I think one of the reasons I don't like working at this current facility is that it doesn't challenge me as a nurse. I take care of the usual things like MIs, CVAs, abdominal pains, and headaches. Standards of care are pretty even across the board and I know what to do from start to finish. Occasionally there is a more complicated patient, but those are the exception and pretty infrequent at that. We do see a large specific population of very sick people, but they are so tightly managed by the inpatient team that there is little to do for them in the ER. I'm getting to the point where I feel as if a lot of my critical thinking and ER-specific skills are going by the wayside.
The point where I definitively realized this was sitting in PALS recert class the other day. The instructor asked a question and I had no clue as to the answer. I used to know it. I used to deal with peds all the time. I used to know those critical weight-based dosages for cardiac meds because I gave them regularly. But somehow now I don't.
I haven't taken care of an actual sick kid in what, eight months? It's kind of scary. I immediately went home and started reading up on peds again because I don't want to be that person who gets complacent on nursing knowledge. Though the fear of accidentally killing a patient is much less pronounced these days, it's still there. And by letting my skills and knowledge base slide is a great way to fuck up and let that deepest fear come to pass.
This facility is mostly nice, the people are nice, and it's super amazing to have a real lunch break all the time or get chances to go pee or sit on my butt with only two patients for three hours because it's a slow day...but if those nice things are at the expense of me progressing in my career, then I don't want to be a part of that hospital.