3 Common Misconceptions About Working in the ER

I get a wide variety of reactions when I tell people I work in the emergency department.  Some people are immediately drawn in, eager for a conversation about my "craziest" stories.  Others ask about my career cautiously saying they just couldn't handle all the blood.  There are a lot of misconceptions about working in the ED, even among those considering the emergency nurse practitioner profession.  Let's take a look at what life in the ER is really like by debunking a few myths.

Myth #1: The ER is Absolutely 'Crazy' at All Times

When I tell someone I work in the emergency department, the term 'crazy' predictably gets brought up.  While the public may think this accurately describes life in the ER, many days it does not- at least not in the every patient has a life threatening medical condition sense most people are referring to.  

There are certainly days on the job that I feel life as an emergency department NP is 'crazy'.  However, my most frantic, stressful days are not usually due to high patient acuity level or performing procedures but rather the need to manage a large number of patients at one time.  Sure, treating a high acuity patient is tough and sewing up complex lacerations requires time and skill, but managing multiple patients simultaneously is a mind game.  Keeping track of lab results, CT scans, medications and consulting specialists for more than six patients at a time is what qualifies as 'crazy' in my book.

Myth #2: The ER is all Blood, Guts and Gore

Yes, the emergency department is a world of blood, guts and pus.  Most patients walking through the sliding glass doors of the ED, however are not bleeding.  Chest pain, abdominal pain, back pain and headaches are problems I frequently treat.  None involve tourniquets, sutures and wound care.  As an emergency department nurse practitioner, I have also seen a number of wounds developing a high tolerance for what qualifies as "gore".  Once you have sewed up a few finger lacerations these no longer seems like "blood and guts" situations.  I do have my share of stab wound stories but they aren't quite as common as you might think. 

Myth #3: Every Patient Who Comes to the ER Has an Emergent Medical Condition

People come to the ER for a variety of low acuity reasons from ear infections to mosquito bites.  Uninsured patients frequent the ER for primary care type problems since the emergency department does not demand up-front payment.  Other patients present to the ER for non-urgent issues as a matter of convenience.  We're open 24/7 which fits with everyone's schedule.  Most patients I treat do not have a life-threatening or even high acuity medical problem.

Do you work in the ER?  What do you think prospective ER NP's need to know before starting a career in emergency medicine?

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Comments

As a nurse, I think prospective ER NPs need to know that this area has a reputation of being procedure heavy and historically, having a more limited scope of practice for an NP than say, primary care. Many NP students in my experience have been surprised by how procedure oriented the work can be for midlevels and how narrow the scope can feel when working side by side with the ER MDs. Also, many student NPs also neglect to consider the irregular work schedules and find themselves unhappy when asked to work weekends, holidays, nights, etc. Its something to consider when looking for a "home" as a midlevel. How close to 9-5 are you trying to get?

Vicedrn