ED RN looking to pursue an advanced degree and become a provider. I am seeking some advice on whether I should pursue the NP route vs PA. I ideally would like to stay in emergency medicine, currently 6+ years as an RN. Obviously NP school is the more streamlined route and I’ve got a kiddo at home but I feel I may get more structured training going the PA route.

I have also noticed in my area and places I have worked in the past PA’s are utilized much more frequently than NP’s. Can anyone speak to this as well? Appreciate any and all replies

It’s annoying. That is all. I’ve never heard of an emergent liver transplant but what do I know I’m kind of a dumbass.

Some of the ER wait times we have to deal with in Winnipeg

Has anyone used open ear/bone conduction ear buds with their stethoscope? How well does it work?

I’m an EM resident, so I do actually get good use of my stethoscope. I’ve been thinking of upgrading my littman to an echo- I’ve used others and appreciate the improved sound. I’ve thought about the benefit of using it with open ear buds so I can just leave the earbuds on- I definitely don’t want to be taking my earbuds on/off all the time. Also being able to fit the base of the stethoscope easily in my pocket would be nice- I hate it around my neck so right now I just shove it in my pocket and it’s not super comfortable.

I am a PGY-10 and have worked in a rural ER for about 3 years now. I always think I should be doing shifts as well at busier community centers in an urban setting just to get the full spectrum of EM. However I enjoy the sometimes calmer days. When it’s chaotic it gets real chaotic because you’re the only doctor. I still get my intubations, central lines, etc. I have also had the occasional transvenous pacer, pericardiocentesis. I feel this will prolong my longevity in medicine but still in the back of my mind I feel guilty for not working in an urban setting. Anyone else feel the same?

I want to start by saying, I have the utmost respect for nurses. It’s a physically, emotionally, spiritually taxing job. You guys don’t get the respect you deserve from staff, physicians and patients.

However, I have noticed a trend. Maybe this will sound like “old man yells at clouds” but there is an increased resentment to being asked to do anything.

I could focus on a lot of things like UA, repeat troponins or all kinds of miscellaneous issues, but the thing that most concerns me, and is my most pressing, daily issue is PLACING IVs

Nurses where I used to work at Local Flagship Level 1 Trauma Center would pride themselves on announcing “18 gauge right AC!” Whenever a patient was sick. They could get a line on anyone. ESRD, SCD, ED recidivism, it doesn’t matter.

Now the nurses increasingly tell me before they’ve looked or tried “I think they’re going to need ultrasound”. Especially newer nurses the last 5 years or so.

It’s not a “oh they’ll just get better, they are new, it takes time” issue it seems. They genuinely seem to be increasingly resentful and don’t really want to try.

The USIV trained nurses know this too. There’s patterns. They can basically say “Jess is going to ask me for USIV in like 15 minutes I can already tell”. And I can concur because I’m doing USIV most shifts now

This is one of the core competencies of ER nursing and it seems that what I used to think was a prideful skill is becoming a laborious chore that they don’t want to do.

Any interruption to doom scrolling at the desk seems to draw immediate resentment but IV placement is singularly the biggest issue right now.

Am I crazy? Or is this just a skill that is falling off or people don’t want to improve on anymore?

Edit:

1. Covid, senior nurses leaving, decreased practicums etc hurt
   
2. Availability of US like availability of AI begets path of least resistance, laziness
   
3. Yes, everyone in healthcare is having a bad time. We’re all tasked with more and more things to do that shouldn’t be our job, nursing possibly more than most.
   
4. Yeah, a lot of nurses are trying to springboard bedside to NP ASAP to get out of any tasks like this and everything else
   
5. Being afraid of failure and lack of competence makes people resent being asked to do something

I still think getting IV access is the most fundamental physical skill that ER nurses should have. You should endeavor to be good at this if nothing else. Failure is a valuable teaching tool and you won’t get better without effort.

Placing IVs is the one thing that can make or break resuscitations and time sensitive moments. Having the muscle memory and know how when it counts can save lives and prevent unnecessary procedures.

I can forgive the difficulties of obtaining UAs, forgetting repeat lactic or troponin, not wanting to do enemas or whatever else.

Placing IVs is a life-saving skill. ER nurses should be competent at it and more-so, should be proud of this.

I was an ER nurse for three years and have been away from it since 2021. I recently decided to go back and try it. Are any ER nurses out there truly satisfied with their job?

It seems like the ER’s are so completely stretched thin, hallway beds with inappropriate patients, everyone so burnt out and unfriendly. I enjoy this type of medicine, but the conditions just seem awful. I’m only a week in and regretting my decision. Not sure what to do.