A break, too late…

The last several days have seen the backside of the crest of the tidal wave of patients in my ED. Finally, it’s just a regular ED and not an utter madhouse like it has been 24/7 for the last three months.

And, it’s too late. We’ve lost several of our experienced ED nurses to other departments and other hospitals. "A nurse is a nurse" you say, and you couldn’t be more wrong. Nurses in the ED environment are an unusual breed, and frankly it takes trying out about ten to find one who can really hack it, and one in twenty really gets it.

That doesn’t make the hackers immune from burnout, unfortunately, and we’ve been burning the brightest candles at both ends for months (metaphor alert).

When I hired on 3 1/2 years ago a traveler (traveling nurse) was unique, now there’s a bunch in our ED. That’s not to say travelers are bad, they aren’t; usually they’re experienced and smart. Unfortunately, they’re also temporary, so all their training leaves at the end of their contract. Thus, the institutional knowledge leaves.

ED’s aren’t run by the docs, but by the nurses, and when we lose one it diminishes us. I miss them all.


  1. John J. Coupal says:

    The nursing profession seems to swerve from a glut of practitioners, to a famine with no stop in between.

  2. Anonymous says:

    I feel your pain. In the ICU’s, it is torture without a good nurse. We must make nursing a more attractive profession otherwise this so-called health care crisis will never be resolved.

  3. ED’s aren’t the only places “run by nurses”. In general, this group of professionals provides the bedrock of most medical institutions. It behooves us all to keep them happy, and to keep them!


  4. Allen,

    I was wondering if you had any thoughts on what caused the tidal wave of patients to hit and then recede after three months? Was it random chance or something else?



  5. First of all, thanks for the nod to Emergency Nurses. It’s great to hear such a supportive opinion of my profession. I completely agree with you on the ratios of average/great ER nurses, and most days I think I fall into the latter category.

    But the exact same process you describe is happening in my department, too, here in the Rockies. We’ve had the usual winter crush, which has been even heavier than usual, staff morale is cruddy and turnover is incredibly high. (Doesn’t help that we’re in the middle of construction of a whole new department and a move to computerized documentation next month.) We’re working short-staffed all the time anymore, and the few new nurses we seem to be getting are travelers and/or local agency nurses thereby not eligible, at our facility, to handle the high-stress assignments like trauma, triage, and of course precepting new nurses. So as a result, the ones of us who really are good and really enjoy our jobs, get stuck precepting every day or working in Triage every day, and don’t get to actually be nurses. It hardly helps morale. Seems like the whole deal is a self-fulfilling prophecy, and some days I wonder when it’ll claim the first patient life.

  6. Wow – thank you so much for salute to ER nurses!

    I work in an ER where 90% of the nurses have been there over 20 years. I started 2 years ago (would have been there myself 20 years ago if I had known how good it was!)What are we going to do when they all retire? I’m a good 20 years from retirement, I figure I’ll work until I’m 70 if my back holds out that long!

    It’s a great department and the docs have all been there forever, too. When a new doctor comes or has to sub, all he has to do is his regular thing and the nurses have him covered.

    It’s true, you are either born to ER nursing or you are not. I thrive on it. Took two “breaks” over the years when I felt I needed a change of pace/specialty but I always wound up longing for the ER again.

    It’s so nice to hear from a doctor, “Thank god you’re on, it’s been nuts today!” when you come to work!

  7. Thanks for all the kind words! I’m not ED, tried it years ago; can’t handle the kids that come through. I do med/surg/ortho and am a traveler. In the 8 years that I have traveled, I must admit that most all the MDs have been really terrific to work with as have the majority of nursing staff.

  8. Nice props!