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ER nurse; responsibilities, training, title
i r smexy, amber!pic
ladyamber wrote in little_details
Location: Massachussetts/East Coast, USA
Time Period: Now-ish

I have a character who works in a Massachusetts ER as a nurse, mostly evening and overnight shifts, and I have some specific questions regarding what his standing/responsibilities would be.


1) To be a mid-to-high level nurse in the ER, what sort of nursing license would he need? RN, NP, one I'm not thinking of right now? I'm sort of assuming RN, but I'd like to be certain. And if he went into nursing once he graduated high school, how many years would he have to be in school to get it?

2) What are the responsibilities of a trauma nurse? Do they just do documentation, are they the ones responsible for starting IVs and giving shots? Are they ever called on to stitch up or patch up a patient on their own? What is a "typical" shift for an ER nurse like, considering there's rarely typical shifts in the ER?

3) Since he's a male nurse, are there responsibilities that would specifically go to him? I'm sort of thinking things like "pinning down an uncooperative patient" and such, but I mostly want to know if there's anything that may possibly come up due to his gender.

4) What's the general opinion nowadays of male nurses? Are there prejudices against them? Do people assume things about their sexual orientation? Are they starting to be more common in hospitals? I've heard of comments like "Nursing's for girls, why aren't you a doctor?" and "He's a male nurse. Must be gay," but I think those date mostly from the 90's, so I'm not sure if it applies anymore. Anecdotal comments much appreciated!

Research done: My Google-Fu is sort of failing on this. I've Googled various combinations of nurse responsibilities/emergency room nursing/male nurses, and while I've found general information, I haven't found a whole lot of anecdotal or detailed information on the subject. The best I've come up with were one or two "day in the life" articles by female trauma nurses, and a blog by an ER nurse in California, so I have some idea, but I'd like some more anecdotal information specifically pertaining to male nurses if at all possible.

Thank you in advance! :D

1. For years of school - there are two ways to be come an RN, an associate degree (2 years full time) or a bachelor degree (4 years full time). Both sit for the same liscensing test, though for a 'higher level' you'd be looking at him having a BSN or a masters. An NP has been through a masters program for example, though there are other programs he could do in graduate school (nursing education for example).

It's also possible to become certified in specific areas once you're an RN and have worked in a department for a few years. I'm not sure if trauma is one of those areas though. That's also something worth looking into.

And in case you didn't run across this site in your search - http://allnurses.com/. Lots of forums and thus personal experiances to draw from.

Oops, sorry, I accidentally hit post before I was done :P

1) It depends on what you mean by mid-to-high level. Do you mean he's an RN with a lot of experience & seniority, or do you mean someone with an advanced degree? You might want to look into something like a Clinical Nurse Specialist, which requires a masters degree. He could be a CNS specializing in ER nursing, for example. It really depends on what you want him to be able to do. You can become an RN with a bachelor's degree (BSN), an associate's degree (ADN), or a Diploma, so it can take from 2-4 years. That might differ depending on the state though, so check the laws specifically for MA. Also, I know at least some masters programs require you to have a BSN to be accepted, so you might be safer just going with a BSN if you want him to have an advanced degree.

2) Their responsibilities will depend on what kind of degree they have, but I'm not sure specifically what they would be in the ER since I'm still a nursing student & I don't have that kind of experience yet.

3) Again, I'm not sure because I'm still a student, but I can imagine he might be more likely to be asked to help move a heavy patient, for example.

4) I'm female, so I haven't experienced any of this first-hand, but I think there is still some prejudice but that it's lessening. He might still run into people who think he "wasn't smart enough" to get into medical school or else he *obviously* would have been a doctor. There are a few male students in my nursing classes and I've never heard anyone gossiping about their sexual orientation, but that's not to say that it couldn't happen. My roommate's boyfriend has been trying to get into the nursing program at my school (there's a ridiculous waiting list), and I've never heard anyone I know question his "manhood" or sexuality or anything like that; I've only heard encouragement for him. I've also heard from my instructors that male RNs get paid better than female RNs, and that they tend to get more respect from male doctors (I don't know if that was based on a study or just anecdotal evidence).

1) At the hospital where my mom works (she's the chief of nursing there), she doesn't hire nurses for the ER unless they're RN/BSN. She'll take regular RNs for other parts of the hospital, almost never LPNs though. The way she says it, the difference in salary is more than made up by the level of autonomy that RN/BSNs can legally function with.

2) In my experience, nurses don't suture. In hospitals, they are always working with doctors. They will be providing a large amount of the care to a patient, but they cannot do it without a licensed physician's orders. It's a legal thing, iirc.

The best way I've heard it described about doctors and nurses is this -- doctors are there to lead the patient care. Nurses are there to provide part of that care, but more importantly, they're there to act as advocates for the patient. They often see less patients than doctors, so they're able to connect with the patients on a deeper level, and they're really the ones that ensure the patient is being given the best care.

4) Several of my friends are male nurses and they don't seem to experience any sort of discrimination. But, on your note of "nursing is for girls," I can't tell you how many times I've been taken for a nurse instead of a (student) doctor, because I'm young and I'm female. It's a fun expose on gender roles within the US.

Night-shift ER PA here.

1) RNs do all of the nursing in our emergency department. NPs are midlevel providers who see patients in a similar fashion to doctors. BSN vs associate's (or "diploma") training makes little difference in the actual job (although there may be a preference for BSNs in hiring.)

2) A typical ER shift for our night nurses (mostly 12 hour shifts, although some hospitals do 8 hrs) is to report ~1845, go to "shift report" where the charge nurse gives any relevant news to the oncoming staff (RNs and "patient care techs"), then go into the ER and find whichever nurse you're relieving, take report on anywhere from zero to 5 patients from him/her (why they're here, pertinent history and physical exam, pending tests, what we think's wrong, are they getting admitted, etc) then proceed with doing whatever needs doing.

Our nurses start IVs, give meds, apply splints & dressings, assess patients, discharge patients, etc. The techs (not RN trained) or nurses either one can draw blood, help with gyn exams/rectal exams, collect flu/strep swabs, insert catheters, collect stool samples, help with procedures. The RNs may start lab/x-ray orders if there will be a wait, and can ask the providers for med orders if they feel they're needed before the patient is seen.

The MD/DO/NP/PA "providers" do the history and physical exam (often repeating a portion of the RN's assessment,) order the diagnostic tests, order the meds, interpret the tests, suture any lacerations/perform intubations/insert chest tubes/etc and form the dispo plan (home, admit, transfer, surgery, etc) along with calling any consultants necessary (general surgeon for appendicitis, orthopedist for a fracture, hospitalist for diabetic ketoacidosis.)

All of this goes on until sometime middle of the night 12-3ish, when our nurses are typically each rotated out to lunch (someone "watches"/covers their patients for the 1/2 hour break) then the nurse returns and repeats the above until 0700 when the day shift shows up.

3) Male nurses are sometimes used for brawn (restraining the drunk/disorderly/crazy,) and occasionally for specific knowledge more common to men. (I had help from a couple of them yesterday in removing an injured football player's pads - as a chick with two daughters, the mechanics of football pads are entirely foreign to me.) They are specifically excused, in our department, from helping with gyn and breast exams, and catheters and rectal exams on females. We've also used our male nurses occasionally to care for patients who pick on the female staff - usually sexual harassment from male patients. The guys take those patients, just to spare their coworkers.

4) No assumptions about sexuality in my ER experience. We have lots of male nurses, and I'd reckon ~10% of them are gay. No one would assume either way (although IME it's a pretty gay-friendly profession - I've never heard/seen an anti-gay comment toward, about, or behind the back of any of our gay staff, male or female.) Our male nurses are perhaps a bit more into traumas/blood & gore than the females (although not every individual, of course) and somewhat less into the pillow-fluffing aspects of nursing, but otherwise I see no substantive differences between our male and female nurses. Frankly, ER selects against the pillow-fluffing types, so we have few of them of any gender.

My stepfather is an ER nurse and an RN. He starts IVs, delivers medication and keeps track of changes in blood pressure, heart rate, all that kind of stuff. He has told me that he never gives stitches; that's the doctor's job. He works three 12 hour shifts per week, more if he picks up extra hours. Based on his fun work stories, he sees at least four drunks and one psych patient a night. And yes, it's his job to subdue the raving, uncooperative patients because he is a tall guy with a large frame. In our area (Michigan), health care jobs are some of the VERY few available, so I think that has made the stereotype about male nurses less applicable.

From what I have experienced, male nurses are more in demand mostly in the emergency ward due to their body strength they can correctly lift a patient up. What is different from male to female nurse is that they are perceived as more of analytical and less emotional therefore most relative’s of patients choose female nurses although at this age, male nurses are taught to attend free ceu programs that teaches them to be more compassionate and sympathetic to the patient. As for RN or NP it depends on what area of responsibility that you are being assigned to as some of the areas are critical and needed more extensive training.

from Rob @ Free ceu programs 
http://continuing-education-for-nurses.com

Try article

(Anonymous)

2011-08-24 02:06 am (UTC)

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