Qualities Required for an ER Nurse

I'm big into lists all of a sudden. I've been making them all week. I go through spurts of obsessive habits and this week I'm looking to complete a notebook full of lists. Sometimes I wonder if I need to be committed.

I thought I'd enlighten my glorious readers (all 6 of you) on the qualities I think an ER nurse should have. If you want to be successful in the ER, please pay attention.......

1. You must be able to adapt quickly to change. The first 60 minutes of your shift may entail finding out about a policy update, initiating a lidocaine drip on a patient, taking a bead out of a 4 year old's nose, finding out the previous policy update was updated again, assisting in a casting, placing a catheter in a 80 year lady with dementia and unique female anatomy, being floated to ICU, being released from ICU, doing pediatric triage, and then going on a run with EMS because they are short staffed.

2. You must be able to hold your urine for 12 hours straight. See number 1 for reference.

3. You must not be a frequent crier. Tears are OK once in a while, but not on a daily basis. Seriously people......if you are that emotional, find a less stressful job.

4. A sense of humor is a must - a vital requirement. You cannot survive without it. Because sometimes it's just dang funny when a man comes in with a foreign object in his "orifice", or Dr Q slips on the freshly mopped floor and lands with his coffee spilled over his scrubs and the hemoccult card he was carrying flat open on his face.

5. You must be a critical thinker. You must understand WHY you are doing what you're doing. Being genuinely surprised that your patient is hard to arouse after 30 minutes on a Versed drip makes the other nurses look at you funny and wonder where the hell you went to school (www.easynursingdegress.com?). Also, not doing a urine dip on a patient that has just been kicked in the gut by a 1 ton horse because "the doctor didn't order it" is just not acceptable.

6. You must be willing to train other nurses. How will we devlop competent nurses to cover for us on our vacation days if we don't make the effort to train them? Really - it's in your best interest to show SusieQ how to assist in a chest tube insertion, because you may want to go to Florida next month and there is noone to cover your shift on Trauma Call except a new inexperienced RN who was never trained. Next thing you know, your boss says "No!"

7. You must not mind body fluids. Blood, vomit, poop, pee - they're all part of a normal day in the ER. Sometimes you even get to have them splashed all over your clothes and in your face.

8. You must be excellent at organization and time management (refer to number 1 once again).

9. You must be able to recognize the fact that a 45 y/o obese male with a history of smoking who is experiencing chest pain needs to be seen before an 80 y/o female with complaints of "it burns when I pee." Triage is your friend - know it, own it.

10. You must be able to prioritize. It is more important for you to obtain an EKG on your 45 y/o male than it is to obtain a urine sample on your 80 y/o female. Just because the doctor ordered the UA first doesn't mean that is the order in which you perform your interventions.

11. You must be a cold, hard bitch. Oh wait - no....that's just me.

12. You must bitch endlessly about how unreal medical shows are, but secretly watch them at home cuddled up in a blankie with a cup of hot chocolate while yelling "You don't shock asystole asshole!"

13. You must be willing to keep up on your education and be aware of current practice. Stating "Well, Abby did it last night on ER" doesn't go over very well with the Chief of Nursing. See number 12. Another tip - People magazine does not contain any CEU's.

14. You must not screw around with your coworkers. Paramedics, police, firefighters - go for it. But another ER nurse or doc? Not a good decision. First, you're mushy mushy kissy kissy in the hallways, making people want to throw up. Then, when things go south (they always do), it becomes difficult to take care of that patient seeking treatment for syphillis without popping a comment off to Big Bob RN about how you're surprised he's not laying on the stretcher - as much as he fooled around on you.

15. You must be able to handle people yelling, screaming, cussing, and spitting at you without taking it personally. Review number 3.

and last, but certainly not least............

16. You must be able to find rewards in the little things - the smile of a child after they've been sewn up and get to choose a sticker, the reassuring beep of the cardiac monitor after you've resuscitated someone, the way the closet at the end of the hall is soundproof so no one will hear you scream when you are losing your mind.

It's a Slow Day

This is what happens when you've reached your breaking point. 3 nurses with a sick sense of humor, one fake baby, a camera, and a slow moment........

Oddities of the Universe Unite!

It always amazes me how just being a nurse attracts the weirdest situations. Sometimes you are standing in line at McDonald's wearing your scrubs (wondering how on earth that little, tiny french fry on the floor became such a mass of squished goo), when the lady in line behind you starts telling you about her copious vaginal bleeding and how many clots she's expelling, while all the other customers are trying not to vomit and silently throwing their ketchup away.

I've even experienced many of these interesting scenarios just driving down the road. You never know what will be on the other side of that corner. If Mel is with you, you can be assured that something crazy or completely hysterical will happen. She attracts the oddities of the universe like flies on the sticky strip of life. I really think she should start working in the Emergency Department. She'd fit right in with the rest of us who are one taco short of a combo plate.

Last year at about this time, Mel and I decided to take a drive to Boise to escape the duldrums of a deep, depressing winter. Can I just take a moment here to say I hate snow? I seriously hate snow. It starts off white and sparkling and amazing. In 4 hours it is crap - and when it starts melting off at the 7th month, it turns into liquid shit. By the 3rd day of snow, I'm ready to pull my ass up to the top of the local skyscraper (all 2 stories of it) and start screaming obscenities nonstop. Kind of like the gentlemen we admitted to the psych hold room last week.

Mel picked me up in the boonies where I live. When we hit the end of the road at the highway, Ms. Eagle Eye Mel looked to the left and spotted an upside down truck in the snow about 1/4 of a mile up the road. A white truck - in white snow. I was oblivious to the situation since I was seizure dancing in the front of her van, rocking out to Third Day, swinging my hair and screaming "Turn it up bab-eeeee!" I think she might have even punched me to get me to pay attention the fifth time she asked me, "Is that a wreck over there?" I finally stopped my seizure dancing and followed the line of sight from the tip of her finger to the corner.

My control freak personality emerged. "Get over there!" I yelled.

Jumping out of the car, we ran to the truck. The cab was pretty much intact, but the bed had been ripped away from the frame. A local cowboy was bent down at the passenger window with his cute little wrangler butt sticking up in the air, trying to help the passenger crawl out of the vehicle. They were having a little difficulty getting her seatbelt undone (but I was enjoying the view), so I started ordering Mel around (bossy little wench that I am), "Go get coats, blankets, whatever you can find". By this time, a few more vehicles had stopped and Mel "borrowed" the needed items.

I turned my attention back to the passenger. I knelt down beside the cowboy and stuck my head in the window. I ran through the whole "Does your neck hurt? Did you lose consciousness? Any pain in your back? Yada, yada, yada," conversation. She kept denying everything. "I'm fine. I'm fine," she kept saying. Mr. Cowboy Man finally got her seatbelt undone and starts pulling her out the window.

"Wait!" she yells. "I can't feel my left leg"

"Ah Crap, Immobilize! Immobilize!" I think. Until the lady so very calmly says to us........................................................




"Actually, I don't have a left leg."


She was an amputee. After the shock wore off, I couldn't help but giggle. I looked at Mel and thought, "This is all your fault."

Mel's Journey

Please watch the progress of my friend Mel as she does a medical mission in Cambodia. She is an amazing nurse who will be going to Cambodia for 2 weeks at the end of April.

You can find her blog here