IamAn ER Nurse and have been for many years. AMA!

What's the creepiest thing you've seen or heard about at work?

Now THIS one is easy. By far the creepiest thing was this one chick Who was about 40 years old. We had her in our psych holding room. All of her testing came back negative for drugs or any other abnormalities but she was clearly off her rocker. The security guard assigned to watch her all the sudden collapsed. We rushed back there to help him and I happened to look into her room. The lights were off and she was standing up but backwards at an impossible angle. As soon as I looked in there she stood right up and the lights came back on. She said "who's next?" It was like something out of a horror movie

Did you previously post this story on r/nosleep? I definitely read this story on there. Very creepy. Props to you. I probably would've quit after seeing that.

Actually yea I did. Scary stuff

Do you have the link to the story ? I'd love to read that.

Here you go

Thank you! That's so freaky

Right? Gave me chills

Wow, what ended up happening with her?

She was transferred to a psych inpatient facility shortly afterward and unfortunately the security guard died in the cardiac Cath Lab from a massive heart attack. Haven't seen her since

Did you find out how she got out of her restraints?

Nope. Never got the story. It's my understanding the investigation is ongoing

Not sure I understand, what do you mean by 'standing up backwards'

Sorry I was dictating this on my phone and it missed a few words. "Standing up bent* backwards"

Favourite and least favourite types of patients? ie what comes in and you go 'oh no' or 'oh this is cool' ?

Least favorite: drunk people that just want to be drunk but the police drag them into the emergency room to sober up. They usually get pissed off at us. Favorite: anything life threatening. I know it sounds morbid but emergency medical personnel do what we do because we love fixing people and "saving lives". Heart attacks, cardiac arrests, respiratory failure, massive wounds or trauma, and patients in SVT are all favorites for me

+100

I had to take my son to ER and there was a drunk guy. The police brought him and the guy was screaming.

It's incredible how drunk people end up claiming / consuming ER resources :-(

Isn't it? Whatever happened to the gold ol' fashioned drunk tank in the PD?

If only we had one in our ER and it had a floor drain and a hose that would be fantastic.

This should be a GoFundMe project

I worked in the ED in Maui, and there is no drunk tank on the island, so all the drunk assholes picked up end up in the psych room in the ED.

That's how it is most places nowadays. No one wants to take responsibility if something happens so they dump them on us. How was Maui? I might come there on my next assignment

maui was great, one of my favorite hospitals. John Mills ED doc there definitely the coolest doctor I've ever met. im a phlebotomist, and we get shit on a lot, and that dude treated us great. life on the island is as good as it seems like it would be, waking up in paradise everyday. I never really realized how many people die on vacation. in a place like maui you see a lot of that. there's also cool shit that doesn't happen in other places like shark attacks/tsunami's. and then its like 73 degrees ever day ever so that's nice.

Dang. I'm in Southern CA right now and the weather is great, the pay is crazy good, and I love it here. I just can't fight the urge to live in Hawaii

What are your tips for passing the NCLEX?

Hurst if you want a review of nursing school. Kaplan if you want test taking strategies. I prefer Kaplan because I'm not good at tests

What's the weirdest thing you've ever seen in a hospital?

Hmm. That's a tough one. Not sure if this is the absolute weirdest thing but I've seen someone go into anaphylaxis because she was allergic to aspirin. The weird part is she didn't take any aspirin. Her boyfriend did just before they had sex and he ejaculated into her

Pretty sure that was a House MD episode. lol

Could have been. The ER physician published the case study because there were no cases like it before. It had only been a theory that severe allergies could be triggered through that type of contact up until this case

I work in a hospitals IT department and have always wanted to ask, what's your opinion on the IT department? Any run-ins with weird IT people?

I love the IT guys. Anyone that can fix an issue fast is OK with me. Most of the time I talk to you guys for something simple like a password reset but when I can't log into my computer, it's anything but simple trying to get my job done

What was the worst experience?

New Years Eve 2014 (Night shift). It seemed like everyone wanted to die and we didn't have resources to save them all. We were in "Code Black" for like 24 hours straight. Several nurses were crying in the breakroom throughout the night and one turned in her resignation the next morning. That and any time we lose a kid or baby. Those are never easy

What's a "Code Black"

Code Black is a generic term for when a hospital is dangerously overcrowded. There are more patients than there are resources. It's called different things in different places but every hospital has that type of status code

code "we be fucked"

Exactly

As a 2nd year resident who did a rotation in a busy ER, how do you treat the med students that come through every year?

Med students are lots of fun. We understand you all are learning so if you act as such, we never have an issue. Ask questions, learn fast, and treat nurses as your coworkers, not as you subordinates.

What would you say to your 18 year old self?

Forget about pre-med. Just go right into nursing. I wasted $15K and 4 years pursuing med school only to shadow a cardiologist for a day a realize I'd rather kill myself than be a practitioner

I often see nurses (or people in scrubs) out and about at the stores. Isn't that sort of a risk of infecting others by wearing clothes from the hospital out and about?

This can present a VERY small risk. I like to think people who wear them out in public have not been in contact with any contagious illnesses since the scrubs were last washed. Many healthcare professionals have zero patient contact but still wear scrubs so it's hard to tell.

Did you start with a ASN/ADN, or BSN?

I am going to be applying to a nursing program in the near future after finishing my pre reqs.

I really want to work in the ER having prior experience as a combat medic for the Army, and had a blast doing it.

I currently only hold an ADN. As it stands now there are only about 25% of hospitals nation wide that only hire BSN or higher

Thanks for the answer!

I aim to getting my BSN afterwards, but haven't decided on pursuing a MSN, or go to PA school afterwards.

I've heard PA school is the way to go but I can't give you any specific examples. Just what I've heard...

What was the goriest thing that you've ever seen?

Kid was hit by a car and launched 20 feet. Tore his arm off and when he landed his face skid on the ground and made him I recognizable. Very sad case. He was 9. Don't play in the street!

That is sad indeed...I don't understand what the better thing would be for you to most efficiently do your job; to be desensitized to the plight of others or to be extremely passionate about your work. To feel sad or not to feel sad at all when bad things happen, both seem to be a double-edged sword if you ask me.

Very true. It's a fine balancing act. If you're too empathetic you'll get burnt out quickly. If you're not empathetic enough, you won't be able to relate to your patients and come off as cold or heartless

Have there been moments that have almost convinced you to give up? ER nursing seems like a crazy job, and I imagine you'd see some horrible things.

When my daughter was 3 months old, I had a 3 month old SIDS baby come in that we could save. Had to go home and drink myself to sleep after that one. Called in sick for the next day (not because of the hangover)

About how much do ER nurses make?

Salary varies based on location throughout the country and years of experience. I started out in Florida making about $40K/yr full time. This year I'll make over $100K in California as a traveling nurse

How many hours are you working for that 100k?

36/week. 3 twelve hour shifts

Is that hourly wage typical? Most nurses I know working that much only make around 50-60k

No it's not typical. I work as a traveling nurse so they give me extra non-taxable money for housing and meals. That stipend also varies on location and job. It's easy to become a traveling nurse but you have to be willing to move every few months

How do you view paramedics?

Tricky question haha. There are good and bad paramedics. Everyone makes mistakes and no one is perfect. If you do your job to the best of your ability and can take constructive criticism without getting pissed, you're OK in my book and I'll treat you as a peer. It's when the medics are lazy or refuse to learn from coworkers and their mistakes that I have an issue. Overall I've found most paramedics to be the former type.

Questions about paramedics....

1. Are they allowed to dose narcotics? I always wondered about if they rolled up on a gun shot victim in obvious pain, are they comforted with any type of pain management for the ride to the hospital?

2. If they are, how much is carried on their ambulance? Is it enough for one trip or do they just refill their meds at the beginning of each shift?

Thanks for your IAMA session, good stuff!

Paramedic protocols vary slightly between each state. I've never seen any paramedics able to give narcotics without a doctors order. I know most medics can give ketamine as a sedative, but I've never heard of narcotics being given. As far as stocking goes...Couldn't tell ya. I imagine they restock after each run but I'm sure they carry enough meds in case they can't make it back to base between runs

Have you ever had to give someone a catheter with a huge dick? or micro penis?

How was that like?

Student nurse here...just Catheterized a male patient with an innie penis. Was not expecting that at all, but straight face and carry on as usual.

Good for you! One of the hardest (no pun intended) caths to get

Yea for both. Had one guy (unconscious) who was described by a female nurse as "a slippery eel". Dude was huge. We see the micro's a lot more often. Even seen a few "inny's" Takes some extra effort but we have a few tricks to find the hole

Currently a nurse for little over a year on telemetry and I'm not really digging it. Do you have any friends in different areas of nursing who love their job?

I absolutely HATED working on the floor. I was miserable for a year. After I got my year in, I transferred to the ER. I love the organized chaos and the fast paced. If you're into getting paid to travel, I'd look into travel nursing. That's what I do now and I'm making bank seeing the country. I can give you more information on that if you'd like

I'd love to learn more about travel nursing. How does it affect you and your relationship with your family compared to some of the more popular positions?

I have a wife and 1 year old daughter. They come with me everywhere and it works out great. I did an AMA on travel nursing a while back if you want more information. Here it is

Thanks for the link. How hard would it be to try a different unit coming from telemetry? I still feel nervous at times even with 1 year of experience, so I'm not sure if they would give me the worst groups during my shifts lol. What's your plans for the long run?

I haven't run into any hospitals giving me the worst assignments. Most of the time they are thankful to have the help. Changing specialties is challenging for the first few weeks but if you're unhappy now, only place to go is up. My long term plan is to travel until I find somewhere I want to settle down

I have been to my local ER many times for mental health issues

Do nurses typically make fun of the ones having mental issues amongst themselves?

Do you ever have trouble sleeping with your work schedule changing ?

No. Mental health is a relatively new field of study and many older nurses and doctors don't quite understand that it is a legitimate issue and many MANY patients go untreated. We do not judge you. We do not make fun of you behind your backs. We want to help and we are glad you're seeking treatment. Sleeping can be hard when you work night shift. Typically people that work night shift die sooner than those who work regular hours. It takes a toll on the body for sure

How do you feel about the legalization of pot? what can we expect to see more of in our hospitals with this around the corner?

I've never had a problem with pot. We usually see cases of people abiding the synthetic stuff and/or the legal drugs (alcohol). If marijuana helps people heal, more power to ya

Hi! I'm a 4th yr pharmacy student. Do you have any advice for someone getting into healthcare?

I've worked several codes, and the worst ones (GI bleeds, VT in the cath lab, abused pts going home with their abusers) seem to stay with me. How do you keep your soul after all the things you see?

Edit: corrected autocorrect

It helps to have a sense of humor. While "treat everyone like they're your family member" sounds good in theory, if we were to actually do that, we'd all be in mental institutions for the stuff we've seen. We treat each patient as a problem to fix (or at least stabilize). This doesn't mean we are heartless or that we aren't empathetic. We just can't get attached to everyone we meet

How irritated are you with people who come to the ER for things that are not emergencies?

It's job security to me. It gets irritating when it backs up the waiting room or these people take a bed from someone who REALLY needs it. Some of the time it's a lack of education or someone who educated themselves on the internet from bad sources. Other times it is the drug seekers, or the homeless with nowhere else to go.

Hi! What you do every day puts you up high in my book. But have you ever had any situations ala "Sex Sent Me to the ER"? If so, how do you handle it without making it even more awkward/embarrassing for all involved?

I was in triage one night when a couple walked in the front door. Mid 40's. Man was holding a bloody ice pack on his junk and the woman a large bloody bandage on the top of her head. They were out for their anniversary at a fancy restaurant. The wife decided to give her husband something extra special and crawled underneath the table ;-). Turns out she had a seizure and bit down on his dick. He couldn't get her off and his only reaction was to take the fork and stab her in the top of her head. Not making this up. Most of the time people laugh about it and I just do my best to remain professional. I've developed quite a poker face. Everyone knows how awkward it can be so you just try to keep a straight face and resist all the jokes that pop up in your head unless the patient starts joking first

Oh my god, I had a gf with epilepsy and the idea of her going into a seizure during a bj terrified me for years. Never happened, but this answer made me cringe. I hadn't thought of that in years.

You're welcome

I heard that another ER nurse never wanted to have her own baby because she's seen all the things that can go wrong with children, does it scare you, too?

I'm actually currently working at a children's hospital in the ER and yes it can sometimes get scary. There's a million syndromes and genetic disorders that can cause lifelong hardships for the families. I just hope that I personally don't have to deal with any of those

Have you ever treated a family member?

Never treated a family member while at work but family members come to me for treatment and advice all the time. About 80% of the time I can give them advice or treatment so they don't have to go to the hospital. Other times my response is "See you doctor"

How do you deal with the stress?

Alcohol!

Just kidding. It's important to leave work at work. I can tell these stories because they're memorable and interesting or funny. 99% of the stress I deal with is forgotten as soon as it leaves the door. We are trained how to handle stressful situations and it's important to appear calm even if we're freaking the fuck out inside. As one of my instructors once said "All bleeding stops eventually"

Have you ever had a case come in where the nurses and doctors couldn't figure out what was wrong right away? Kind of like the patients who end up on Medical Diagnosis?

I've seen that 2 or 3 times. I can't think of a specific case but they're usually after traveling over seas and bring back some disease that US doctors aren't very familiar with. That why there are specialists to figure things like that out.

Do you have any suggestions for a nursing student inspiring to be a ER nurse? I have a year left in school. I would like to get some experience in the field I'm interested and would wondering if it would help?

If any of the local hospitals hire nursing students as techs in the ER or on he floor, look into that while in school. It's great practical experience and you get to know the management and they get to know you. It's great to get a foot in the door

You may not be answering but I hope this reaches you.

I have an illness called CRPS/RSD. I am fortunate because I was diagnosed early and have access to an amazing medical team.

With that said, I moved across the state so when emergencies occur I now end up going to a small town ER instead of the ER that has my team of doctors. I have been treated like hell despite the fact that I don't take any narcotics and never have asked for them. It seems like if you have a pain disorder you are immediately not taken seriously. At times, it could have seriously effected my health. I once ended up with a serious infection because doctors ignored my symptoms of pain (even though I've never had pain in my ear.)

I just wanted to ask you if you could go to RSDS.org and familiarize yourself with the CRPS/RSD emergency room protocol. It was created to help make the lives of both patients and emergency room staff easier because we don't like being treated like drug addicts when we come in for stuff, and you don't like giving us the medication we need. Ketamine has been useful in treating pain episodes.

Sometimes with RSD we have comorbidities that we don't realize we have yet and that can be scary. When we come in with pain and nothing is wrong, but we swear it hurts, often something IS wrong but the ER is not the place you will find it. This has happened to me numerous times. I have left the ER feeling like I'm crazy, no one believes me, and that my pain isn't real. In addition, instead of just validating how I feel I get drugged to high heaven. I hate being medicated like that. Please keep this in mind when you have interactions with these patients.

Also, while I get there will always be drug addicts who make it hard for those of us with legitimate conditions, please keep in mind that sometimes the person who you think might be a drug addict could truly be suffering and your kindness could mean the world to them.

Finally, please familiarize yourself with this disease. I have always had positive interactions with hospitalize staff who have heard of my disease, even if just a little bit. All negative reactions have been from people who don't know what it is. They seem to hear "Pain" and don't hear anything else.

So could you please do those things?

Absolutely. I love learning about new conditions and illnesses. I have seen and heard of this condition before and it's not pretty. Unfortunately you're correct and many healthcare workers are jaded because of the drug addicts. That's not an excuse for poor treatment though. Hopefully you'll have better experiences in the future

What has been the strangest up the butt item?

A foam pool noodle. Some 40 year old guy put a condom on it and his wife helped shove it up there about 8 inches. He couldn't get it out so he cut off the end, and took a nap in hopes it would come out on its own. Came to see us a few hours later

Have you ever experienced a mass casualty event?

Not yet. They don't happen as often as Greys Anatomy says they do

What's your advice for passing marijuana pee test? Like how many months of not smoking for the lab see that I am clean?

No one can really say how long you will test positive for marijuana, since the rate of THC metabolism varies per individual. The amount of marijuana consumed can also alter the window of time that your body retains traces of THC. First time users usually pass the test within 4-5 days. Frequent users usually around 10-14 days. Extreme cases can be detected up to 2 months

What are things ER volunteers with no clinical training can do to make your life easier?

Warm blankets to the patients and families. It goes a looooong way. Also just stopping by the rooms and saying hi. These people are having one of their worst days ever and a friendly face helps quite a bit

Are DOs treated any differently the MDs by mid levels? What about by their fellow physicians?

I can't speak for fellow physicians, but I've never seen any DO treated differently by nursing staff. Often times DO's are more approachable than MD's so friendliness goes a long way

I've been to the ER a few times: you guys absolutely rock!!!

How do you feel about ER visits that are not immediately life threatening ? E.g. kidney stone, sleeping leg due to compressed nerve, panic attacks ?

Stuff like that is understandable because they can be quite painful and feel like and emergency. An emergency doesn't always have to be life threatening. I enjoy helping people and those types of cases usually yield a positive result because of what we can do in the ER so it's still rewarding (hope that makes sense)

How can you tell when someone isn't cut out for the profession?

You definitely have to be a "people person". You can talk all the shit you want behind their back but if you can't handle yourself professionally when you're face to face, you might want to consider something that deals less with people

Why do you have a captain America bandana on and a superman under your picture? Is it for children or just to get a good laugh from people in the ER?

A little of both haha. Kids are the hardest to please and it sometimes can relax people when they know their nurse is a real person with a real personality

What's your favourite medical tv series/movie?

Scrubs is my favorite of all time. Currently I'm into Code Black. It's ehh as far as accuracy goes but 100x more accurate than Greys Anatomy or other medical dramas

Including ER? Loved that show.

I never got to see ER while it was on. I'm bummed. I feel like I missed out

I watched all 15 seasons. The first season is on Amazon for less than 20 bucks. I'm really curious what you would think about it.

I'll check it out and get back to ya

How is Scrubs as far as accuracy goes?

Scrubs was actually relatively accurate medically. There are obviously more nurses than just Carla and Laverne, but the cases weren't wildly abstract, the doctors didn't overstep their specialties, and the doctors didn't overreact to dumb stuff. I love Scrubs

How often do you see patients with something like POTS/dysautonomia? I've been to the ER twice in the past year when I've had a bad flare and I always feel bad because most nurses don't know what it is and shrug it off as anxiety/panic attack and keep saying I'm just very dehydrated. Anyways, keep doing what you do! We need more nurses!

Those rare disorders are....rare. Nurses and doctors are required to stay up to date with continued education and practices, but things like that don't come around very often. You really have to have been around a long time to have physically seen some of the rarest conditions. I've personally never seen POTS but I would definitely recognize it if I did. I love medical mystery shows and one of my favorite episodes was on a POTS case. I'm sorry you haven't had better experiences, but we don't always know everything. It may be beneficial to ask your nurse "Are you familiar with POTS?" next time. Just a thought

I'd like to shadow nurses because they do more of the nitty gritty stuff. Especially in the ER.

How should I approach doing this? Would it bother you?

What should I be especially mindful of?

I'm not sure if a program exists that allows non-healthcare professionals to shadow nurses. I wish there was. Too many laws about confidentiality I suppose. It wouldn't bother me at all. I would try contacting the director of your local ER and ask. If they let you do it, be mindful to not get in the way. Good luck!

Do you ever watch TV medical dramas? Are any of them realistic, or do you find them preposterous and laughable? I'm a fan of the genre, but two new ones (Code Black and Chicago Med) seem less realistic (to my untrained eye) than ER.

Haven't seen ER. Code Black is somewhat close to realistic. Greys Anatomy is way off. Honestly, the closest to real life show I ever watched was Scrubs. The biggest problem these shows have is that the doctors do everything. When in reality, the doctors do very few actual procedures. The doctors are the thinkers and orderers. The nurses and CNA's are the doers

Whats your experience with ER's from other contries?

Never worked over seas but I've heard good things. I've heard patients in other countries are less "entitled" feeling and much more grateful for helping them out

Any time I read anything about hospitals or medical care in the US I'm astounded at how people have to pay for their care. Have you ever had to refuse to help someone because they simply couldn't pay their way?

No. EMTALA is a federal law that will literally shut a hospital down if they ever turn someone away. If you show up to an ER, you will be treated no matter what. Nurses know nothing about your insurance or financial status unless you volunteer that information. The insurance stuff is a totally separate department

Do you have any regrets about past experiences in your job?

No not that I can think of. Everything I've done has lead to where I am today, and I love it

In your opinion which kinds are the best run hospitals and which are the worst?

Interesting thought. Best run in terms of patients satisfaction, Board of Directors satisfaction, or employee satisfaction?

What tips can you give for someone aspiring to be a nurse ?

Stick with it. It might get hard but in the end the rewards are definitely worth it. If you don't like the field you're in, there are plenty of other nursing fields to be a part of

Why do you think your better and more interesting than other people just 'cause you are a medic?

1) Never said I was better than anyone. 2) I never said I was a medic. 3) you're*