A true trauma junkie is hard to find, but the ER is so much more than blood, guts, and heart attacks. Have you ever wondered if the ER was the right place for you? Read on to learn more about what it takes to make it in the trenches.

1. ER nursing is not regular nursing. The only head-to-toe assessments you will find here are in trauma patients who have actual injuries… well… head-to-toe. The ER focuses on system assessments. They are quick and to the point, but a mistake in this assessment can cost valuable time or may even be deadly. It might seem like less work, but the stakes are higher. You need strong assessment skills and an eye for detail (without much time to look).
2. If things are going well, you will turn your team over several times throughout the day. Everyone grouches about admission, but the ER sees a revolving door all day, every day. Each patient starts from scratch. If you are the kind of person who doesn’t mind making fast connections before moving on, that’s perfect. If you prefer to get to know your patients and keep them longer, the ER isn’t for you.
3. Your nurse/patient ratio is one to however many people are in the hall. The ER functions through teamwork. You can bet that while you may start your day with three patients, you will likely end up carrying a team for another nurse who ends up with a critical 1:1 patient. The floors can shut their census down when things are full, but the ER never closes. True emergencies don’t wait, so you can end up withholds for the floors, hall beds full of patients, and waiting rooms hours deep.
4. There is no telling what will walk, roll, or crawl through the door, so the ER nurse has to be prepared for anything at any time of day. If you like structure, this isn’t the place for you. If your secret joy is keeping one step ahead all day while the department burns around you, head straight to the ER and do not pass go (but please collect your sign-on bonus).
5. You have to be open to everything. Very little surprises the ER nurse; they’ve heard it all and seen way more than they cared to. You may find some jaded ER nurses, but you won’t find ones that aren’t tolerant. We’ve seen the best and the worst of humans and will treat them both with kind words and respect. There is no room for judgment here. The ER nurse will get whatever you got stuck, out of wherever you stuck it, and then go pray with the Catholic nun in the next room without batting an eye.
6. ER nurses are critical care nurses. Don’t let the laid-back, dark humor fool you. These nurses run some of the best codes, know critical protocols, and are prepared for just about any emergency in the book. It may not look organized, but that team can get through anything 12 hours can throw at them. You will need to keep up on the latest news, learn the newest algorithms, and meet all the same expectations with less fancy equipment and higher patient ratios than the ICU.
7. If you don’t already have mad skills, you will earn them. You can laugh all you want at that 22 in the left foot, but there aren’t many nurses out there who can nail an IV as an ER nurse can. These nurses help perform pelvic exams and drop NGs like they are hot. They can throw a foley in from across the room and can whip out an NIHSS in less time than it took you to find it in the charting system. ER nurses work with less and learn to make do with what they have, so you have to be flexible and resourceful.
8. Prioritization is the name of the game. Who comes first? You will triage patients into categories and then prioritize what care you provide. You will re-prioritize at the drop of a hat many times a day as new patients arrive, conditions change, or your bladder reaches the bursting point. If you weren’t good at those “which answer is the BEST answer” questions, this isn’t a game you will want to try your hand at. Those split-second decisions need to be the right ones.
9. Your whole day can go up in flames, but you will drop everything for your patients. You will hold it together during final breaths and then walk smiling into the next room. You will have great saves and terrible losses. The ER isn’t for the faint of heart. There is poop and maggots, and birth, followed by death, vomit, and pain. In the middle of that mess, you will find an ER nurse holding a hand, giving a smile, or making a joke like it’s totally normal to see a bone splintered through the skin or a blood sugar of 900.
10. Finally, ER nurses are some of the best team players in medicine. Your team member will drop a line AND draw your labs while you check in your ambulance. Your charge will discharge your patient while you get one to the cath lab. Your techs will have your back when that troponin repeat is due, but you are sitting with the psych patient. If you can’t play on a team, don’t join the sport.

Do you have what it takes to be a kick-ass ER nurse? If this sounds like a great day at work, figure out what you need to do to get there. Now is a great time to transition into a new adventure!