Day in the Life of an ER Nurse in 2021 (Emergency Room Nurse)
Welcome back to another video. In this video I will be going over what I do and what it looks like to work in the emergency department as a registered nurse.
This is not going to be a vlog style video as I do not want to record videos at work especially during a pandemic. Instead I am going to narrate and explain what the shift is typically like for 12 hours.
I start at my shift at 0730 by looking at the assignment I have been placed into. In the emergency department, there are 5 different places that I can be assigned to work in. The five areas are: First Aid, Intake, Acute, Trauma and Triage. If you want to learn more about the differences check out my other videos or my emergency nursing playlist in my channel. Typically, since I am not trained to work in triage or trauma, I work in the acute or intake section of the ED. In today’s example I will talk about the acute section. In acute I am responsible for 4 beds which means 4 patients, so I start my shift getting report on the patients in the beds and their plan. It is typical in the ED that I do not have patients occupied in all my beds, this is because the goal of the ED is to diagnose, somewhat stabilize and get them up onto the appropriate floors they belong to. However due to logistically reasons we often get patients in beds for longer periods of time.
Anyways, the day starts by identifying the sickest person or the least stable person I have to take care of. Sometimes that means a patient that is in active chest pain, dysrhythmia, pancreatitis or someone who has manic and is on 4 point restraints. So I start by doing a primary assessment and a focused assessment on what they are here for. Then I document my findings and make sure I have vital signs that are done routinely. In the ED you don’t always have orders, does not mean you do not do it, you take responsibility of things based on need. Typically this means doing vital signs every hour or two and having them on telemetry — better to be safe.
After I do my assessment and documentation it is time to look at medications and see if it is appropriate to give them. Orders can often be duplicated or mistakes are commonly made by the prescribing physician therefore it is even more important in the ED to do the safety checks. It’s common for orders to be duplicated because the patient is on regular medications at home and so when they present the physician does not know that they have already taken their regular medications and consequently order them again.
New admissions, it is typical for a patient to be brought in within the first few hours of coming in. The patient is often brought by the ambulance, but there is a chance it is brought from trauma or intake. Regardless, it is your job to do a thorough assessment utilizing the ED framework we learned in school and identify areas where there needs to be further investigation. Interventions you provide as nurse are based on what you think may be the reason they are here, is it an infection? Obtain urine specimen and dip it, if it is pneumonia check for adventitious sounds or ask if they have a productive cough. Depending on the reason they are here, it may be necessary for the nurse to provide interventions before the physician is able to have the time to see the patient. In addition, it is up to the nurses judgement to see if the physician needs to see the patient right away or not. In the ED, nursing initiated actions are very common and the scope is based on the culture in the department. This is all done while I am caring for the patients I already have.
Once all this is done, I go on a 30 minute break in the morning from 0730 – 1230. I come back on break making sure vital signs are done and there has progression on their journey in their stay at the ED. Are they needing a physician to reassess them? Have they come back from medical imaging, and the results have been reported and we need a physician to take a look? Or do they need to have a social work, physiotherapy or occupational therapy consult in order to safely discharge them from the hospital? This is a constant thought you have as the day goes by on top of making sure the patients are not dying.
By now, a patient is often discharged or sent upstairs to a floor for further interventions or investigation. Essentially a patient has typically left one of the four beds you are in charge of and now it is time to receive the next one. The cycle of admission/discharges continues until it is the end of the day, at which point the night nurse shows up and takes care of the 4 beds you were assigned to.
That is the end of this video! I wanted to share what it is like in the acute beds to give my friends and family an idea of what it is like being an emergency department nurse as I always get asked. Hopefully this clarifies and maybe if enough people like the video I will explain what it is like working in the other sections of the emergency department. If you enjoyed this video please consider giving it a thumbs up! Thank you for watching and I will catch you in the next video!
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