The RN’s Guide to Survival in a Chaotic ED

  • Eileen Johnson
  • |

Admit it. If you’re an Emergency Department (ED) nurse, you’re probably an adrenaline junkie. You know the signs and symptoms:

  • Your heart begins to race and your pupils dilate when you hear the EMS radio go off;
  • You would rather eat your lunch out of an emesis basin at the nurses’ station than miss any of the action;
  • You look at everyone’s veins no matter where you are to determine the size of the IV catheter you can insert;
  • You can walk into the department and know the types of patients that are there just by the sounds and smells;
  • There are certain practitioners you just do not like to work with because they are too slow;
  • A good code is your cup of tea!

Recognize yourself in any of those signs? If so, you are probably an ED nurse. You thrive on the apparent chaos and take pride in your ability to handle the stress. You should be proud of yourself. Many nurses run screaming out of the ED or cower in a corner when things become hectic. However, you don’t – well, at least until the chaos becomes too much for you!

How can you ensure your continued survival in the chaos of the ED? Although every technique won’t work for everyone, you are sure to find a few pearls in these ideas. Remember what Hans Selye taught us: Without good management strategies, chaos leads to stress, and stress can lead to illness or injury.

Recognize Unhealthy Stress

The first tip for survival is to recognize when the chaos is beginning to have negative effects on you. One of the key signs of stress in an ED nurse is the loss of a sense of humor. Much of our survival as ED nurses is built on the ability to find humor in most situations. When you lose that, you can bet that stress has gotten the best of you.

If you begin to dread coming to work or find that you are exceptionally moody or irritable, you are probably feeling the results of prolonged stress. Physical signs of stress might include nausea, vomiting, and diarrhea. The first step to dealing with the chaos is to be able to recognize when stress is hurting you.

Be Organized

Particularly in the chaos of a busy ED, it is critical that you are organized. Know where equipment is; know the policies and procedures for your department; know how to prioritize your work. Remember that the principles of triage apply in the back part of the department as much as at the triage desk.

Keep Communication Lines Open

Remember that communication involves receiving messages as well as sending them. If you are always talking, you are not listening. Stop and listen when a patient, family member, provider, or other staff member is talking. Usually, that action will take less than a minute and may provide the information you need to care for your patient.

Learn to Relax

Relax? In a chaotic Emergency Department? Sure! Even amid chaos, you can count to ten, close your eyes for a few seconds, and take a few slow, deep breaths. Think about the physiology involved: as you breathe deeply, the supply of oxygen increases in your brain. This increase in oxygen activates the parasympathetic nervous system leading to a sense of calm. If that doesn’t work, step away from the situation for a minute.


I can hear what you are thinking: Exercise? Like I don’t get enough exercise while running in the ED?

Regular, planned exercise outside of the department can help decrease the stress you feel when you are working. Again, there is a good physiological basis for the use of exercise to manage stress. Stress prompts the release of cortisol, the hormone that is primarily responsible for the “fight or flight” syndrome. Too much cortisol can have devastating effects on your body.

Exercise causes the body to release cortisol. So, why is the release of cortisol during exercise good? If you exercise regularly, the amount of cortisol released decreases. Your body will acclimate to the decreased cortisol, and you will be able to function better and longer in the ED.

Connect with the Team

Although sometimes it feels like it in a chaotic ED, remember that you are not alone in the chaos. Find someone with whom you work that you can trust and talk to when you get stressed. Sometimes, you need a friendly ear; other times, a coworker can provide an idea that can help solve the problem that is adding to your stress.


Emergency Department teams are notoriously bad at having a debrief session after stressful events. The purpose of a debriefing session is to provide a quick critique of the event: what did we do well? What could we have done better? Normally, this does NOT have to be a formal event, and can usually be done in less than 5 minutes. In a major event such as the unexpected death of a child, the team might need a more formal session led by a chaplain or social worker.


If you find that you simply cannot handle the chaos in the ED, it might be time to transfer to another department where the stressors are different. Many times, getting out of the ED for a period of time will help you decide whether or not you really want to be in that department.

Eileen Johnson

Meet The Author

Eileen Johnson is a Master’s prepared Registered Nurse with almost 40 years of experience in acute care, hospice and palliative care, long-term care, education of healthcare students, and hospital medicine. In her career, Eileen has provided direct patient care and has served in multiple leadership positions. She has expertise in quality, risk management, business analysis in healthcare, and process improvement.

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