Ever wondered what it’s like to work in an emergency room? Read below as I make a diary of what it’s like to work a day in the life of an ER nurse.
5:20: Up and at ’em. I get coffee before the shower, because I stayed up too late watching a certain show’s season finale.
6:55: Clock in. I walk over to get report from the night shift nurse. She is in a patient’s room, so I spend some time reviewing the charts of the patients who are already in the zone I’m assigned. I have four rooms today, ER 5-8.
7:15: I’ve done a quick assessment of my rooms and what shape they’re in—I’ll need to stock linens and supplies before the day gets too crazy. It’s a Monday in the emergency room (ER), a day notorious for its patient volume. Mondays are the busiest—whether it’s because no one wants to come in on the weekend or because people generally are sicker, we’ll never know.
8:04: It’s after 8:00 a.m. and this is the first time I’ve sat down again at my computer to chart. I’ve assessed my two patients, started intravenous (IV) lines and drawn bloodwork, administered medications, and restocked my rooms as much as possible. I’m charting the work I’ve done so far and documenting medical histories and medication information.
8:22: Received my first discharge of the morning. Discharging a patient involves removing any IV, taking a last set of vital signs, and perhaps most importantly, thorough patient education. I will be providing instructions to this patient about her follow up for chest pain, any warning signs warranting return to the ER, and how to take her prescription medication at home.
8:45: It’s the calm before the storm. I’ve had time to refill my coffee mug, clean my rooms up a bit, and now I just sit and wait for my zone to fill up. I currently have just one patient with abdominal pain. I gave her contrast dye to drink, and when she returns from her CT scan (computerized tomography) I will give her some additional medications for pain, nausea, and rehydration.
9:10: I receive a new patient with leg pain from ambulance arrival, quick differential diagnosis after my assessment is to rule out a deep vein thrombosis (or blood clot) in his leg. He’s presenting with leg pain and has a history of blood clots, and takes blood thinners. His leg isn’t red or swollen, so we’ll see.
9:13: I look over the imaging results for my patient with abdominal pain. The CT scan is completely normal. I prepare for her discharge.
9:50: Ultrasound shows no blood clot, leg pain patient will go home.
10:07: I’ve turned over two of my rooms to two new patient arrivals. One arrived by ambulance, a 91-year-old female with shortness of breath and respiratory distress, whose oxygen saturation (normally 100%) is only 84%. I immediately place nasal cannula on her nose and position her for better oxygenation. She may have a possible congestive heart failure (CHF) exacerbation or pneumonia (PNA), so I am starting an IV, drawing the lab work, and preparing her for a chest x-ray (CXR). My other new patient is a 28-year-old male with fevers and facial swelling down into his face and neck. He looks like the characteristic photograph of a mumps illness, and he’s spent time in Disney World recently, so perhaps he was around a sick or unvaccinated child. I start IV fluids and bloodwork on him as well, and do a screen for strep throat and mono.
10:21: I’ve drawn additional lab work and given medication to my patients. I’m about to get a new patient into my other room, someone whose chief complaint is a headache.
10:25: I’m looking over the lab results for my CHF vs. PNA case. Fortunately, she only has a heart failure exacerbation: The CXR shows no pulmonary infiltrates, and her BNP (B-type natriuretic peptide, a cardiac enzyme that indicates heart stretching in response to fluid overload) is extremely elevated. We’ve given her a diuretic called lasix to pull some fluids off her lungs and try to improve her oxygenation, so now I’m waiting for her to start urinating every 15 minutes. Her call bell is in reach, but she’s 91 and not ambulatory, so the next hour will be interesting.
10:35: The morning rush is here! We are slammed. I got an “ETOH”—alcohol intoxication—who we place in the hallway. He’s a frequent flyer, so after checking his vitals and a blood sugar, I place a sandwich and urinal within reach. I’m helping out some of my coworkers as our zones fill up and the waiting room starts to build. We get four new nurses at 11:00 (who work swing-shift, 11:00-23:00), so on Mondays all we have to do is hold out til our reinforcements arrive!
10:39: My possible mumps patient is off to imaging for a CT of his neck to check for any masses or soft tissue neck swelling. My headache patient will be getting some lab work, fluids, and medications for his pain. It’s also time to help the 91-year-old to the bathroom and recheck her vital signs now that she’s diuresing. I’m on it.
10:50: Rut ro, apparently we are considering a lumbar puncture (LP) to rule out meningitis on the headache patient, because he now reports he’s also been having some neck stiffness, low-grade fevers, and fatigue. It’s funny that sometimes patients tell the nurse a completely different story than they tell the physician.
11:20: In the last 30 minutes I’ve provided an extensive education session on lumbar punctures, as my headache/neck pain patient is understandably anxious about the prospect. I’ve assessed a new elderly patient here for weakness and hypotension (rule-out dehydration, urine infection, or some other infectious or septic process); I’ve drawn her labs, collected a urine sample, and checked her orthostatic vital signs and an EKG. We are giving her fluids, since her pressure a little soft in the 80s/50s. I’ve applied a complex wound dressing to a patient who just got a laceration repair on his elbow, rounded on my possible mumps patient, and assisted my (now admitted) CHF patient to the restroom and rechecked her vital signs. She’s actually doing much better now, 96% oxygen saturation on a lower level of O2. She’s perkier now, too!
11:35: My patient definitely has mumps, as confirmed with an amylase level. I will discharge him, check on my head-neckache patient, and go grab a quick snack before I faint from hunger!
12:15: I’ve discharged the mumps patient and gotten a new patient, a female in her 60s who recently had an ablation surgery for a cardiac arrhythmia who now presents with chest tightness and shortness of breath, especially on exertion. I’ve done an EKG, drawn her labs, assessed her, and now we will wait for a chest XR and echocardiogram to rule out atrial fibrillation versus asthma. She is stable, but I have her on the monitors for now. My patient with the neckache has decided against medical advice to forego the LP, so we are waiting to finalize the plan of care. My hypotensive patient is stable, and I’m waiting for a bed assignment upstairs so I can call report on my admitted CHF patient.
12:40: Time for a diet soda and some pretzels. My admitted CHF exacerbation is getting rather impatient waiting for her bed upstairs. My new patient just got back from imaging.
13:50: Another hour as flown by without much time at my computer station. I transported the CHF patient up to our telemetry unit on a cardiac monitor, and I gave bedside report to her nurse upstairs. I also discharged my patient who declined his LP (but made sure to give extensive information about warning signs and symptoms dictating his return to the ER, should he actually have meningitis). I gave additional fluids to my hypotensive patient, and administered a breathing treatment to my lady with asthma vs. A-fib. I also received a new patient who had a syncopal episode (fainting) this morning—I drew his labs, got an EKG, and placed him on the monitor.
14:10: I’ve discharged my hypotensive patient. She responded well to fluids, she must have been low on volume. I rechecked her blood pressures and she was stable to discharge home with follow up. Now, since I’m down to two patients, I’m running to the back to eat my sandwich. A rare “lunch break”—I’ll take it!
14:30: I came back from lunch with a full zone—gotta catch up! Two new patients and several new orders on my other ones. I also have a psych patient, who reports having thoughts of suicide. We place her in one-to-one observation with a sitter, remove her belongings, and call the social worker for consult.
14:50: I now have a cancer patient with shortness of breath, fevers, and a cough, as well as a woman in her thirties with chest discomfort. I’m about to discharge my A-fib vs. asthma patient—turns out it was asthma!
15:41: My rooms have turned over again. My newest patient is a 41-year-old female with right lower quadrant abdominal pain that is tender to palpation, with nausea, vomiting, fevers, chills, and loss of appetite. Sounds like a classic appendicitis to me, so we will work her up to rule that out or in. I’ve discharged my syncopal episode, and I’m waiting to hear more about the plan of care for my others. Lab results are back, so we just need dispositions to get these patients on the road.
16:35: I’ve turned over some of my rooms again. My psych patient has been determined stable for discharge with resources for follow up and some medication prescriptions. My possible appy is waiting to drink contrast and head over to CT, and I’ve given a breathing treatment to my patient with bronchitis. I just had an impromptu education session with a diabetic patient who didn’t take any insulin today “because I didn’t really eat anything.” Her blood sugar was 500, so we can’t discharge her now (even though her headache is gone) until we get her sugar under control. Up go the fluids, in goes the insulin!
16:55: I got pulled over to our ambulatory care area to help a colleague with a backlog of wound care, crutches teaching, and medication administration on that side. Mondays are also a big day for the fast-track area, lots of people who have minor injuries. Summer is also “laceration season,” along with bug bites, sunburns, and minor accidents.
17:10: The post-work rush is here, the waiting room is filling up. I help a colleague grab a stat EKG and blood work on a patient with diaphoresis, shortness of breath, and chest pain.
18:15: A few more patient discharges, medications, assessments ensue. The possible appendectomy will be transported to the operating room for surgery, so I have to draw a few additional pre-procedure labs and hang some IV antibiotics. Almost done, just keep swimming!
18:36: I rush down the hall because my patient-care cell phone is alarming that there is a Code Stroke in room 1. I hurry into the room and my fellow nurses and I quickly grab a blood sugar, attach the patient to the monitor, perform an EKG, and assess the patient according to the NIH Stroke Scale. The patient has slurred speech and right-sided weakness, and the primary nurse shuttles her off to CT for imaging. If the patient is a candidate for the clot-blocking medication called TPA, it needs to be administered within 60 minutes to meet the core measure standard for strokes. I know the patient is in good hands with my colleagues!
18:55: Made it through the day without a code. Time to give report to the incoming night-shift nurse. I round on my patients one last time, recheck vital signs, and tell them I am leaving but they are in great hands with the night nurse.
19:19: Clock out. Walk to my car. Phew!
19:24: As I drive by the main ER entrance I see the headache patient I had earlier walking back in. I consider stopping for a moment, but figure his symptoms didn’t go away and that he wanted the LP now. I say a quick prayer he doesn’t have meningitis and drive off-campus. Another day on the books, and I’m back tomorrow for more.