It’s Friday night in the emergency room (ER), and the pace has picked up steadily since I started my shift at 3 p.m. Right now, I’m running five rooms, and I’m lucky to have an experienced tech helping me.  

EMS arrives with a 55-year-old male complaining of back pain. He’s calm and walking easily, and his vitals are normal except for a slightly elevated blood pressure. He says he’s just nervous. I tell him to rest and I’ll be back soon to retake his blood pressure, just to be safe.

I move into my next room where a patient has just been sent back from the waiting room. The triage note says she’s here for a pregnancy test. The patient is cheerful, and we chat about her college coursework while I help her settle in. As an ER nurse, I’m able to enter certain orders independently, so I order the urine pregnancy test and move on. 

The patient in room three is a frequent flyer with cyclic vomiting. These cases can be tough.  He wants Dilaudid and he wants it now. I perform a full assessment, enter the basic orders for abdominal pain, and try to make the patient as comfortable as I can until the doctor can see him.  

Room four is a new mom with intense abdominal pain. She’s only a few days postpartum after a cesarean section. She has a fever, and I’m worried about infection, but she’s worried about her milk supply. I call my charge nurse to ask if there’s a breast pump anywhere in the hospital. Our small community hospital doesn’t have a maternity unit, but I’m determined to find a solution.

I check in with the patient in my fifth room, a nonverbal patient with sepsis. I double-check that he’s getting his fluids, cultures, and antibiotics according to protocol, and ensure he’s clean and comfortable.

As I leave his room, the tech grabs me to say she’s concerned about the repeat BP for my back pain patient.  But before I can go in to assess him, the lab calls with a critical value for the patient in Room 2.

This was my pregnancy test patient, the one who was supposed to be an easy in-and-out. Except the lab is telling me her glucose levels are off the chart. I dig deeper into the patient’s chart and realize she’s a Type I diabetic with frequent admissions for ketoacidosis, a fact she failed to mention when I asked about her medical history.

I ask my tech to put my back pain patient on the monitor and run BPs every five minutes while I deal with the patient in diabetic crisis. It’s an intense few minutes while I work with the doctor to get her started on fluids and an insulin drip. But my tech pulls me aside while I’m bringing bags of saline into Room 2 to explain that the back pain patient now has a BP of 190/125. Now I’m really worried. I ask the tech to do an EKG while I finish up, and by the time I’m done, my tech is running at full speed, EKG waving in the air.

I glance at it, and send her directly to the doctor – any doctor – and hurry into his room. It’s only been 45 minutes, but the patient now appears diaphoretic and anxious. I grab my phone and radio the charge nurse to let them know we have a probable STEMI (a type of heart attack). I’m going to need help.  In seconds, I have a team of nurses with me, starting lines and administering aspirin, nitroglycerin, and fluids. I tip off my charge that I have critical patients in rooms 2 and 4 and ask if someone can check on them. Every ER nurse knows that things can change on a dime, and everyone is ready to step in when there’s a crisis.  

The patient is stabilized and on his way to the cath lab within minutes. I check on my diabetic patient, and she’s already being prepped to go up to the intensive care unit (ICU) thanks to my top-notch tech. In our ER, we always do bedside reports for ICU patients, so I notify my charge nurse that I’ll be off the floor for a few minutes while I transfer her. After I return, I check in with my sepsis patient, but my charge nurse is already there. I’m grateful yet again to be part of such a good team. Finally, I’m able to return to my maternity patient. I’m shocked to learn that our hospital doesn’t have a single breast pump.

I make a mental note to come up with a proposal for the nursing administration to acquire one in the future. 
In the meantime, I get my patient set up on fluids and antibiotics per the doctor’s orders. Then, I teach her how to hand express. It’s not a typical ER skill, but in this job, you need to know a little bit of everything. This is her first baby and she’s nervous, but within a few minutes, she’s got the hang of things.  I find my tech and give her a big hug for the way she advocated for our STEMI patient. There’s no time to rest though. My rooms have already been filled with new patients. My head is swimming at how quickly everything changed, but I’m also unbelievably proud to be part of such a smart, intuitive team.

If you think you would enjoy the autonomy, fast pace, and variety of cases that come into the ER, then don’t wait to schedule your free EARN evaluation today. In just 15 minutes, you’ll be matched with a peer nurse who is eager to know more about you and your career aspirations.

Elizabeth is a former ER nurse and current nurse writer who specializes in health content for businesses, patients, and healthcare providers. Her work in healthcare has spanned the globe, from Bosnia-Herzegovina to Colombia to Guatemala.