Pros and Cons of Being an Emergency Room (ER) Nurse: Should You Become an ER Nurse?

If you are a new registered nurse, considering whether you should choose a career in the ER, understanding the pros and cons of being an emergency room (ER) nurse, will help you to make a more learned decision. Emergency departments in hospitals are there to meet medical emergencies and to help save people's lives, so are emergency department nurses and doctors.

Is that what you see as your calling?

There is tremendous personal and professional satisfaction for registered nurses who choose to work in the ER. These nurses train to assist doctors in the ER, as well as to carry out the nursing care for patients in need of emergency room services. Registered nurses and doctors function as a team.

Unfortunately, saving lives is not always possible. At times, there is joy experienced by registered nurses working in hospital ERs, but there may also be sorrow resulting from tragedy or trauma, so understanding the death and dying process is important.

The ER in any hospital can be an exciting, interesting and challenging place to work, but at the same time, there is a high level of stress for registered nurses. Time flies by quickly, because the ER has continual activity. It is a place where the unexpected happens suddenly.

The initial, as well as the ongoing assessment of the registered nurse regarding a patient's condition is always important. A judgment call is often necessary, because the ER nurse has to communicate the patient's needs to the ER doctor or other doctors. Communication may be necessary with respect to the patient's family doctor, specialists, other health care professionals or non-professionals, as well as family members. Good communication skills are essential.

Time is of the essence when patients are critically ill. What the registered nurse does may determine whether a patient lives or dies, as doctors are not always present in many hospital ER settings. Life and death can be a finely tuned balance, at any time.

Care, compassion and concern may not always appear to be evident, because of the urgency of critical patient scenarios. The demands of ER doctors are invariably high. Registered nurses assume a great deal of responsibility for their patients and attempt to meet their demands, as well as those of family members and others.

Many hospital ERs offer out-patient care for minor surgery or serve as walk-in clinics, as well as being emergency care facilities for patients brought to the ER by ambulance, police, fire fighters, community emergency response workers, family members or others. Busy physicians en route to the hospital, often agree to meet, examine and treat their patients or those of other doctors in the ER. Ministers and priests may also be called. 

The ER serves the local community and thus, alcohol, tobacco or substance abuse patients tend to walk in at any time and in any condition, sometimes rather than sleep on the street. Many times, they are suicidal, cold, hungry, thirsty, ill, injured and confused. The ER can become a noisy and chaotic place for registered nurses to work, because these patients tend to be disruptive. Their safety, as well as the safety of others, is important.

Emergencies have to take priority in terms of medical care, which is frustrating for other patients who have arrived in the ER, expecting to receive immediate attention from the registered nurses on duty. Patients are often reluctant to wait and may become frustrated, upset and angry. The frustration, frequently directed at registered nurses, demands good conflict management skills.

Obtaining, documenting and processing a patient's information can be a time consuming task for registered nurses, particularly on evening and night shift. The patient's identity may not be obtainable if he or she arrives in the ER deceased, inebriated, semi-conscious or unconscious.

Expectant mothers may arrive at the ER with a delivery in process. Patients may have severe cardiac problems or be unable to breathe. Children or infants can be screaming at the top of their lungs. Patients may be fighting or arguing with their spouses or teenagers. Cardiac arrests can happen suddenly. Patients can be hemorrhaging.

At times, there may not be enough hands to do everything needed, particularly on holidays and weekends, which tend to be the busiest times for ERs. That means that registered nurses may have to miss meals and breaks, as well as work overtime to help resolve crises. At times, staff has to taken from other parts of the hospital like ICU, recovery room, cardiology, obstetrics or pediatrics, to help meet urgent or specific patient needs, as well as the patient overload.

Record keeping is important in the ER because patients come and go quickly. Each patient has a chart to record medications, treatments and procedures. These become part of the hospital medical records. Documentation and accuracy are always important because of the high risk of error and possibility of lawsuits.

Registered nurses arrange the admission of patients to the hospital, when necessary. Patient education and instruction in the ER is important because patients leave, as soon as they are treated and may not have proper follow-up care. Thus, understanding what the doctor's directives are, what he or she has ordered or prescribed and being able to explain it to patients, is a crucial aspect of the registered nurse's work. The registered nurse may have to obtain blood, urine or other kinds of samples and send them to the lab. The registered nurses handles the ordering of x-rays, other lab work and physician referrals.

For any new registered nurse, who is considering working in the ER, it is advisable to take specific ER training and obtain certification. Developing advanced skills in CPR, medication administration, intravenous therapy, first aid, patient assessment and evaluation and counseling is important.

Registered nurses may not always receive thanks or appreciation from patients or their families. Often tensions run high and doctors can tend to be abrupt. Registered nurses must be extremely careful, as patients may be potentially violent, particularly when they are ill or confused.

For registered nurses working in the ER, there is always a high risk of infection, particularly when there is global crisis, like the spread of the H1N1 virus.

During a time of severe economic decline, depending upon the hospital budget, the essential medical supplies may not be available. Hospital patient beds may not be available and patients may line the hallways on stretchers or cots. The shortage of nurses and doctors means that the demands on registered nurses increases.

Should you be an ER nurse? The drama of the ER is never ending and the work can be exciting. 

Understanding what happens in a hospital ER will help you to make your decision. It is ultimately up to you to decide, but the majority of registered nurses who work in hospital ER units will recommend it.