The ER Exit

A small blurb into my experience as an ER nurse.

“The greatest enemy of knowledge is not ignorance; it is the illusion of knowledge.”
— Stephen Hawking

Posts

Reflections after 8+ years in the emergency room setting. From EMT to RN. How I navigated the role and what I wish other nurses or those considering the profession knew.

  • 🚨 When Chaos Hits the RooM: What Every ER Nurse Should Know Before the Code Starts

    There’s this strange moment during a code—especially when you’re new—where it’s so loud, so frantic, that your brain does the opposite of panic:

    It zones in.
    So far in, in fact, that you almost start to tune everything else out.

    This hyperfocus can be a gift… but it can also be dangerous if you’re not used to working under pressure—especially if you’re learning, and so is your resident.

    Staying calm is essential. But so is being confident, and more importantly:
    ✅ Communicating clearly
    ✅ Repeating back orders
    ✅ Double-checking everything—especially meds

    💉 Sedation First. Always.

    One of the most common missteps during a code—especially in high-stress RSI situations—is mixing up the med order.

    Sedation always goes before the paralytic.

    It sounds obvious, but in the rush, it can get flipped. And while your doctor should be giving clear, step-by-step instructions, it’s often another nurse at the bedside who’s actually pushing the meds.

    That’s why I’ve gotten in the habit of calmly asking:

    “Just to confirm—Versed first, then Roc?”
    or
    “That’s 100 of Propofol before the paralytic, correct?”

    Even among experienced teams, mistakes happen—and you’re the final checkpoint. It’s not about calling someone out—it’s about protecting the patient when the room is moving a mile a minute.

    Sometimes it’s a miscommunication.
    Sometimes it’s a slip of the tongue.
    But either way—you’re the one holding the syringe. So double-check everything.

    🧠 Why I Created My Code Room Cheat Sheet

    Some ERs are lucky—pharmacy is present at every code, especially in Level 1 trauma centers. But that’s not the norm everywhere. At several hospitals I’ve worked in, we didn’t have that luxury.

    That’s why I made a small, durable badge card for myself:

    • Common adult sedation meds
    • Typical doses + routes
    • The correct sequence during RSI/intubation
    • Quick reminders when your adrenaline is spiking and your brain stalls out

    👉 [Click here to grab my ER Code Cheat Sheet for Nurses]
    It’s designed to fit on your badge and give you confidence in the chaos.

    🧰 Running the Room: Know Your Setup

    If you are the nurse in charge of a code room, then guess what?
    That room is your responsibility.

    At a minimum, you should:

    • Know where everything is (airways, meds, suction, crash cart, emergency blood setup)
    • Know if it’s fully stocked (ask for or help create a checklist!)
    • Know who’s doing what (assign roles early)

    Even before the code hits the room, I mentally walk through everything. Why?

    Because you can’t lead in chaos if you don’t know your terrain.

    🧍‍♀️ Key RN Roles During a Code:

    Here’s how I like to break it down when I’m assigning roles:

    • Recorder: Writes down meds, times, compressions, shocks. This is often me—it helps me stay in charge and keep the big picture in view.
    • IV/Med Nurse: Pushes code drugs, draws labs, confirms doses
    • Airway Assistant: Assists RT or MD with BVM or intubation setup
    • Compressor: Rotates every 2 minutes
    • Runner: Goes to lab, gets extra meds/supplies
    • Monitor Nurse: Tracks vitals, rhythm, and defib pads

    ✅ Pro tip: If someone isn’t actively helping, kindly ask them to step aside.
    Too many bodies = too much noise = too much risk.

    🧬 Communication is Everything

    One of the most overlooked skills in the code room? Hierarchy control.

    In a teaching hospital, there might be three MDs with ideas. That’s not a bad thing—but it can get messy.

    So I ask:

    “Dr. Smith, are you running this code?”
    “Great—I’ll be taking orders from you directly. Everyone else can funnel through you.”

    This keeps communication clear and prevents conflicting orders, which can delay or harm patient care.

    💨 Don’t Forget RT

    If your ER has Respiratory Therapy, they should be alerted the moment you are about a code or intubation coming.

    They’ll be the ones:

    • Setting up the vent
    • Assisting in bagging
    • Helping with advanced airways

    In codes, they’re your best friend. Don’t assume someone else called them—make sure.

    💬 Final Thoughts

    Running a code is intense—but it becomes manageable when you’re prepared.
    Know your meds.
    Know your roles.
    Know your room.
    And when things get loud and fast—be the one who slows it down by getting it right.

    👉 Need a quick refresher you can keep on your badge
    Grab my ER Sedation + Code Meds Cheat Sheet—for the moments when your brain goes blank and the adrenaline is spiking.
    [Click here to grab my ER Code Cheat Sheet for Nurses]

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  • 🩺 You Don’t Have to Be a People Person to Be a Great Nurse

    What They Don’t Tell You About Emergency Nursing, Part 1

    When you think of ER nursing, you probably imagine fast-paced decision-making, trauma bays, and complex medical scenarios. And yes—those things are absolutely part of it.

    But what no one really tells you is this:

    One of the most important skills you’ll develop in the ER is learning how to talk to people.
    All kinds of people. In all kinds of states.

    Here’s the funny part: you don’t even need to be a “people person.”
    You just need to be observant, intuitive, and genuine. And honestly? It’s a very underrated ability. One that can either make a difference to a patient/family member in their time of need or an outcome with a psych. And trust me we are also human, and thus never perfect and this is why we must recognize our own signs of stress and burnout prior to it happening.

    👀 It’s About Reading People—Fast

    When someone rolls into your ER bay, you have to make instant judgments—not just about vitals or physical symptoms, but about their emotional state, communication style, and even what tone of voice they’ll respond best to.

    Some patients want warmth.
    Some want directness.
    Some want humor.
    Some will give you a hard time regardless of what you say.

    Being able to read the room—even in 15 seconds—is a superpower that only comes with time. But it starts by paying attention.

    💬 Always Start with the Basics

    No matter how chaotic the shift or how urgent the task, one thing I always do:

    “Hi, my name is ____. I’ll be your nurse today.”

    Simple. Clear. Grounding.
    That one sentence sets the tone and establishes trust from the first second. It keeps the moment human.

    ⏱ Multitask with Intention (It Makes a Huge Difference)

    In the ER, you’re constantly working around your to-do list—drawing labs, checking orders, placing patients on monitors, grabbing meds—and still trying to make people feel seen.

    One of the best tricks I’ve learned over the years?
    Time your full assessment with the provider visit.
    Why?
    Because most providers will ask many of the same questions you need for your chart—and it helps the patient avoid repeating their story 5 times.

    Yes, some repetition is medically necessary. But if someone’s feeling sick, anxious, or exhausted, they will notice and appreciate when you’re trying to streamline things for them.
    And yes—a happier patient often makes your job easier.

    👶 Don’t Forget the Kids (and Their Parents)

    Pediatric patients deserve a special mention here—because the communication dance is completely different.

    You’re not just treating a child.
    You’re treating the entire unit: child + caregiver(s).

    Here’s what’s worked for me:

    • I always address the child first—even if they’re little. A quick “Hi buddy, I’m your nurse today. We’re going to help you feel better, okay?” goes a long way.
    • Then, I turn to the parents—and refer to them as “Mom” and “Dad” in the room. “Hey Mom, I’m going to place this monitor on his chest now. Totally painless—just some stickers.”
      “Dad, we’ll get those meds started shortly—thank you for helping him stay calm.”

    It seems simple, but it’s powerful.
    Calling them Mom or Dad acknowledges their role and reassures them that you see how important this tiny human is to them. Because let’s be real—they’re scared. Even if they don’t show it. And children, who are emotionally tuned into their parents, will pick up on every cue.

    If you can calm the parents—you calm the child, too.

    🙋‍♀️ You Don’t Need to Be a Talker—You Just Need to Connect

    People assume ER nurses are outgoing, chatty, energetic. And sure, some of us are.
    But honestly? You can be quiet. You can be introverted. You can be soft-spoken.

    What matters is that you’re present, empathetic, and adaptable.
    That you listen. That you adjust your tone. That you explain things clearly—even when you’re busy.

    And most of all, that you remember:

    In the middle of the chaos, there’s still a real human sitting in that stretcher, waiting to be heard.

    💬 Let’s Talk

    What’s something you do to connect with patients when you’re short on time but still want to make an impact?
    Drop it in the comments—I’d love to hear what works for you.

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  • Things I Wish I Knew My First Year in the ER:

    💧You Can’t Pour From an Empty Cup: Why Taking Care of Yourself Comes First in the ER

    When I first started working in the ER, people would tell me,

    “You have to take care of yourself before you can take care of others.”

    It sounded cliché. Like something you’d read on a Pinterest quote board.

    But I’ve come to realize—it couldn’t be more true.
    Because if you don’t? Resentment builds. You start snapping at your coworkers. You take things way more personally than they were meant. You get foggy, drained, reactive… and frankly, not safe.

    And the wild part? Sometimes it takes a few bites of food or a sip of water to bring you back to baseline.

    🍽 The Hangry Nurse Is Real

    I can’t tell you how many times I’ve caught myself getting annoyed at everything—patients, families, even coworkers—only to realize:

    “Oh. I’m starving. And I haven’t had water in 6 hours.”

    Unfortunately, in the ER, there will rarely be a “perfect” time to take a lunch. The chaos doesn’t schedule around your hunger. So you have to plan ahead and advocate for yourself.

    For me, starting around 11:00 AM, I begin mentally scanning my patient list—looking for a safe window to break away. That might mean:

    • Knocking out a few higher-priority tasks early
    • Delaying a non-urgent phone call
    • Catching up on charting after my body is refueled

    Even if it’s 10 minutes instead of 30—it’s possible.

    💦 Hydration Is Not Optional (No, Seriously)

    You wouldn’t believe how easy it is to forget to drink water until your head is pounding. So here’s what works for me:

    • I bring a massive water bottle to work. One I won’t need to refill halfway through the shift (because, spoiler: I won’t).
    • I keep it at the nurses station with a straw lid—so I can sneak in sips while charting. Yes, I know. No food or drink at the desk.
      But listen—I will break that rule forever. For my own health. Period.
    • If I’m falling behind, I’ll chug some between patients or during a quick walk to the med room.

    🚽 Pee Breaks Are Sacred

    Let me say it louder for the nurses in the back:

    Pee breaks are not a luxury—they’re a reset.

    Sometimes the 90 seconds I spend in the bathroom are the only time I’m alone, without alarms, phones, or someone needing something from me.

    Even if I don’t need to go—I go.
    Just to breathe. Just to be alone with my thoughts.
    It helps more than you’d think.

    🧠 Taking Care of You = Taking Better Care of Them

    When I’m fed, hydrated, and grounded, I’m:

    • More patient with the person screaming at me
    • More clear-headed during a rapid response
    • More compassionate with families on the worst day of their life

    Self-care isn’t selfish.
    It’s actually one of the most important clinical skills you can have.

    💬 Let’s Talk

    What do you do during a shift to take care of yourself—mentally, physically, emotionally?
    Drop it in the comments—I’m always looking for new ways to protect my energy (and sanity).

    Leave a comment

  • 🩺 Thrown Into the Fire: What Starting as a New Grad ER Nurse Taught Me About Humility, Grit, and Growth

    I didn’t know if I could stomach the blood, chaos, or pressure—so I signed up to be an EMT.

    That’s how this whole journey started. I ran calls for multiple towns, mostly to see if I was truly cut out for healthcare / the nurse life —and if I could handle the culture that came with it. Spoiler: I was captivated. I loved the dynamic of always learning and working alongside people who could really teach you a thing or two.

    Fast forward a few years. During my final nursing school rotation, I was placed in an emergency department—and ended up being hired straight into that very ER after graduation. That kind of direct transition was rare back then, especially at a Level 1 trauma, teaching hospital. New grads just didn’t start there, which makes sense for patient safety reasons. But also for burn out. If I wasn’t young, with 0 kids and had that fire of wanting to absorb so much from so many different areas of expertise, I don’t think I would have survived. (For instance, if I was to start over now I would be recognizing the many different disadvantages with a family and the lack of experienced nurses that work in the ER nowadays. In addition to the worsening staffing that continues to reek havoc in healthcare.)

    Looking back, it was way harder than nursing school—and maybe even harder than my first degree, which had enough chemistry to melt your brain (iykyk). But the challenge was exactly what I needed. It pulled me out of my comfort zone and taught me the most important lesson of my career:

    To be a great ER nurse, you have to get comfortable being uncomfortable.

    🔄 The Learning Curve Is Steep—And That’s the Point

    There’s no sugarcoating it—those early days were brutal. You don’t walk into the ER knowing how to run a trauma, manage multiple crashing patients, or comfort a mom who just lost her child. You learn by showing up. By watching. By doing.

    And most importantly—by asking questions. All the questions.

    Yes, even the ones that feel “dumb.”
    Actually—especially those.

    Because every time you risk sounding clueless, you gain clarity. You gain confidence. And you gain trust—from your team and from yourself.

    💬 Be the Nurse Who Asks, Listens, and Tries

    To grow in this field, you have to humble yourself constantly. That means:

    • Sitting in with doctors, PAs, APRNs, and seasoned nurses when they explain things to patients—because listening teaches you just as much as doing.
    • Telling a patient, “That’s a great question. I’m not sure—but I’ll go find someone who knows.”
    • Accepting that you are human, and you will never know it all.
    • Utilizing all your resources and specialties provided; Ex: your pharmacists, radiology, charge RN, etc.
    • Healthcare is the definition of team sport
      • No one succeeds alone in the ER—not the nurse, not the doctor, not the tech, not the transporter. It often takes a whole team with multiple teammates working in sync just to stabilize one patient.

    New nurses often hesitate here. They don’t want to look weak, slow, or unprepared. But guess what? Every expert in that ER was once brand new too.

    You don’t build clinical confidence in a classroom—you build it at the bedside.

    You try things. You ask for backup. You give yourself grace but also recognize when it’s time to step aside and get help.

    🤍 Final Thoughts: Growth Isn’t Comfortable—But It’s Worth It

    If I could go back and tell my younger self anything, it would be this:

    You’re not supposed to have it all figured out right now.
    But if you keep showing up, asking, and trying—you’ll be someone your team can count on.
    And more importantly, you’ll become someone you can count on.

    The ER is unpredictable, humbling, and at times—completely overwhelming.
    But it’s also one of the most incredible places to grow as a nurse, and as a person.

    💭 Let’s Talk

    Have you ever felt this way in your own field—medical or not?
    Drop a comment if this resonates, or if you’ve had a “thrown into the fire” kind of experience that shaped who you are. I’d love to hear your story too.

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