Thinking of becoming an ER nurse rather than an ER doctor: which job is easier and less stressful?
Q: I was interested in becoming an ER doctor, but decided that it might be too hard for me after reading all of the Q & A's on your www.ERbook.net site. So I was thinking about perhaps becoming an ER nurse. Could you tell me if working as an ER nurse would be easier than being an ER doctor, right? I am a very happy, bubbly, and silly person, so I think it would be a little easier for me to be a nurse. Hope you have some answers for me!
Answer by Kevin Pezzi, MD: Yes, it is considerably easier to become an ER nurse than an ER doctor. Becoming an RN requires a minimum of two years; after that, hospitals provide an ER orientation for new recruits that was typically six weeks long in my experience. Becoming an ER doctor requires several more years of training that is substantially more intensive.
In my opinion, the work that ER doctors do is also more difficult and stressful than what ER nurses do. When I worked as an attending ER doctor in a large hospital, there were several nurses working on every shift, plus various clerks and techs, but just me to handle dozens of patients at one time.
Various ER nurses have previously written to me claiming that ER nursing is just as stressful as being an ER doctor, or even more so. They typically cite examples such as, "Doctors just write orders, but we're the ones who have to actually start the IVs, administer medications, etc." That is true, but:
- Nurses cannot do surgery, perform lumbar punctures (spinal taps), start central lines, run codes, read EKGs, read x-rays, consult with other physicians, supervise residents and medical students, do a complete H&P (history and physical), write prescriptions, make diagnoses, commit psychiatric patients, dictate charts, etc., so ER doctors have plenty to do.
- For every ER doctor, there are typically several ER nurses and techs. An ER nurse will usually have only a few patients at any one time, whereas a doctor could have dozens of them.
- Emergency departments are often staffed with ER techs, phlebotomists, and other personnel who draw blood, perform EKGS and other procedures, and assist patients in various ways—all of which eases the burden on nurses.
- Having several nurses working at any one time creates a built-in support system in which nurses who are less busy can assist ones who are swamped. In contrast, ER doctors who work single-coverage (one doctor on duty) shifts, as I usually did, must do all of the doctoring if there are 25, 30, 35, 40, or more patients. If another patient walks in the door and the doc is already overwhelmed with patients, tough luck—the ER doctor must still see that patient, somehow, and if he doesn't see that patient quickly enough or thoroughly enough, he can be sued for millions (read this page to get an idea of the stress that ER doctors face when the emergency department is busy). If the ER nurses are all maxed out, nursing supervisors typically order nurses from other departments to go to the ER and help the ER nurses. ER physicians do not have that luxury.
Furthermore, doctors do something that is not outwardly visible: they're the ones who make the tough, split-second decisions. They're the ones who are ultimately responsible for patients living and dying. They're the ones who nurses call when a screaming mother runs into the ER with a blue baby in her hands.
I am not trying to trivialize the importance of what nurses do, because I am one of those doctors who thinks that doctors and nurses are both integral and indispensable parts of the healthcare team. Considering the above factors and others that I discussed elsewhere in this site and in ERbook.net, I contend that the overall workload and stress level is much greater on ER doctors than nurses. However, ER doctors earn about four times more than ER nurses, so they are compensated for the added burdens they shoulder and for the extra decade of training they must endure. Incidentally, to become a doctor I often worked 110 hours per week (sometimes more), so the extra decade of education/residency was more like another 20-plus years of training, as compared with average ER nurses.
“A career is wonderful, but you can't curl up with it on a cold night.”
— Marilyn Monroe
I have a friend who works as a cardiology nurse. Before meeting me, she felt that doctors had easier jobs than nurses. It may appear that way on a cardiology floor where the cardiologists pop in wearing their spiffy suits, quickly make rounds, write a few orders, and then disappear, but that is just one aspect of what cardiologists do. If she saw the rest, she would likely feel otherwise. She now knows enough about what ER doctors do to realize that she has it much easier than ER doctors.
However, nurses in general have one major stress that doctors do not: similar to middle-managers in business, nurses often feel trapped on all sides. In the case of nurses, they often feel caught (and powerless) between their supervisors, hospital administrators, doctors, and angry/demanding/abusive patients or their family members. I recently read a scientific article which stated that people age faster when they work in jobs in which there is significant stress but no real control over it. Doctors have more stress overall, but their position, power, and authority gives them more control than nurses have. Consequently, the physical consequences of that stress are usually less for physicians than nurses. If administrators and nursing supervisors truly cared about their nurses, they would give more praise, positive feedback, and sincere appreciation. The nurses I know often complain how they hate being treated like easily replaceable peons by administrators. "I wish my boss had something positive to say for a change," one nurse lamented, "but the only time I hear from him is when he criticizes something I did!"
> I am a very happy, bubbly, and silly person, so I think it would be a little easier for me to be a nurse.
Having such attributes is equally compatible with being a doctor, too. It doesn't matter if you are a doctor or a nurse: if you wish to optimally harmonize with your patients and do the best possible job caring for them, you must adapt your personality to suit the circumstances. I could be as serious as a heart attack in dealing with one patient, and then step into another room, whip a stuffed animal out of my pocket, and play with a young child or sing to her in order to gain her cooperation for something that kids often resist, such as eye, ear, nose, or throat examinations. The "just muscle your way in" approach that many second-rate docs utilize is needlessly traumatizing to pediatric patients and frequently results in inferior exams, diagnoses, and treatments.
Working in the ER can be tough on anyone, but you seem to have a wonderful personality that would be a very welcome addition to an emergency department. I am sure that your patients and co-workers will love you!
- Emergency department nurses aren't like the rest of us
Comment: I could write a book giving examples of good and great ER nurses versus bad ones. Unfortunately for the good ones, in nursing (as in medicine) there's a homogenization of recognition of excellence as well as pay for it. If you're a great nurse, you aren't paid more than the slackers who tarnish the reputations of nurses in general. In my opinion, superb nurses should be paid like doctors and receive some commensurate title, while the bad nurses should be given a kick in the butt and a limited number of chances to improve before being fired. Bad nurses hurt (and sometimes kill) patients and make doctors want to pull their hair out. Doctors respect good nurses and loathe bad ones with contempt they sometimes find difficult to conceal.