Emergency Nurse

Monitors are going off. Secretary is letting you know that the lab is on line one for you with a critical blood result. You have a patient on the call bell stating that they need to be cleaned because they just soiled themselves. Family just showed up for your admitted patient in room 25 and they would like to speak with their nurse. Your charge nurse just took a rescue call that you have a STEMI coming in, pre-alerted and confirmed by cardiology and your ED attending that the patient is having a potentially fatal heart rhythm. You are also team lead today, and per usual, you’ll take the STEMI on top of your other four patients.

You start to prep the room and gather supplies and staff to help you move this STEMI as quickly as possible to the cath lab for stent placement. But, don’t forget, you still have a call on line one (or was it line three?), a patient to clean, and a family to smooth over before they report you and your “lack of care.”

And just like clock-work, your STEMI arrives.

57 year old-male who was mowing his lawn this morning, fell down to the ground and started complaining of chest pain. No cardiac history, otherwise healthy. Wife is on her way to the hospital. In under 20 minutes, you receive report from the EMS crew, blood work is taken, EKG repeated to confirm ST-elevation, the patient is changed into a surgical gown and shaved where appropriate, heparin is given with some morphine, and your patient is transferred from the ER to the operating table. In under 20 minutes. In under 20 minutes, you and your team worked diligently and collaboratively to save your patient’s life. He gets to wake up to his wife at bedside after surgery and call his kids to let them know he made it out okay and he’ll see them in a little while.

Now back to the mental check-list. Lab was calling to let you know that your patient in the hallway has a critically low hemoglobin, you’ll have to get consent with the attending and begin a blood transfusion. Now on to clean your patient, who is going to have to have an extra pair of hands to help roll. Another rescue is coming in, sounds like a stable patient who had a fall. You’ll assign that patient to a hallway and give it to one of your nurses. Now onto room 25. You walk in, with breakfast in hand and a smile on your face. You introduce yourself and the family member shakes her head at you and looks away. You professionally move on and give the patient his tray. The family member then begins to question you as to why her family is still in the ER, and you explain as you have routinely done for the past year, “Unfortunately we have no idea when we will have available beds, but I promise as soon as I know I will let you know, is there anything I can get you right now? Coffee, water, warm blankets?” You have to move aside the looks and feelings of disappointment because you know you've done all you can.

Back to the nurse’s station to document everything that occurred in the first few hours, including the STEMI. And oh, breakfast? You’ll just wait until lunch because there has to be some break at some point. Another rescue, a man in his 50s found unresponsive after swimming. They are currently performing CPR en route. You’ll give that one to another nurse, because you are still at four patients. Report is being given by EMS when they arrive, the patient was on vacation from out of town and family is on the way.

Now this is where your job really, really sucks. You would take all the ass-wiping, the “I’ll sue you,” and dissatisfaction of those that can’t be satisfied, if you could just prevent yourself from having to tell a family that their loved one has passed. There is nothing more heart-wrenching than having to mentally tell yourself to emotionally disconnect so you can do your job with a clear head, and then have to be the strong one in a room as family walks in to see their passed loved one, who they just saw an hour ago enjoying his vacation. And trust me, it gets even harder when the spouse falls into your arms and tells the deceased family member, “just fight for me, just keep fighting.” That patient did not get to go home or wake-up to his wife.

These are just a few scenarios an emergency nurse has to deal with on a day-to-day basis for 12-13 hours at a time. This does not include the increase in mental health patients that we see on a daily basis that may shout profanities at you or attempt to physically assault you. This does not include taking trauma patients, where metrics are everything and you are having to put your other patients on the back burner for about 30 minutes to prioritize. This does not include the stroke work-ups that we perform, where you may have to be one-on-one with those patients for a few hours for neurological assessments while having other patients. This does not include the sepsis patients that we see, where metrics are also being evaluated and pushing antibiotics into the patient as fast as you can may be the key thing to their survival. This job is not for the simple-minded, and most definitely not for the weak hearted.

Then, when you finally give report and go home you have to adapt and disconnect from everything you went through in order to “not bring work home.” You have to sit through dinners with friends and talk about work, but in a way to not make yours seem any more important. You have to pretend as though what you see at work is normal. Holding grieving loved ones, being cussed out by strangers you are taking care of, and not eating a real meal or having more than a 10-minute break at work is “normal.” And that is just the tip of the iceberg and where the burn out begins.

My name is Madisyn. I am 23 years old. I am the daughter of a hard-working business woman and a military father. I have a rambunctious and loving family full of three siblings, who for the most part are in pretty good shape. I have the most caring boyfriend who has been my grounding force and the arms for me to fall into when I need to emotionally release a day of work. For the most part, I am usually the responsible friend but if you see me on “one of those days,” you’ll catch a hazy IPA or glass of red in my hand at the end of the night. When I have the time, and mostly the energy, I’ll be running in the neighborhood or trying to surf the two-foot waves we have here at home. I am always down to travel, even just for an overnight "down south". I love spending quality time with my friends and family, although physical touch will always take priority.

I am a trauma-certified emergency nurse.

My first month as an orientee, we had a patient pass from a random cardiac arrest when he woke up. He did not make it and the wife had been going in and out of the room with other family members throughout the morning. Although it was not my direct patient, I noticed that the wife was waiting at the nurse’s station. I asked her what I could do to help her and she said, “I was just looking for the way out, I am ready to go now.” So, I told her I would walk with her towards the exit. She began to cry as I was apologizing for her loss. She responded, “I will never get to kiss him goodnight and tell him I love him again.”

Those words stuck with me. Do not take a day for granted. Tell your loved ones you love them as often as you can and more than enough times, because as many times as you do, it will never be enough.

Emergency nurses know this more than most. Give your emergency nurses extra love today as the week comes to an end. Hug them a little tighter, let them know how proud of them you are and how much you recognize that their jobs are one of the most mentally and physically taxing. Listen to them when they need to talk about their day and encourage them to reconnect with the reason they got into this line of work to begin with. Because they need it now more than ever.

And do this often, not just during Emergency Nurse’s week.

P.S. Shout-out to the nurses, techs, attendings, and all collaborative members that make my job easier and hold our ER together.