Emergency Nursing and My Future: Questions
Of course, some background is needed..
I'm currently an EDT at a high volume Level 1 teaching hospital in a midsize midwestern/ rust belt city. This is a return to the medical world after a decade out guiding backpacking and canoeing trips. I previously worked as an EDT in the late 2000s after getting my EMT-B (which I've since let lapse). Since returning to hospital work, I've worked in a Cathlab/EP/IR pre post position, OR, and now back in my comfy place in the ED.
The amount of change from 2007 to 2026 in the ED is vast while at the same time remaining the same old-same old. The biggest, most apparent difference is the lack of experienced RNs, and the accompanying lack of autonomy in the nursing role. In my memory, back then, there were always 3 or 4 nurses on each shift that were like sage medical wizards. They would present like any other nurse, telling patients the canned "Its above my paygrade, the Dr will be in to discuss with you". They would sigh and complain about the bullshit just a much or more than the rest of us. But when you walked out of a room they could explain everything wrong with any patient before we even got reads or labs back. Or when shit hit the fan, they would just go into a mode and give directives, start interventions, and even have meds drawn up, so that when the Doc rolled in, they were ready to go. They had seen it all and knew medicine better than some of the Docs.
Now, there is one, maybe two of those nurses in this department (of approximately 200) and they work part time or PRN. The ones that are on the path to experience are actively looking for a way out. I understand Covid did a number on experience all over the hospital, but even the new grads that came in after Covid are leaving after 6 months, a year, 2 years. They're not staying long enough to ascend to the "battle axe" throne. The outlook seems dire. We've lost the institutional knowledge and cant seem to build it back.
For the past few years I've been pursuing an ADN part time at local community college, and I've just begun clinicals. I've always "known" I wanted to be an ED nurse. I like the environment, the feeling of awaiting a trauma or code, the teamwork, being a competent assistant in the workflow, the detective work of initial diagnosis, the sense of pride I feel when telling someone I work ER and they return with that face of "damn! better you than me".
However, as I get closer to the RN role, I'm wondering if I'm missing something. Is the ER really that bad as a nurse? Is the bullshit really that much more impactful in that role?
Between my time in Emergency Med and procedural units, its difficult for me to even conceptualize floor nursing, but would that be a better route? Is it even possible anymore to hang on long enough to become the Ripley of the Resus Room?