November 8, 2008, 12:49 pm

Livin’ La Vida ER

This may come as a shock, but in my entire nursing education, I never had my instructors help me get dressed.

“Dressings” had a whole new meaning by the time I was in college.

I wonder if this came from the “RN-to-Mrs.” degree program.

If Nursie McZip, RN, could not get your dress fastened all the way, did you flunk the course?

After all, if you were doing those calisthenics, your dress would close!

Wait a minute.

Now it all makes sense!

They were dressing up for Social Dancing and Etiquette 101

Perhaps this was a totally strict nursing school and dating boys was not permitted.

No fraternizing with the medical students!

Besides, you never knew when a formal dance would spontaneously erupt on the ward.


I had intended to write a somewhat scathing rant over another item from a recent “staff meeting”.

Lord knows it has given me enough material for a National Blog Ranting Month (NaBloRaMo?).

The latest “idea” is to take nurses from other departments (specifically medical/surgical and telemetry units), have them pass a few competencies and then come on down to the emergency department and fill in some holes in the schedule!

While the ER is immune from census issues, the floors are not. The floor nurses are getting canceled. A lot.

So why not utilize them down in the emergency department?

After all a nurse is a nurse is a nurse, right?



I read what they were planning to do and I went ballistic.


Emergency nursing is what is called a “specialty “. It takes a certain mind-set and a particular type of person to function efficiently in that environment. It takes skills that aren’t necessarily measurable in “competencies”.

Imagine taking those same nurses and telling them they are going to attain “competencies” and work in the intensive care unit or in labor and delivery or in surgery. Sounds ludicrous, right?

What makes the head honchos think it will be any more feasible in the emergency department?

We aren’t talking a helping hand for a shift here, folks. They are talking putting our med/surg colleagues in schedule holes as actual staff – as in given an assignment.

I am not disrespecting my colleagues, either. They are competent professionals in their fields and I’ll welcome an extra pair of hands for a shift any day. But to expect a non-emergency department nurse to function with a full assignment in a department they may see occasionally is ludicrous and unfair to not only the ER nurses, but to the nurse assigned to float to the department.

But…what if…..


It isn’t unusual for the hospital census to drop, particularly in the summer.

That’s how it was back in the mid-80s. Folks just weren’t requiring critical care, elective surgeries were down. Nurses at a certain hospital voted on whether to lay-off vs. “job-share”, dropping their work schedule by one day per pay period across the board.

Mind you, this was before the days of part-time schedules. You worked full time or per diem and nothing in between.

They voted to “job-share”.

It was great. The extra day off did not have to be covered by vacation, it was just “excused”.

The low census persisted. One day the manager of the Critical Care Unit made an offer.

Would anyone like to orient to the emergency department for three days, to help out during busy times or act as another pair of hands for a shift instead of taking an extra day off?

A few of the nurses raised their hands.


One of those nurses went down to the small emergency department to orient and observe. Over the next week she did that three times.

She was hooked after the first day.

She never considered working in an emergency department. Just the thought of it had been frightening, but not anymore. She dipped her toe into the world of emergency nursing and found the water quite inviting.

She transfered to the ER at the first opportunity.

With the exception of a brief foray into pediatric telephone triage, I’ve been working in emergency departments ever since.


I never would have considered ER nursing if I had not had the opportunity to observe and orient to the department.

How many other potential ER nurses are working in my very hospital? Nurses who, if asked today, would shudder at the thought of ever working ER, but would find their niche in the chaos we call a shift.

Seems I need to re-think my initial reluctance to show our colleagues what ER nursing is all about.

Sometimes it’s good to remember where you came from so you can help others who want to get to where you are.

Even if they don’t know it yet.


  • Strong One

    November 8, 2008 at 6:25 pm

    Maybe this ‘hole-filling’ issue could be more concrete of an action? Instead of them doing compentencies and rolling on in. Maybe they should to some sort of transitionary orientation??
    Get their feet wet with the tricks of the trade?
    And as I sit here typing this I now think how in the WORLD would this work if we tried this in the ICU..
    I see your point now.

  • NPs Save Lives

    November 8, 2008 at 6:47 pm

    I worked in the ER for a few shifts. Once in triage (I had such a headache afterwards) and once on a regular rotation. Kudos to you all. I could never work in the ER on a regular basis. ICU is another area that I would occasionally get pulled into. Same feeling there. I think that I would have felt better if I had a better and longer orientation. I was so out of my comfort zone!

  • annemiek

    November 9, 2008 at 6:10 am

    For a while we did cross training during slow periods, instead of calling people off. I liked it, but it is not being done any more because of budget. Now if we float to the ER (not happening very often, our census on med-surg is high enough) we team up with someone. I liked going down there, starting IV’s, blooddraws, help with a chest tube etc. The moment I knew that I couldn’t work down there was when I had to hold a kid for a blood draw. I almost cried with him. I don’t think I could handle the peds!

  • Shellee

    November 9, 2008 at 11:59 am

    I love the old nursing photos, Kim. I don’t know where you find them, but they are great! We truly have a rich heritage in nursing. In my 30 plus years of being a nurse, I have worked in many areas and though I am not currently working as an ER Nurse, a part of it has remained in my soul. You are right . . . ER Nurses Rock! It takes a special person for all areas of nursing, but somehow if you connect as an ER Nurse, it becomes a part of you. A piece of my heart will always be there.

  • Julie

    November 9, 2008 at 3:14 pm

    A view from the other side:

    I work in a rural hospital (came here from a trauma center) and we cover ALL areas. Our nurses work in OB, Peds, M/S, ER, and OB. I almost have come to believe that rural nursing is a speciality in and of itself. It can be scary, but it’s the only choice we got. We are 2 hours from any other hospital and the nurses here are amazing!

    Are they experts in all areas? No. Are they competent? Yes. We may just be lucky, but we have some amazing staff members.

    In fact today I started in the ER and am now working in OB waiting for a delivery to happen.

    crazy, eh? But the reality is there.

    Now in a large hospital where you have plenty of staff who can specialize then I totally agree with you. 100%. It’s just not feasible in a rural/frontier area. No one wants to live here (barely) much less have the hospital hire separate nurse for each area (which could mean 4 nurses for 2 patients – holy boredom batman!)

    Hope it all works out for you guys!

  • Nurse K

    November 9, 2008 at 6:57 pm

    Julie—In my crayzee ex-husband’s hometown, you rang a bell if you needed ER, and the “OB” charge (they had like OB and 10 med/surg-types beds total) who also cross-covered the ER would come down and the ER doc would wake up and help you. We had to do this when sister-in-law broke her foot. I was impressed.

    BTW, I’d totally wear that dress in the first picture.

  • Mother Jones, RN

    November 10, 2008 at 5:46 am

    OMG! I would refuse to go work in the ER because I love patients and I don’t want to kill them. That whole thing that a nurse is a nurse is a nurse is BS, excuse my language. That’s just how it goes…the lunatics are still running the asylum, or in this case, your hospital.


  • Julie

    November 10, 2008 at 5:32 pm

    Nurse K –

    Sounds like our old hospital! LOL. We just moved into our new one last year, but before that our building was built in the 1930’s or 40’s. One story, 10 beds, 1 OB, 2 ER. If you came after 4 PM for the ER, you rang a buzzer at the back door and we had to run across the hospital to go open the door for you and check you in.

    OH the joys of rural nursing. Now we’re a little more high tech and with the times – thank the Lord.

  • […] at Emergiblog talks about a time she griped about hospital administrators, only to realize that their idea is exactly how she got into ER nursing.  People do have the habit […]

  • Leann

    November 11, 2008 at 11:21 am

    I work at a large hospital ED with over 40 beds. One thing we have done, due to hospital/ER overcrowding, is hire a med/surg nurse to care for the admitted patients who are boarded in the ER, awaiting beds upstairs. She had a full orientation to the ER, however. I think it’s worked very well. She only has to take ER patients occasionally, and handles them well. But she doesn’t take the critical ER patients. Another thing we have done is hire an ‘admission nurse.’ Again, to help with completing admission assessments and the like on boarded inpatients. But when it comes to bringing nurses down from med/surg units, they get a full (12-16 week) orientation. There is no 3-day thing. I think if people want to shadow an experienced ER nurse, to ‘dip their toe in the water,’ that’s fine. but not to take assignments.

  • Meghan

    November 12, 2008 at 9:48 pm

    Oh boy, a nurse is not just a nurse. And we all know the ER is a way different environment from the floor (I certainly couldn’t work the floor anymore). We get the occasional float from med/surg or tele, but we just use them to do tasks- draw blood, start IV’s, give meds. But I can’t seem them taking an assignment.

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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