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By Robert G. Hess Jr.
PhD, RN, FAAN Executive vice president and chief clinical executive
PhD, RN, FAAN Executive vice president and chief clinical executive
Having a license doesn’t mean you’re competent. It didn’t take me long to realize this years ago when I added the
emergency department
to my critical care nursing areas of responsibility as a director. That addition not only took me far from my comfort zone as a clinical nurse, but outside of my skills. I had figured that specialty couldn’t be much different than critical care, right? I couldn’t have been more mistaken.
A case in point occurred when I offered to “help out” during a particularly hectic day. The ED was on divert, again. A senior staff nurse asked me if I could take the vital signs on the 12-year-old patient in room 2. I said, “Uh, I don’t think so. I don’t do children.” She said, “Oh Bob, get over yourself.” I learned ED nurses have a very specialized practice, and it wasn’t mine. But I was the director, so I dabbled. It was intense — one day we had three codes going at once in three contiguous rooms. It could be chronic — from day to day we “boarded” patients because the hospital had run out of med-surg beds.

It was scary — one evening we received an influx of patients who kept getting more critical as moments passed, and the medical staff had no clue about what was wrong with them. (They were the initial patients with Legionnaires disease from the 1976 Bellevue Stratford Hotel outbreak in Philadelphia).

It was sad — we constantly admitted young men who were dying from bizarre fungal diseases (they were AIDS patients before we had a name for the disease). But it wasn’t boring.
Laying it on the line
Emergency nurses have their own identities, which can’t be shared with any other nursing specialty. They remain technically savvy in a chaotic practice, fueled by a steady drip of adrenalin with a periodic bolus of the unexpected.

I have an ED colleague who must stay current with 10 different certifications, including advanced cardiac life support and advanced trauma care for nurses. These nurses sometimes lay it all on the line for their patients. I remember hopping on a city bus outside of our ED to code a passenger, while the bus driver drove the bus around the block to get to our ambulance bay.

That wasn’t as dramatic as the guy who pulled a knife on me while I waited for the city cops to arrive to calm down this person, who was supposed to be a sick “patient” in our ED. Extrapolating from our
2018 Nursing Salary Research Report
, ED nurses are probably not in it for the money. Their mean annual base salary is $72,821.78, lower than the $78,023.02 for critical care nurses and slightly higher than the $69,937.50 for med-surg nurses, but far below the mean salary of $82,708.91 for all the nurses surveyed.

They are more unsatisfied with their salary (combined very unsatisfied or and unsatisfied categories, 13.3%) than their critical care (6.7%) or med/surg (8.9%) colleagues. And they must not only must maintain those expensive certifications mentioned earlier but do so all on their own; more of them
maintain certification
by their professional organization than any other nursing specialty. For example, 51.3% are credentialed in Certified Emergency Nursing by their professional organization as opposed to 46.5% in critical care nursing, 34.4% in med/surg nursing, and 39.5% in all nursing specialties.

Our Salary Survey found that emergency nurses with an intent to leave nursing was 18.6% as opposed to 13.4% for critical care, 16.6% for med/surg, and 14.1% overall for all nursing specialties.
It was intense — one day we had three codes going at once in three contiguous rooms. It could be chronic — from day to day we 'boarded' patients because the hospital had run out of med-surg beds."
— Robert G. Hess Jr., RN
What keeps an ED RN going?
So why and how do emergency nurses persevere in their specialty with not only dedication but passion? I looked to two veteran ED nurses for a perspective.
Anne-Marie Summerhays, BSN, RN, CEN, SANE, charge nurse, Legacy Good Samaritan Medical Center, Portland, Ore., who has worked nights in the ED for 18 years said she wonders when it will be time to move along to another area of nursing. 

“Right now, I still love my job!” she said. “I know that I'm a different person than when I started in the ED back in 2000. I'm not as naïve, I don't have quite the same ‘bring-it-on’ attitude I used to, and I have to work harder to keep from putting up walls when things get hairy. But I have other things instead — I have compassion that has grown from lots of life experiences. I have good knowledge and an ED RN's instincts.” Summerhays lists things that keep her engaged at work. She volunteers in communities in Africa and the Philippines. She visits the gym and practices yoga. She tries to stay positive in the face of surrounding negativity. She builds relationships with coworkers. And she tries to stay up to date. Summerhays said she educates herself and has her CEN, for which she is proud. Another nurse, Pat Clutter, RN, MEd, CEN, FAEN, a staff nurse at Mercy Hospital Lebanon in Lebanon, Mo., and an independent educator and journalist, said she often wonders why she stays in the ED. “I do think that one thing that keeps me going at the bedside is that I do other things that keep me fresh and able to remain compassionate at the bedside,” she said.
Clutter teaches CEN review courses, triage courses, cultural competency and other courses, which allows her to share her knowledge with other nurses. She also works “in the mission field,” has been a cruise ship nurse for decades, and is “very invested” in the Emergency Nurses Association and its advocacy efforts. “I do truly believe that this has made me a better nurse and provided me with understanding that I never believed possible.” Clutter cites the problems of changing practice plagued by short staffing, computers, rules and regulations, insurance companies’ intrusions, and the almighty dollar, but said she stays in the ED because she wants to make things better.

“I want to help young nurses become long-term nurses — help them stay in our specialty field, and I want to help administration understand that there are better ways to do things that actually put the patient in the forefront.” Somehow, every time I interview a good nurse, it always comes down to the patients. They are the reasons most of us become nurses. And in many cases, they’re the reason why good nurses, like Summerhays and Clutter stay in practice. As a nurse and baby boomer patient, I am grateful for that.

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Robert G. Hess Jr., PhD, RN, FAAN, is OnCourse Learning's executive vice president and chief clinical executive, and founder and CEO of the Forum for Shared Governance. As an editor for, Hess has penned several editorials on career topics. As a presenter at professional conferences, Hess often addresses participants on how to find the right job and steps for building a successful career.
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