco on standing orders to just about every one who even remotely needed it—& guess what?…they all stopped whining while waiting to be seen–another one of the triage nurses & I joked that I should’ve had a Pez dispenser to hand the happy pills out…some of them ended up being dispo’d with more or less serious conditions, some not…but they all left feeling better than when they first walked in the door saying they were going to die in the next five minutes if they didn’t immediately see a doctor…I learned a long time ago in this business to pick & choose my battles with both patients & staff…I always say to people that I will honor any reasonable request, but the reverse is also true…so, if you want another warm blanket–yes, I’ll get it for you, plus a sandwich or soda, or whatever else you’d like…as long as you say please…but, I’ll get it even if you don’t say please–as long as you ask nicely…I just deal with people at work like I would anywhere else…I show you respect & I expect the same in return…when I first starting working ICU, I heard from many experienced nurses–You don’t know nothin’ about ICU until you’ve been here at least 5 years–& I found that to be largely true & the same applies to ER/Trauma…I long ago stopped worrying about why somebody came to the ER…you’re here now, so may as well make the best of it…you are my patient & I am your nurse–you are quite literally entrusting me with your life when you enter that front door & it is always my intent to honor that trust…and, just as an aside–because, yes, I’m a person too–I’m going through a lot this year because I lost my wife & my heart is truly broken…I’ve always been good with helping families deal with loss anyway…but, now I really feel their pain & it hurts…I’ll call the Chaplain &/or social worker in at 2am & I’ll also ask the House Supervisor to get personally involved a lot of times…& believe me, the families are appreciative, even if they said initially they were ok dealing with it on their own…I’m starting to ramble on I know…but those of you who know what I feel & what I do & what I know will understand why…Aloha

    • I have the same philosophy Big Wang! Some staff will go on and on about how horribly certain people abuse the ER. We have some drunks that show up for 10 days in a row. No medical complaints, just public drunkenness. is it annoying??? Hell yes!! But they’re here, just treat them and move on. Cant turn people away in the ER. A little patient education goes a long way….
      Peace.

  54. Step into emergency only if you are really sick. Having SEVERE headache or abdominal pain does not mean its emergency, but it also does not mean its non emergency. Respect the professionals. We are all trained to triage and nurse patient!
    Yes I agreed that Communication plays an important role. But as patient if you are not understand what you are waiting for, you can always clarify and check with the nurse.
    If you think that waiting for that few hours is going to hurt you, then think again. Many nurses worked through their 8 hours shift without going to the toilet to pee, kept nothing by mouth just to take care of all the incoming patients (who might be your love one).
    Please treasure us and respect us. I believe your understanding will allow us to do the extra miles for you :)

  55. I have worked EMS and radiology in a hospital for 15+ years. I have nothing but respect for ER staff, all of them. Someone stated they were “just a tech”. To that person, you are an integral part of the er staff and patient care. The nurses and docs need you to do your part so they can do theirs. It’s TEAM work and EVERYONE is important from registrars to housekeepers( environmental services). My thanks to everyone.
    As far as wait times, I’m surprised no one has mentioned the ever abundant repeat drug seekers that NEED their pain medications!
    To the person talking about the abilities of ER staff, if you had a clue how knowledgable these people are. They usually are not right out of school as these people are highly skilled. They have to know meds, signs, symptoms, treatments, and be able to question physician diagnosis and treatments when things don’t ” sound” right. They are the patient liaison and I would say most don’t do it for the pay or the thanks they get as they are few and far between. They do it for the love of the job and the ability to make a difference in the lives of others.
    Once again thanks for all you do.

  56. And this is exactly why I never go to a ER for anything. I did a one month as a nurses aid in the ER and said no thank you. Every day was INSANE! The worst we’re the pain med junkies, bums and the “I have a cold/fever” people. The next time I set foot in the ER I will be on deaths door step. People have lost sight of the fact that we as humans get sick. We get colds, the flu, diarrhea, and will vomit. It is part of life. That is what over the counter meds are for. Take an aspirin, take a shower and go to bed! I would rather spend 4 hours in my own home resting than 4 hours next to some smelly bum with “back pain”

    And yes I have broken my arm, I went to urgent care (not the ER at a hospital) the took x-rays, set the bone, slapped a cast on and sent me on my way with some Vicodin. I was in and out in less than 4 hours.

  57. I once waited 6* hours after cutting off a finger without so much as a Tylenol and never complained. Why? I was not DYING. Im an RT at a children’s hospital with a 12 bed ER so we rarely have complaints but once I had an adult come in needing our help because this patient was high on crack and needed us to help sober him up so he could go to work later. We can’t turn anyone away! I assure you angry patients that your wait time isn’t caused by lazy or slow staff. My hospital has had to pay me for that 30 minute break for lunch as I never got to take it. I would never wish this on anyone, but when you feel that crushing tightness your chest or are involved in a serious MVC, you will be thankful we prioritize. What if we said “ma’am we will start CPR on your child in approximately 45 minutes. There are two patients in front of you”.

  58. Jenn, great article and I appreciate all of the conversation it has generated! I wanted to comment on the “explaining wait times” issue. You mentioned that most of the complaints you get center around waiting. I work as a Patient Experience Manager, supporting a health system with 5 ED’s that saw almost 300,000 visits last year. You are absolutely right, the #1 issues consistently identified in our patient feedback was around waiting, and specifically communication about the wait time.

    I have worked in a clinical role in the ED as well and agree it is incredibly difficult to give accurate estimates of wait times. Now that I’m on “the other side” in an administrative role, what I teach our caregivers (learned myself from experience) is that our patients appreciate authenticity. If you tell a patient 30 minutes until *the next thing that’s going to happen* and then 3 cardiac issues come in, tell the patient (or better yet, send in someone from the leadership team – we love feeling needed! – to tell the patient) that the wait is going to be a bit longer and we wanted to keep them informed. It’s even ok to say, “I’m not sure how much longer it is going to be at this point, but one of us will be back in the next 45 minutes to give you an update”.

    People, in general, are more forgiving than I think we sometimes assume they are, especially when your job is to interact with customers who are mostly feeling sick, tired, and cranky. 9/10 patients will appreciate the authentic communication about wait times, and I don’t worry about the other 1/10.

    Again, thanks for sharing and for always being there for your community!

  59. I can only imagine all the tasks performed by the ER Nurse/staff. My husband was in the ER Christmas Day and was admitted after 7 hours. I’m sure it would be repetitive, but, communication is the key. Letting people know the timeframe or perhaps that there are a couple of urgent cases before you, or just checking in periodically to give a person a timeframe or expectation. I’m sure all is being done that can be done. Anxiety makes the time crawl by slowly. Music is the international language, so perhaps some calming sounds/music would lower a person’s anxiety. My Sister is an RN and worked in LA Calif. She said, “seven hours is nothing, we had people on stretchers in the hallways that took over a day to get to.” Guess it isn’t so bad for us, however we are in a town of 40,000 people.

  60. This is a problem of the ER being used as a replacement for primary/urgent care. People don’t always realize how some ERs can be much more effective and efficient than others. There’s a comparison of different ER wait times here: http://www.hospitalstats.org/ER-Wait-Time/ that shows that some ER wait times are minutes while a nearby hospital might have hours of delays. Non-critical cases could be funneled to the lower-utilized hospitals, it would reduce the wait while allowing staff to focus on the urgent cases.

  61. Jenn,
    What a great read! I sat and read through the countless replies you got in response to your blog and I found myself nodding in agreement, laughing, and wanting to smack some people for their ignorant and rude responses…but you responded respectfully and knowledgeably every time…kudos! I have worked in medicine for almost 16 years wearing many different hats. I started as and EMT/paramedic then became a nurse that started in general med/surg working my way through neuro, liver kidney specialty, cardiac tele, trauma ICU and eventually down to the ER. Each experience brought its own goods and bads and I don’t believe that anyone should be belittling anyone else’s experience or education. We all went into the medical field because we enjoy caring for people and feel some satisfaction from it but like any other human we have our complaints and pet peeves…we are not invincible. I don’t want to list stories of my experiences of the good, the bad and the crazy but I do think that people should keep in mind that medicine has become another form of customer service. Gone are the days of doing our jobs proficiently with compassion and good intention and now are the days of dealing with entitled, demanding and unrealistic people that make our jobs so much harder. No insurance, no primary care, and no patience is not a reason to flood our emergency rooms. If that is your choice then it also your choice to wait your turn. Nursing is not easy and I may get paid for what I do but no where in my job description did it tell me my hourly rate included being belittled, screamed at, pushed, spit at, missed lunches, no time to use the restroom, or that people would question my abilities and desire to do my job. I am thankful for the people I work with everyday because none of us could do it without the support of peers!

  62. This may very well be what happens at your ER, but I can tell you a few stories about visiting the ER locally. I’ve seen the nursing staff waiting on a doctor to order this or order that. I’ve seen them waiting on the doctor to give advice of what needs to happen. My daughter had to go to the ER for a relatively simple problem. There was NO ONE in the ER at the time. We waited and waited and waited. And then you’re right a critical patient came in. We understood then that we had to wait, but if the doctor had helped my daughter when she came in, we would’ve been home and out of the way when the critical patient came in. The six hour wait was entirely too long and there was no way to excuse it away with “critical patient” excuses. While you may be constantly running in your ER, that is NOT the case across the country.

  63. I agree with you Jenn, but I don’t fit the description of the regular ER patient……. The reason is….. I’ve been to Urgent care and most of the time they referred me to the ER (oh well there goes a $25 fee I could’ve used to buy much needed food for my family. You see most of us older people, on disability can’t afford a Urgent Care co-pay, after paying a monthly health care premium of $107.00 a month and our Medicare part B which has gone up to over $100.00 a month. I have to pick & choose each month between paying outstanding doctors bills, co-pays for doctors visits, rent, utility bills, food, gas, and prescriptions. For example: I couldn’t afford my heart medicine this month so the consequence was my feet & ankles swelled up so much it felt like my skin would split open with every step I took. When I’ve gone to doctors appointments, the ER, Urgent Care, or even been admitted to the hospital for surgery’s, I have never been a bad patient. I’ve always been upbeat, patient, and as undemanding as possible. I believe if you have a positive attitude it will help you recover faster and feel better. So you see we are whisked through triage, back to the waiting room, into a exam room, draw blood/urine sample/ex-rays, nurse fills out report, doctor see’s us, nurse comes back in to interpret what doctor said, then another nurse comes in with release/instructions for meds/eating/physical demands, and we go home. Most people don’t understand how long it takes for test results or ex-rays to get done or even realize how short staffed and over worked the nurses and doctors are. My husband has congestive heart failure so I’ve had my share of ER visits. It’s getting better though and he hasn’t had very many ER visits (he doesen’t even want to hear the word ER lol). The only thing he’s complained about is the fact that he’s been in the cath. lab 11 times and didn’t even get a t-shirt lol.

  64. ElizabethG,
    If someone doesn’t have insurance and uses the ER instead of a PCP for every farting little boo-boo and sore throat, that is NOT the problem of the ER staff OR the patients who are waiting to be seen. Don’t want to wait? Get off your fat ass and get a job with insurance benefits, and find yourself a PCP. If you can’t be bothered, sit down in the waiting room, shut your piehole, and wait like everyone else. Just because you qualify for free care (which, by the way, is PAID FOR by the taxes of those ER nurses and staff that are busting their asses and putting up with RUDE assholes like you) doesn’t mean you get preferential treatment. And here’s some advice from someone on the inside–keep bitching, and find your wait extended. Keep treating the staff poorly, and you may find that you have to wait EXTRA LONG for that pain med.

  65. I’m a retired ER-ICU RN. I miss it terribly and believe it or not the persona you hold on too is missed greatly when you leave. No one ever understands everything that you do in the ER. I worked in a shock trauma center and then floated to ICU where I felt safer. When the guns started blazing and big metal doors came down with a bang I decided to get out. Also At 6:40am while walking into the hospital for the day, some starting firing on us walking into work. That was just too much for me. I still miss nursing, the little old lady or man who is scared. The little kid who needs a hug or a tender touch to sooth the boo boos away. Nurses work with people that are at their lowest in their life. Most often they are scared and need to know that their health is your concern. If you have to wait would you like your loved one taken in fast if they were having a MI? I think a lot of hospitals have fast track now and it’s good. ER’s need to be used for emergency not just doctors visits. The ICU I worked for 15 years had metal detectors at the door. I did have to admit I did feel safer, but when the war out in the street comes into the hospital it’s time to reassess your value of life. Most hospitals aren’t like that hospital. That hospital was in our nations capital.. I now live in an area that the nearest hospital is 40 miles away. Doctors are 15 miles away. The emergency field personal are great and do their best when things go bad. Give that nurse a thank you when she seems a little gruff, it’s only that she’s tired and has a 100 things to do before she can go home to her family. A thank you is so greatly appreciated.

  66. I have been to the ER many times with my kids and for myself, and I’ve never seen all those things going on that was said in the original post.. Not only do you wait for hours to be called back to be treated, once you are called back you wait another several hours to be seen.. The help stands at the nurses station the whole time and talks instead of going on and taking care of the matter of cause.. They speak of their vacations and their plans for the week ends coming up when they should be doing their jobs.. I have found this type of service with every trip.. And with every time they need to come in and out it’s at least 1/2-45 minutes before they come back again… And after the Dr finally sees you it takes another 45 minutes for them to come back with release papers!!! I guess their week end plans are more important than taking care of the matter at hand!!!

    • Teresa, sorry to hear your experiences have been like that. We nurses are humans too and are involved with each other’s lives just like all other humans. But that doesn’t mean the time to do it is when others are in need. I apologize on their behalf and hope your future experiences are better.
      However, all the things I mentioned and so much more do happen in the ER, on a frequent basis. How often depends on the ER.

  67. I would also like to share something with you. Being an ER nurse for many more years than any I have mentioned………………………………………………………………ER nurses, read this! permalink

    ________________________________________
    after circling the drain with compassion fatigue, I stumbled upon this article that was published in the ACEP: read it and tell me you don’t feel proud!
    ++++++++++++++++++++++++++++++++++++
    Guest Editorial
    ACEP News
    September 2006
    By David F. Baehren, M.D.
    For a generation or two, we have lamented the loss of role models in society.
    As parents and individuals, we naturally seek out others we would like to emulate. Sadly, a serious search through the popular culture leaves us empty-handed and empty-hearted. Thanks to a long list of legal and moral shenanigans, many entertainers, politicians, and athletes long since abdicated this momentous position of responsibility.
    We usually look afar for heroes and role models, and in doing so overlook a group of professionals who live and work in our midst: nurses.
    And not just any kind of nurse: the emergency nurse. There are plenty of people involved in emergency care, and no emergency department could function without all of these people working as a team. But it is the emergency nurse who shoulders the weight of patient care. Without these modern-day heroes, individually and collectively we would be in quite a pinch.
    This unique breed of men and women are the lock stitch in the fabric of our health care safety net. Their job is a physical, emotional, and intellectual challenge.
    Who helped the paramedics lift the last 300-pound patient who came in?
    Who took the verbal lashing from the curmudgeon giving admitting orders over the phone?
    Who came to tell you that the guy you ordered the nitro drip for is taking Viagra?
    The emergency nurse has the thankless job of sitting in triage while both the long and the short buses unload at once. With limited information, they usually send the patient in the right direction while having to fend off some narcissistic clown with a zit on his butt. They absorb the penetrating stares from weary lobby dwellers and channel all that negative energy to some secret place they only tell you about when you go to triage school.
    Other kinds of nurses serve key roles in health care and attend to their patients admirably. However, few function under the gun like emergency nurses do.
    It is the emergency nurse who cares for the critical heart failure patient until the intensive care unit is “ready” to accept the patient. The productivity of the emergency nurse expands gracefully to accommodate the endless flow of patients while the rest of the hospital “can’t take report.” Many of our patients arrive “unwashed.” It is the emergency nurse who delivers them “washed and folded.” To prepare for admission a patient with a hip fracture who lay in stool for a day requires an immense amount of care–and caring.
    Few nurses outside of the emergency department deal with patients who are as cantankerous, uncooperative, and violent. These nurses must deal with patients who are in their worst physical and emotional state. We all know it is a stressful time for patients and family, and we all know who the wheelbarrow is that the shovel dumps into.
    For the most part, the nurses expect some of this and carry on in good humor. There are times, however, when the patience of a saint is required.
    In fact, I believe that when emergency nurses go to heaven, they get in the fast lane, flash their hospital ID, and get the thumbs-up at the gate. They earn this privilege after being sworn at, demeaned, spit on, threatened, and sometimes kicked, choked, grabbed, or slugged. After this, they go on to the next patient as if they had just stopped to smell a gardenia for a moment.
    Great strength of character is required for sustained work in our field. The emergency department is a loud, chaotic, and stressful environment. To hold up under these conditions is no small feat. To care for the deathly ill, comfort suffering children, and give solace to those who grieve their dead takes discipline, stamina, and tenderness. To sit with and console the family of a teenager who just died in an accident takes the strength of 10 men.
    Every day emergency nurses do what we are all called to do but find so arduous in practice. That is: to love our neighbors as ourselves.
    They care for those whom society renders invisible. Emergency nurses do what the man who changed the world 2,000 years ago did. They look squarely in the eye and hold the hand of those most couldn’t bear to touch. They wash stinky feet, clean excrement, and smell breath that would give most people nightmares.
    And they do it with grace.
    So, here’s to the emergency nurse. Shake the hand of a hero before your next shift.
    DR. BAEHREN lives in Ottawa Hills, Ohio, and practices emergency medicine. He is the author of “Roads to Hilton Head Island.” He welcomes your feedback at DFBaehren@ameritech.net.

  68. I worked in a small 4 bed ER one time where the ambulance stretchers had to go thru the waiting room. A father came to the desk asking when his daughter would be seen for her cold saying they had been there 3 hours. I replied, “If you have been here for 3 hours then you have seen how many ambulances have come in. I don’t know how long it will be, but you could go the clinic in the morning.”

  69. This just shows how UK now accepts 3rd rate service while paying through the nose for it. I moved to Taiwan ten years ago. They have the mist amazing health services compared to UK. Waiting time in er is minutes and often no waiting. The reason is because it’s not run by accountants & filled with every level of beurocracy. I called at 4 pm Dec 20 to make appointment with doctor. None of this messing about to see a go.Two hourss later I am with a consultant. He arranged ct scan for Dec 25 with immediate meeting as soon as I had dine the scan. I was then scheduled into hospital Dec 29 for operation Dec 30. This would take over a year in UK, here it took about ten days. Go figure. People in UK are brain washed about their health service. They all think it just needs a bit more money spending on it.

  70. Fabulous post. I’m not in medicine. My 4-year-old daughter has Leukemia and a central line. Chemo makes her immunocompromised, and her central line provides heightened concern for infections. If she gets a fever when the oncology clinic is closed – nights, weekends, holidays – then we go to the ED. She can’t sit in the waiting room.

    I know its got to be annoying for somebody in the waiting room to watch us come through the door. The receptionist hears our name, and we are whisked off to a room with a brand new 101 degree temperature. That is probably frustrating. Believe me, I’d rather my baby didn’t have cancer.

    We know that she *probably* isn’t extremely emergent. So does the ED staff. We cut in front of everybody who isn’t threatening to die right now. Once on IV, we may be there 6-8 hours, and we may see our nurses and techs very infrequently. We know that. We bring books and games, we watch a lot of movies.

    When her status changes, she gets to push the nurse call button. And we wait our turn.

    I am so grateful for the ED. They treat every fever like it is the big bad blood infection until we know different. And then they still treat us with respect and professionalism and courtesy – subject to the requirements of more emergent patients.

    From the parent of one apparently fine kid who cut in front of your very clearly sad and uncomfortable kid, I would trade places. The front of the line sucks.

    Thanks forever to the staff of our ED and every other dedicated ED nurse, doctor, tech, environmental crew, and fridge re-stocker.

  71. “Confessions of an ER Nurse” – Jenn as someone with 17 years in the Trauma /neuroscience ICU. I’d just like to say. “Well done & well written” We have an awesome job, and do an awesome job of performing it. Few people outside of our circle REALLY know. Though tears and laughter, … Keep the Faith Sister.
    Chip Vokey RN, Dallas Texas

    • Thanks, Chip. Such an honour to have you read and appreciate this! I look forward to someday having the experience you do. We certainly do have an awesome job!

  72. I have a friend who this year celebrated 50 years as an RN most of that 50 years has been in the ER of a rural hospital in Western Michigan a farming community, a lot of farm accidents. Our son who died of a brain tumor 28 years ago, was treated more then once in that little ER, they always got him in and stabalized him so he could be transported to the City Hospital 70 mile away, where his Neuro Surgeon was, she was there when he had his first seizure and many more after that.. I love and respect the nursing community especially the ER nurses they do an awsome job. I saw one deliver a baby on the bathroom floor of the ER, one time and another who wisely suggested that if my grand daughter had stuck a bead up her nose, that if we could get her to blow real heard she might be able to get it out by herself and keep us from a 4 hr. wait to see a doctor who would make her blow it out. Sounded good to us, so we took the 2 year old into the bathroom and said lets blow your nose, blow real hard and out popped the bead and we didn’t have to wait. Thanked the nurse for the wise advice and left. I think sometimes if people would wait and go to a doctor or an Urgent Care facility it would lighten the load on the ER’s and time waiting would not be as bad. I worked EMS for a few years nd saw a lot of time wasted on a cold or the flu, or the time my neighbor cut her finger with a knife, I looked at it dressed and wrapped it but that wasn’t good enough so she went to the ER they looked at it dressed and wrapped it and sent her on her way 5 hrs. later. Not everything is worthy of an ER visit.

  73. Having been an ED director for 25 years I know of no harder job in the hospital than working in the ED — everybody busts their humps — clerks, techs, nurses, doctors — everybody. The problem — hospital CEOs seem to assume that it is OK for patients to wait — sometimes hours — they seem to assume it is acceptable to hold admitted patients in the ED protracted periods, they seem to think that helpers for the staff — techs, LVNs, scribes don’t need to be around to help deal with the ridiculous EMRs that have staff at the computer terminals instead of the bedside. What other business would treat its customers so consistently so poorly and not value their time like EDs don’t seem to. Ask anybody and they will tell you to plan and wait when you go to the ED. We have a national reputation for making people wait. We act like we are doing the patients a favor — well in some EDs, that actually may be true, but not in most. Every soul who works in an ED should see the outrageous bills that patients get. For what is being charged you would think that the patients are getting superb, extraordinary service — but they are not. And, yes, really sick patients come first, but you have to remember that if it were not for the 80% of patients who we send home there would be no ED. We could never survive economically on just the patients that get admitted or the very sick or injured. So we need all of those febrile babies and lacerations and back pains and tooth aches that everyone seems to think are abusing the ED. Primary care doctors are full — you won’t get a same day appointment — the baby is sick when dad come home from work. Bottom line — if the CEOs bonus were based on ED throughput performance these problems would be fixed pronto.

  74. When a nice old lady ran me over on my bike ride, the EMS was great (besides not giving me any pain meds). On the way to town they asked where I wanted to got and I chose the ER where the homeless people and gang violence vic’s dont go… As they rolled me in I made a comment that there were no stabbing vic’s and the EMT said “yeah, wrong hospital..”
    I was seen right away, x-rayed, kidneys checked and discharged in like 3 hrs. Pain meds finally got to me after they did x-rays which was my only complaint (Fracture S4 laying flat on a metal table hurts). Then I passed out on the drive home and got to be admitted a second time to the same ER and was moved to the front of the line quickly then moved to a bed before my vitals were finished because I was about to pass out again. Felt better after IV fluids (previous trip required 3-4 pints of water to produce a urine sample) but this time I got a night in the hospital and LOTS of tests, LOTS! I was greatful that there was a good triage process. The process that is annoying is the billing process. Bills from the hospital being seperated from the Doc’s is a major source of frustration and confusion! One Doc that a saw briefly at the end of his shift only to wake me up and tell me he’d be passing me off to someone else!
    This was my only trip as a patient to an ER. All my previous fracturs were treated with NSAIDS, RICE, and BEER until I determined the need to head to an urgent care clinic. As a lay person my guess from previous visits to ER waiting rooms is that 80-90% of walkins would be better served at an urgent care clinic. But due to lack of insurance/means, over reaction and/or lack of intelegence people go to the ER. When my wife had a UTI in the Utah desert on a Saturday we went to great pains to find an open urgent care clinic to avoid the cost of an ER visit. If there were more accessable free urgent care clinics and some sort of penalty for blatant (like multiple visits for non ER issues) misuse of an ER it could help.

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