Emergency Room Nursing

Rachel Cochrane






English III Honors B

Mr. Piatak

February 27, 2014

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Rachel Cochrane
Mr. Piatak
English III Honors B
February 27, 2014
Emergency Room Nursing
Emergency room nurses provide an essential link between the care doctors give and the
patients who receive it. Modern nursing, founded by Florence Nightingale, a british reformer,
has since become specialized: An emergency nurse is a registered nurse with specialized
education and experience in caring for emergency patients (Emergency Nurse). The duties
and responsibilities includes caring for patients with an array of injuries or illnesses in countless
environments such as helicopters, hospitals and ambulances. In order to become an emergency
room nurse one must attend a college with a four year bachelors program in nursing, take the
classes on the nursing track for that school, apply and get into their nursing program, graduate
from the nursing program and complete the National Council Licensure Examination resulting in
a license for registered nursing. The outlook for nursing has become extremely positive, with the
career growing at a high rate due to the aging population and overall health of the nation. The
occupation provides many ways to grow by moving into a management position or specializing
even further. Hospitals view emergency room nursing as an essential part of the hospital
environment, as they provide critical care to patients around the clock. This paper will provide
research on the origin of nursing itself, the duties and responsibilities of an emergency room
nurse, provide the steps that one would need to take to become an emergency room nurse and
give an outlook on the future of the profession.
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The history of nursing begins with Florence Nightingale, an English nurse, and the
founder of modern nursing. Florence Nightingale dedicated her life to taking care of the sick,
wounded veterans and to the promotion of her vision of an effective public health-care system.
She sparked a reform in Britain that changed nursing from an unappreciated job, thought only to
take care of the dead, to a well respected profession. Nightingale had the nickname The Lady
with the Lamp for her belief that a nurse's care never ceased, night or day. She became the first
woman given the British Order of Merit for her great influences to healthcare (Lock, et al.).
Florence Nightingale taught nursing as a noble profession, and she made it so that others would
see this, too.
Considering the history of the profession, the responsibilities of nurses qualify as vast,
yet imperative, to the health of patients. The responsibilities of a registered nurse include
treatment in a hospital, such as recording patients' medical histories and symptoms,
administering patients medicines and treatments, setting up plans for patients care or
contributing to existing plans. There are also many other responsibilities, as well as, observing
patients and recording these observations, consulting with doctors and other healthcare
professionals, operating and monitoring medical equipment, helping perform diagnostic tests and
analyzing those results. Responsibilities also include helping patients after they leave the hospital
by teaching patients and their families how to manage an illness or injury, and explaining what to
do at home after treatment. Nurses carry the responsibility of the patients care from the moment
they walk into a hospital leading up to home care of the patients after they leave (Registered
Nurse). Some see these responsibilities as basic, but they prevail as extremely necessary to
make sure a patient throughout the duration of their admit ion to a hospital.

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Nurses work in collaboration with physicians and members of other healthcare
specialties, providing more personal care than doctors by looking after patients throughout their
stay at a hospital. Today, people view nurses as highly respected and valued members of a health
care system who bring their own body of knowledge from their extensive education to the
process of health care (Registered Nurse). Nurses, whose usual duties include assessing
patients and administering medication must preform tasks outside of their job description,
including providing dietary needs and preforming maintenance work in order to keep the hospital
running properly. Most full time nurses work three 12 hour shifts per week resulting in a 36 hour
work week. In some workplaces, hospitals divide holidays and require nurses to work two
major holidays, such as Christmas and Thanksgiving, and two minor holidays including
Fourth of July, Memorial Day and Labor Day, to keep things fair. Nurses feel as if they have
made a difference can feel extremely fulfilled by some aspects of this job. Nurses get this joy
from making patients comfortable, seeing them leave the hospital rehabilitated or, in some cases,
from comforting their families if the patient has died (Luther). The profession of nursing comes
with an extensive list responsibilities, however these all encompass qualities that make them
necessary to providing the best condition of care for patients.
Regardless of these responsibilities, stress greatly influences the profession of nursing,
while some work environments, such as a physicians office, provide low stress environments,
the emergency room distinguishes itself as one of the most stressful places to work. Registered
nurse Shelly Luther describes the most stressful parts of her job as dealing with patients seeking
drugs, multitasking in order to prioritize her time, having to pay close attention to the details of
her patients health in order to help them get the care they need and seeing patients go through the
process of dying (Luther). Stress has serious effect on nurses executing their jobs properly, as the
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Royal College of Nursing reported that of 2,000 nurses polled more than half had been made
unwell by stress in the last year. Four in five nurses said they had gone to work despite feeling
unwell. Statistics like these show that stress in the workplace not only jeopardizes the health of
nurses, but the health of their patients. These patients cannot receive the best quality care if
treated by a nurse who cannot think clearly because of their mental health. Also, 56% of the
same nurses polled reported to have experienced either verbal or physical violence from a patient
within the past year (Stress on Nurses). Nurses, especially in the emergency room run more
of a risk of feeling physically or verbally threatened by their patients. Patients coming into the
emergency room who could either have mental health problems or impairment by drugs or
alcohol stand more likely to lash out on someone simply trying to help them (Adrianessens).
Patients have spit, hit and kicked nurses because they either possess mental problems, are
inmates, or simply feel confused. In the worst cases, nurses must use restraints or sedatives to
keep themselves safe. However, security will arrive in a timely manner and remain available to
assist hospital staff in matter like these (Luther). Extremely high turnover rates of 20% within 18
months of working in the emergency room reflect back on hospital management. These rates hurt
not only patients, who could receive better care with more experienced nurses, but hospitals
because they must train new nurses, wasting the hospitals money and time. Such high turnover
rates only adds to the worldwide nursing shortage which causes patients to work more, which
cycles back to stress (Adrianessens). Although stress in any workplace can never act as a positive
thing, stress in a hospital can have disastrous results. In order to provide the greatest quality care,
hospital management needs to work with their employes to provide a safer, more comfortable
work environment.
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With this in mind, emergency nurses care for patients and their families not only in
diverse hospitals, but anywhere someone may have a medical emergency. Part of an emergency
room nurses job description includes providing quality patient care for people of all ages and in
all health conditions. Emergency room nurses must possess both general and specific knowledge
about health care to provide quality patient care in order to assess and treat whatever might come
into the emergency room. Emergency nurses treat a wide variety of illnesses or injury situations,
ranging in severity from a sore throat to a heart attack and everything in between (Emergency
Nurse). Nurses must have a constant awareness of everything going on around them in order to
intervene as soon as possible if things go bad (Luther). The nurses work in one of the most
critical departments, utilizing the education they received in nursing school to administer crucial
care to the trauma victims as they walk through the doors everyday.
As a consequence, emergency nurses having to provide patient care for almost any
situation they may encounter means specialization rarely happens. Specialization does happen
when nurses focus on one type of care they will give to patients in order to become more
proficient and provide to best care in a certain field. Emergency nurses can continually update
their education by taking new courses and from real life experience this helps emergency room
nurses stay informed of the latest trends, issues, and procedures in medicine today (Emergency
Nurse). All in all, emergency nurses have a fast paced career that requires much knowledge and
experience in order to provide care to the variety of patients that walk through the emergency
room doors.
Furthermore, nursing exists as an excellent career choice because of the generous salary it
offers, along with its promising outlook in the near future. The average salary for a registered
nurse in the U.S. averages at $65,470 per year or $31.48 per hour (Bureau of Labor Statistics).
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While the average salary for ER nurses in North Carolina pays $65,600 annually or $34 per hour
(Staff Nurse). North Carolina has a booming economy and a large growth in population,
factors which make North Carolina an ideal place to work as an emergency room nurse. An
emergency room nursing job pays one of the highest salaries in the field because of the intense
strenuous work nurses in the emergency room perform everyday. The job outlook for nursing
grows at a rate of 19% per year, the US Department of Labor has reported. Factors including an
increased emphasis on preventative care, growing rates of chronic conditions, such as diabetes
and obesity, and demand for healthcare services from the baby boomer population affect the
outlook of this job (Bureau of Labor Statistics).These figures offer a desirable addition to the
career, but commitment and handwork accompany this profession.
Before one should think about salary, one must attend a nursing school. Two educational
paths exist that one must choose from in order to become a registered nurse. The first path,
earning a bachelors degree, remains the most popular; this includes a four year program at a
university, which requires two years of basic college classes and then two more years at a
nursing school. This path provides a natural career route for students directly out of high school
because students will go to a university just like their peers. Acquiring a four year nursing degree
means greater opportunity for promotion and a way to qualify for higher paying careers because
one has received a college degree along with attending nursing school. The second option to
become a registered nurse can be achieved by attaining a hospital based diploma or an
associates degree. Completion takes two years for both of these programs, however associates
degrees have gradually started replacing hospital based diplomas offered at local community
colleges (RN: Education Requirements). Most professional employers seek nurses with a
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bachelors degree more often because students will have more experience when entering the
workforce.
UNC Chapel Hills school of nursing has established itself as one of the best nursing
schools in North Carolina. In their extremely competitive nursing school, UNC Chapel Hill
accepts only the best of the best. In order for Chapel Hill to accept a student into the nursing
program, they must have a cumulative college GPA of 2.8 and submit an in depth application.
This application must include a descriptive personal essay, history of community service and a
list of special skills and abilities. The university wants their students to have the potential to
contribute to the overall nursing profession, hence why their extensive application process
prevails (First Degree Admissions). UNC Wilmington remans as another well respected
nursing school in North Carolina. UNC Wilmingtons nursing program requires a total GPA of
2.7, which ranks a bit lower than that required of Chapel Hills nursing students. UNC
Wilmingtons nursing program aims to give its students a foundation for their nursing careers.
Students achieve this purpose through interactions between the nurses and their patients and
other health care professionals including doctors, pharmacists, physicians assistants and other
nurses (School of Nursing). Both UNC Chapel Hill and UNC Wilmington offer outstanding
and competitive nursing programs that one could gain authentic experience through classes and
clinical programs.
During the course of the nursing programs schools like UNC Chapel Hill and UNC
Wilmington provide clinical experience to their students in hospitals. Nursing students learn
through supervised clinicals in different departments like pediatrics, psychiatry, maternity and
surgery. Many programs offer this experience in other environments such as nursing care
facilities, public health departments, home health agencies and ambulatory clinics. Recently a
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strong emphasis has been put on nurses receiving a college education so that nurses will have the
education to use the latest methods of diagnosing and therapy. This kind of knowledge requires
training in both the classroom and in a hospital but students also must pass a state licenser exam
even after they have graduated and become a registered nurse. Practically every state licensing
board requires a nurses success in the passing of the Nation Council Licenser Examination
before they can practice nursing. The National Council of State Boards of Nursing constructed
this test to include psychosocial integrity, healthcare environment safety, health promotion and
physiological integrity. This exam ensures newly licensed, entry-level nurses can preform their
duties safely, responsibly and effectively (RN: Education Requirements). Basically, the Nation
Council Licenser Examination makes certain that the public remains protected in their health
care and that they have the opportunity to receive quality care from nurses.
In addition, the workplace today takes part in an ongoing education process as colleges
and other educational institutions offer classes and degrees to continue ones development as a
nurse; online schools also offer classes that can continue this process. Nursing changes as nurses
become more and more specialized than in days past. Today, specialties include: operating room
nurses, geriatric nurses, medical-surgical nurses, labor and delivery nurses, pediatric nurses,
intensive care unit nurses, and even psychiatric nurses. The career has become a lot more
competitive and by continuing education and clinical experience, nurses can ensure that they
remain on top of their game from the moment they graduate nursing school until they retire from
nursing, ensuring them jobs and putting them in the running for promotions (Blanche). By
specializing, nurses can focus on a part of the profession they enjoy, gain experience with it and
have a higher possibility in gaining a job in that field.
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In the same manner, the nursing field continually changes as new practices that increase
productivity and quality of care commence. The shifts nurses work and where they complete
these shifts has changed dramatically; for example, about 60% of nurses work in hospitals or
impatient and outpatient clinics, while the the rest of nurses work in different environments
including nursing homes, medical offices and government healthcare facilities. This situation
continues to change as healthcare delivery switches from inpatient hospital to outpatient
ambulatory and community facilities. (Registered Nurse) Outpatient procedures provide a
more economical option for both the hospital and the patient and have become more and more
common as new technologies develop that require less invasive procedures, therefore a shorter
recovery time and less severity in general.
In the same way changes to shifts and workplaces have changed nursing, science
advances with new technologies, the advancements affect of which nursing. Nursing has
dramatically changed technology such as wireless communications, real-time location systems,
delivery robots, workflow management systems, wireless patient monitoring, electronic
medication administration with bar coding, electronic clinical documentation with clinical
decision support, and interactive patient systems, meaning productivity has increased and quality
of life can change dramatically for a patient. Paper patient records and charts have now shifted to
electronic records, which means greater accessibility between doctors. Diagnosing and treating
patients will happen quicker because of this new accessibility and the need to rely on patients for
their medical history will eventually become nonexistent (Heller). For example, if a trauma
patient comes into the emergency room, a nurse would no longer need to find out if the patient
has allergies or previous medical problems, but can simply ask for their name and the name of
their primary physician. However, this means that this private information could end up not just
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in the hands of patients and their healthcare teams, but in the hands of insurance companies
which could potentially raise premiums for some people.
A point often overlooked remains that the male to female ratio of nurses in the field has
also changed the profession of nursing. Nursing originally distinguished itself as a job for men
either religiously by serving the church, or in the military. However, once the Civil War began
women started to enter the work force and stepped into the mens nursing positions while they
were away at war. By the early twentieth century, nursing schools and nursing positions in the
military only accepted women and the military did not start accepting men again until after the
Korean War (Gross). Now, while the number of female nurses still outnumbers the number of
men, in the nursing community, men have become greatly encouraged to join the profession that
society once deemed solely for women. Men still have a long way to come in order to catch up to
the number of women in the profession, but men and womens salaries have achieved equality in
this profession. Nursing provides one of the only fields in which women can break the glass
ceiling separating womens salaries from reaching the degree of mens salaries. Women and men
earn the same amount of money consistently in nursing, something very rarely achieved in any
other profession. Nursing has broken gender stereotypes starting with men working a job thought
previously only for women and then by paying these men and women the same. As far as
statistics go, men make up less than 10% of registered nurses, but this has increased from 1970
when only men made up only 2.7% of nurses. Additionally men make up about 12% of students
in Bachelors programs for nursing in universities (Williams). Nursing prevails as an
undoubtedly progressive job, where men and women remain act as equals in their salaries and
their responsibilities.
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Furthermore, the possibilities seem endless for growth as an emergency room nurse, as
one of the easiest ways to grow in the career results in becoming an emergency room manager.
Emergency room managers work by providing support, life saving information, and an unbiased
voice during the many stressful situations that take place in the emergency room. Emergency
room managers complete these responsibilities by advocating on the behalf of their patients, their
families and staff to provide solution that benefit everyone. In order to become an emergency
room manager, one would need to try to add supervisory responsibilities to their resume. These
responsibilities could serve as stepping stones leading to a management position. Continuing
ones education would also help in growing to become an emergency room manager because it
would provide a greater knowledge and more experience in management. Classes in
management would help one handle the legal, economic, planning, directional responsibilities
that come with the job.
In light of this, nurses can also grow in their profession by specializing in a certain
department. Most registered nurses start their career as generalist, or someone who focuses on
nursing in general instead of specializing, so that can find a job easier because hospitals will
have the option to place nurses wherever they need help at the time. Once a nurse has
experienced working in the different departments of a hospital, they can choose something they
like such as pediatrics or oncology and specialize in it. By specializing, nurses can often earn a
higher salary or receive a promotion because it shows their knowledge in a certain field.
Registered nurse Shelly Luther, who has specialized in liver and kidney transplant recommends
that a nurse should enter a speciality as soon as possible in order to gain more experience
(Luther). Nurses can become certified in a specialty and this typically requires two or more years
of working in that field and passing a certification exam. The American Nurses Credentialing
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Center administers this exam, which shows if the student possesses professionalism, ambition
and a willingness to learn needed in order to formally specialize (Decker). Specialization can
unquestionably help excel nurses in their career, as it provides an expanded knowledge on a
certain department and can occasionally lead to a promotion.
To conclude, emergency room nurses provide life saving care to everyone who walks
through the doors of the emergency room. From its origin nursing has had the qualities of a
selfless profession, caring for everyone in need. Their responsibilities revolve around the comfort
and benefit of their patients. This rings especially true in the emergency room where nurses must
constantly provide care for from the most to the least serious of emergencies to and tensions run
high. Although the education needed for this profession remains extensive, there remains the
potential outcome for hundreds of lives to be saved.




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