The Secret Lives of ER Nurses: What We Can’t Say Out Loud

Working in the emergency room is a constant battle between chaos and control, compassion and detachment, life and death. It’s a world most people will never fully understand. You simply cannot unless you’ve lived it.

Nurses carry secrets—the kind we don’t talk about “outside” or to our families at the dinner table. Because we’re not supposed to. Because if we did, no one would believe us. Or worse, they believe us, and they don’t know what to do with that truth. They might shift uncomfortably, offer an awkward “I don’t know how you do it”, and then move on, grateful it’s our burden to carry, not theirs.

So we swallow it down. Squash it. Compartmentalization at its finest. We push the worst moments into some locked box, telling ourselves we will deal with it later.

Later never seems to come.

1. We Make Dark Jokes to Survive

If the general public overheard the way nurses talk with each other in the break room, whispering at the nurses’ station or even after a code, they’d probably think we were heartless. But gallows humor is our coping mechanism. We joke about the absolute absurdity of our reality- like the patient who came in with a lightbulb stuck where the sun don’t shine because he “slipped and fell on it”, the patient who destroyed an entire exam room in a drug-induced psychosis or the infant who was put to bed and never woke up. We find a way to laugh not because we don’t care, but because if we didn’t, we’d break.

This one is tough. I used to engage in it too. For well over a decade, those jokes were a form of armor, a way to keep the emotional weight at bay. It was either try to laugh or literally feel nothing at all. I’m not sure which one is more fucked up. I was more of the “unfeeling” type, but I never resented the jokes.

In the months nearing my resignation, it started to feel different. The lack of feeling became a burning in my throat and a knot in my gut—the kind that comes from suffocating tears. The same jokes that once were our survival felt wrong. Not out of any judgment of my colleagues—never. I understood why they needed that release. But for me, the exhaustion had sunk too deep. The emptiness and humor were not enough anymore to hold back the frustration, the resentment, the emotional depletion.  

2. We Know When Someone is Going to Die—And Sometimes, We Can’t Stop It

There’s a look, a smell, a feeling in the air. ER nurses develop a sixth sense for impending death.

The hardest part? Watching someone slip away despite doing everything right. We’ve all had that patient who was fine until they weren’t. The ones cracking jokes with you while you start their IV, who crash minutes later. The ones who come in for something routine and never leave.

We don’t talk about how those moments stay with us, creeping into our thoughts at 3 a.m, while we’re washing the dishes, while we’re decompressing at the beach on our days off.

3. We Lie to Patients—and It’s for Their Own Good

We tell them, “It’s just a little poke” or “It’s just a little pressure”, when we know it’s going to hurt. We say, “You’re going to be okay”, even when we have a gut feeling they won’t be. We reassure families that their loved one “went peacefully”, even when we just spent 45 minutes doing chest compressions, cracking ribs, and shocking them back to life, only to lose them anyway.

The truth is brutal. And sometimes, kindness requires deception.

4. We Are Haunted by the Ones We Couldn’t Save

Ask any ER nurse, and they’ll tell you about that patient. The one who still visits them in their dreams. Maybe it was a child, cold and lifeless on the trauma bay table. Maybe it was a young father who died in a freak accident, leaving his family shattered. Maybe it was the overdose victim who had just been discharged hours before. No matter how many people we save, the losses stay with us.

I remember her. She was beautifully rebuilding her life. She told me her recovery story and how proud she was of what she’d accomplished and overcome. She talked with me for a long time about her new path, the degree she was working on, preparing herself for a career. She was reconnecting with her father, trying to rebuild a life that addiction had taken from her.

But that night, she had nowhere to go. She had come to us after leaving her significant other, escaping an unhealthy, fearful dynamic. She had no home, no safety net, no real options. Not at that time of night, not at our hospital, not in our county, not without money.

We don’t—can’t—offer housing placement. We don’t admit people just because they don’t have anywhere to sleep. We are too busy, too overwhelmed, too full and have no resources to help this situation other than a couple of pieces of paper with shelters listed on them to give to the homeless. Like so many before her, she was discharged.

A few hours later, towards the end of my shift, a local fire rescue calls ahead with a cardiac arrest. We set up, we prepare. They arrive.

It is her.

Someone found her on an early morning walk. Dead in some bushes. She had succumbed to her habits in her loneliness, her darkness, her fear, her sickness, maybe just the sheer weight of feeling unwanted and helpless in a world that had no place for her.

I’ll never know why. I remember her. I will never forget.

5. We Work Sick, Exhausted, and Broken—Because We Have No Choice

There’s many a reason so many nurses hit burnout. But, this. We push through fevers, migraines, and injuries because calling in means leaving our coworkers drowning. We run on caffeine and adrenaline, skipping meals and ignoring our own pain. We block out the patient that just called us every horrible name under the sun or physically assaulted us or a friend. And even when we’re at our limit, we keep going—because the patients keep coming. Our work family needs us.

We are the heroes, and heroes don’t call out sick.

6. We Go Home Feeling Like We’re Failing

No matter how many IVs we start, how many codes we run, how many patients we help, it never feels like enough. We clock out knowing that the waiting room is still full, that someone’s still suffering, that another crisis is unfolding without us. We joke that we have FOMO not being at work, but the reality is, we question whether we did enough, whether we missed something, whether we could have made more of a difference.

7. We Love It—And We Hate It

There’s no adrenaline rush for us like a trauma case, no feeling like bringing someone back from the brink of death. But the cost of that high is everything—our mental health, our relationships, our sense of self. We love our patients, our team, the moments of victory, our survival. But we hate the system, the exhaustion, the emotional toll.

Why We Stay Silent

We don’t talk about these things because people don’t want to hear them. Because administration would rather silence it than fix the system. Because if we admitted how broken healthcare truly is, the illusion of control would shatter.

We don’t allow grief. We package it up, store it away, tell ourselves we’re fine and, in my experience, it feels wrong when we aren’t fine. We tell ourselves to toughen up, put it away, carry on. Nurses carry the weight of a world most people never see. A weight that doesn’t disappear. It lingers, presses down on us, shift after shift, year after year.

And for some of us, that weight becomes too heavy to carry.

For a long time, I told myself that’s just how it is: build the wall, grow a thicker skin, keep going. For years, I did. Until I couldn’t anymore.

If you had asked me even 3 years ago, I was going to die an ER nurse.

3 years isn’t long when you’re planning on forever. It didn’t happen overnight. It was a slow burn, a nagging unraveling, a quiet realization that I was no longer the kind of nurse I wanted to be. That the things I once found meaningful in their different ways felt empty. That I was carrying too many ghosts and not enough hope.

So I walked away. Not because I didn’t care, but because I did—too much, too long. Because survival should mean more than just enduring.

I don’t know what the answer is.

I don’t know how we fix a system that treats nurses the way it does, that fails patients who need help most.

I do know this: the silence isn’t helping, even if nobody wants to hear the truth.