I love this profession, but not everything about it is puppies and rainbows. In this episode, I give you 10 reasons you may not want to pursue a career in an emergency department. Unless the reasons get you excited. Then you should totally do it!

United States


00:00:03this is the rain Saturday weather
00:00:42Halo when walking back to the podcast this is Cameron and you're listening to the nursing Crash Cart episode number 9 or 10 reasons not to be an idiot now I think this is a fantastic job and the more exposure that I have two other aspects of healthcare it definitely reinforces that an emergency department is where I am meant to say elbows deep in sucking chest wounds and gunshot wounds and intubations and chest compressions is an amazing career there are days where I leave the department at the end of my shift and thank can you believe they pay us to have this much fun
00:01:24but just like with any job there are parts that aren't talked about some parts that make the job difficult in a bad way and parts that distinctly leave some people with an impression that this isn't the career they thought it would be
00:01:40I talked about reasons why I love working in an emergency department now let me tell you some reasons why you might not want to work in one and then you can try to weigh these reasons against your passion for this feel and see if it still comes out on top
00:01:56number 10 Andy completely obvious One Drug Seekers you know there are days where I wish they would just come in and say hi I'm here so I don't withdraw from my Percocets Oxycontin heroin addiction and I could use some help I don't have anything else wrong with me at all instead they want you to contact the Academy Awards and try to get a late nomination for the best portrayal of back pain or abdominal pain they present with pain out of proportion to jump off the bed with the slightest touch yet
00:02:32miraculously their labs are all normal the ultrasounds normal the CAT scan is normal
00:02:40the teaching on the need for follow-up care is completely ignored
00:02:45the number of times that staff respond to a call light for pain or Hospital socks or a turkey sandwich or Sierra Mist or crackers or a bus pass or because they've gag themselves until he vomited on the floor it's a gigantic waste of Hospital resources
00:03:03resources that could have been used for someone who is open honest about their visit today
00:03:11addiction is horrible it's easy to be cynical because we see it every day but it is horrible we don't give it the credit it deserves however the addicted don't give us the credit we deserve you develop a Gestalt for The Seekers but the one that you ignore is the one with a surgical abdomen so they all get worked up they deplete your entire stock of hydromorphone because they have you tolerance of a black rhino they leave AMA when they get to the floor when it when it takes too long for the next dose in the Ed
00:03:47but you know I enjoy talking with these people who are open and honest about their addiction I'll advocate for these people we're not going to fix them today but we can get them a fix and then get them some resources for some help and then get them out of the department but the amount of wastefulness that you will see daily because of addictions that emergency departments are absolutely guilty helping feed will drain your soul if you let it
00:04:15number 9 the smells oh God the smells
00:04:21necrotic tissue bloody stool cascading off of bed and splashing on the floor blood-filled emesis ricocheting off the wall like it's coming out of Linda Blair the ammonia smell of the crazy cat lady he was about 2 hours away from being eaten by your pets because they thought she was dead gangrenous diabetic foot wounds help feet in general people with enough yeast to open a bakery smells that are so bad but hours later you catch a whiff of it and realize it's it's permeated your scrubs and the Cilia of your nose and you might as well go take a bath in chlorhexidine because you won't feel clean ever again
00:05:04number 8
00:05:06the majority of your patients don't need to be in the emergency department
00:05:11hang nails are not emergencies nausea for one hour also not an emergency back pain for 6 years with no new injury nope not an emergency
00:05:26I just want to know if I'm pregnant nope still not an emergency the unfortunate truth is the vast majority of patients that you will see are appropriate for an urgent care or their family doctor but simply come because of the convenience of not having to make an appointment not requiring Insurance not charging anything upfront and because apparently our sandwiches and carbonated beverages are the best around TV shows have absolutely lied to you there's not a mass-casualty Trainwreck every single day you're not into beating every third patient and you don't crack the chest every single trauma that comes through
00:06:05number 7
00:06:07the EDD is a Dumping Ground drunk guy that the police picked up they drop them off in the emergency department how have the schizophrenic guy who's been off of his meds and he's screaming out of stuffed animal at a bus stop to the needy we go family doctor could make an appointment today send them to the emergency department someone has unspecified abdominal pain in an Urgent Care could be unhappy better get to the e d
00:06:37family member who is visiting a patient on the floor. Hypoglycemic because they haven't eaten all day well here's your phone call hi this is so and so from the floor yeah we had a family member there sugar is 47 he kind of got a little little clammy honest he's awake now and he's eating but we're going to send them down to you for an evaluation we told him you wouldn't have that he wouldn't have to wait or anything you just get him a bed right away since his wife's up here
00:07:04between the abuse abuse for the emergency department and The Dumping that occurs there's absolutely no wonder that most are overcrowded with long wait times
00:07:15number 6 you have to work fast it's all about throughput moving the meat treat him and stratum EKG with an 8 minutes aspirin within 10 minutes cath lab within 15 minutes stroke alert head CT within 15 minutes lab back within 30 minutes septic patient blood culture getting sent antibiotics going within an hour there's a ton of time based metrics and you don't know what's coming in the door next all these things would be easy to meet if you were overstaffed and have the whole day plant but you don't get to come in and start your shift and say you know what let's have The Distillery at 11:30 will schedule the stroke alert for 1400 and then you always get the septic shock shock patient between 16 and 1700
00:08:00you may have all three in your assignments all at once
00:08:04and be understaffed
00:08:07you better get busy
00:08:09number 5 you have to think fast this ties in with the speed of the work you don't get three ships in 3 days in a row to have time to talk with a patient and their family you get realistically between assessments reassessments maybe you also triage the patient and then discharge somewhere around 20 to 30 minutes of face-to-face time with most of your patients obviously more for the critically ill but last for that yes I V worried well patient
00:08:41you need to know who need you the most what's the most important task at any given time what's safe to delegate what can't be delegated what's the worst case scenario the patient you just saw How likely is that going to happen is there anything you can do to prevent it critical thinking done safely and done quickly there's an old saying that good judgment comes from experience and experience comes from bad judgment we don't always get the liberty of bad judgement in healthcare
00:09:11constantly be filing away patient presentations in your mind so you know the dance of every little thing that comes your way
00:09:19number for the chaos it is adorable watching those who are new to an EDI environment trying to plan things things that I've heard from new hires include at what time are pain medications given and when is dinner served and their schedule for bathing do you do Audrey rooms during the day shift and even room during the night shift and if you're wondering the answers are hopefully within a few minutes of it being ordered never and if you think they need it and no one's dying go for
00:09:56you don't get to plan you reorder your task every moment and you do what's most important then you drop it off or the patient leaves in debating and hope your fellow coworkers are making sure the rest of your Simon is at least breathing then a family member yells at you because they've been waiting for 40 minutes for that warm blanket you promised or loved one
00:10:16number three the lack of finality
00:10:20there's a reason that people who work in the EDD have hobbies outside the department that allow them to see something through from start to finish because we don't get that in our job hey what happened at stroke alert last night that guy on pressors that we sent out to the unit last week ever wake up hey that's similar to that we had yesterday ended up on a balloon pump how they do yesterday's on a wraparound bed today
00:10:47she don't get to see what happens to him you stabilize and you move on to the next so you don't get to see how they do on Day 2 or day 20 and when they come back to the hospital for the Hallmark story to thank everyone that helped them it's the ICU nurse that they're going to go think
00:11:06it's not going to be the team that got Ross that decompress the long reduce the femur fracture in the trauma Bay but don't worry you're doing it all again today
00:11:15number to the rest of the hospital seems to hate you it doesn't matter what you do when you did it wrong why you being patient 705 don't you know that shift change well gee I'm sorry I didn't realize that our patients should plan their work UPS around your schedule do you mind coming downstairs and tell him not to the chest pains and lacerations the people vomiting in my waiting room who are not so patiently waiting for this guy's room there's about 40 of them have fun
00:11:43this is my second admission today will really it's my 12 but I just charged another dozen or the ever-popular when you're calling reports when was your last bowel movement man they're here for chest pain if you want to know so much. I'll be your way in 5 minutes
00:11:58we can take that patient has a systolic blood pressure of 202 if it's over 200 they have to go to the step-down unit nevermind the fact they been in PO for the last 8 hours haven't had their blood pressure medication this evening. Range and they have zero signs of end organ failure the protocols mean we have to waste more time waiting for a bed because clinical judgment gets thrown out the window for fear of getting fired or reprimanded because of systolic blood pressure was charted at 1:19 I wasn't charted at 199 instead of 202
00:12:29yet they all secretly want to be you there's not a hot new show on TV this fall called med-surg you don't watch reruns of circulating or nurse on Bravo
00:12:42yeah there was a spotlight on a local news station regarding the care for a critical Peace Center hospital and on the social media story link there was a common saying we are there and help care for this patient except you know they don't because that's where you work but people will say they work in a needy because it's cool to work in and eat
00:13:08and number one
00:13:10people just won't understand your job when someone hears what you do and they say oh wow that's to be exciting what's that like
00:13:19and you can't possibly explain to them what it's like you can try to give generalizations but you can't really make somebody quote on quote get it
00:13:28healed ask you about your most goriest or your the grossest thing you've ever seen and you just kind of draw a blank I don't keep a top 10 list around for parties of gross stuff
00:13:41I can tell you about some of the things where I feel I had to step away from the patients wipe away some tears compose myself and then move on to the next patient because a toddler drowned or family had a difficult time coping with the loss of a loved one or 10 year old that was referred to a pediatric oncologist for a new diagnosis of brain cancer at the gross stuff the Gory stuff man that's TV Land and stay in my memory for the next shift without someone bringing it up specifically
00:14:10people don't really understand the nursing profession in general look at that whole ordeal with the view recently there is a complete misconception about what nursing even is in this era of healthcare and we joke in the e d that are in stands for refreshments and narcotics but people outside of any real exposure to the Healthcare System they just don't grasp the breadth and the death of what is asked of us day in and day out
00:14:39is anything like what's on TV yeah I totally remember that time where Tema residents perform Total Care in my assignment in the Ed
00:14:48they don't understand what emergency means everyone feels their viral cough or one day of vomiting is an emergency but you can't grab them by their shirt and drag them into a resuscitation room and make them stare at a real emergency they don't understand why you prioritize something else over crackers and ice chips for their loved one they don't understand that just because it's an emergency department it doesn't mean you're going to be in and out in 30 minutes and they sure won't understand when you try and tell them what it's like to be an ER nurse
00:15:24and that's it for today if you can handle these 10 things and you still want to work in the e d then come join us because despite these reasons it is the best and most rewarding job with the greatest team of people that I've ever been a part of if I can't be Batman or Neil deGrasse Tyson I'll take ER nurse I hope you enjoy hearing about some of the darker side of the e d today if you want to contact me you can email me a TD Crash Cart at gmail.com catch me on Twitter at Edie crash cart and find me on the web at www.rushcard.com if you enjoy this podcast you can check out more episodes on iTunes or Stitcher radio and thank you again for listening and I hope you still want to be ER nurses after this podcast
00:16:12unless you can be Batman then you know go me Batman

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