“Level II, trauma room 1, eta 5 minutes” As you walk into your shift, you hear the words booming overhead. Stethoscope around your neck, pens in your pocket, you are ready to go for your shift in the ER.
The charge nurse mentioned the department is short staffed tonight, a common problem. After you get your report on your 5-patient assignment from the nurse whose shift is ending, you quickly check on your patients and make sure they are stable so you can head to the trauma room to assist. Not knowing what to expect, you throw on your lead vest and enter the trauma room.
A man lay on the table, exposed and bleeding. A motorcycle accident. Doctors, nurses and paramedics surround him, each with a unique and equally important task. Blood is being drawn, monitors are being hooked up, oxygen is being administered. All done simultaneously, this organized chaos may save this man’s life.
Your co-worker shouts for assistance; the man is waking up and is combative. You dash over to help, running to the medication dispensary to obtain a sedative. You draw up the medication, scan the wristband, and hand it to your colleague.
Now your pager is going off: one of your patients used the call light and is requesting assistance. The unit clerk didn’t specify what exactly they needed. Leaving your vest behind, you head to the room in need. In the distance you can hear cries, shouts and even some laughter. It’s a busy night.
“Stroke alert, room 5, stroke alert, room 5” the overhead goes off again.
Room 5. That’s your room.
While you were in with the trauma patient, the physician went to see your patient and is now calling a stroke alert.
Your patient, Mr. Jones, was fine just minutes ago when you checked on him at the beginning of your shift. He complained of a mild headache, but was otherwise stable and comfortable. Had something changed?
When you enter room 5, along with the stroke team, all fitting in the tiny hospital room, you smile briefly at his wife and turn your attention to Mr. Jones, who is now confused with an elevated blood pressure and the inability to move his right arm. You assist the neurology team with a stroke scale assessment and while you’re doing that, you voice-call the radiology team to let them know you will be bringing your patient over to CT scan to assess what, if any, kind of stroke Mr. Jones is having.
Because of the nature of Mr. Jones’ symptoms, you have to perform a stroke scale assessment on him every five minutes. Based on the results of the CT scan, the doctor orders you to start tPa, a critical drug used for ischemic strokes. You educate his wife and comfort her, all while carefully monitoring Mr. Jones. You ask a colleague to check on your other patients.
Mr. Jones finally gets a bed on the neuro-critical care floor, so you transport him and the IV pump carefully running the tPa up to the floor. You give your hand-off report and rush back down to the emergency department. When you arrive, you see you have a new patient in room 5: a 13-year-old female patient with abdominal pain and vomiting.
You open all the drawers and prepare your supplies. This patient needs an IV started, labs drawn, a head-to-toe physical assessment, and medication for pain and nausea. Within minutes, you have your tasks completed. You calm the patient, informing her the medication will kick in soon and she will feel some relief. She is scared, saying she has never been in the hospital before and never had a CT scan, so you explain the reason for the test and what she can expect.
While you’re walking down the hall to take a bathroom break for the first time since your shift began, the doctor catches you and asks if your patient’s pain is relieved. You give a brief update and remind yourself to document the updated pain assessment. Everything you do needs to be charted in the electronic health record, and so far you haven’t had time to complete your documentation.
After returning from the bathroom, you see new orders on all of your patients. Medication for room 4, crutches for the broken foot in room 3, and a dressing application for room 2.
The tasks continue for a few more hours.
The test results for the patient in room 5 come back. She is positive for appendicitis and will be going to surgery. Her fear has intensified.
Despite how busy you are, you pause.
You enter her room, take a seat (for the first time tonight) in the chair next to her bed, and answer her questions. You hold her hand, tell her she is in the best of hands, and explain what will happen next. You teach her about appendicitis, and what all of the big fancy words really mean. You can see the anxiety leave her face; you even see her smile.
You prepare her belongings, hand them to her mother and complete the pre-surgical documentation. You get her mom a cup of coffee and tell her where the surgical floor is.
The transport staff comes to take the patient to surgery, and your patient smiles and says, “I’m ready.” Before rolling out of the room, your patient says, “Thank you – I know you are busy, but I appreciate you calming me down. It really meant a lot to me.”
And you smile back, tell her she’s going to do great, and give her a thumbs up.
This is what ER nursing is all about. It’s not about the tasks and the charting. It’s about the people, people experiencing loss, grief, trauma, shock, and pain. Sometimes all at once. ER nurses combine their clinical expertise with a special kind of caring. They put on a brave face when they need to, but sometimes all that is needed is a smile. ER nursing is all about making a difference in the lives of people experiencing their darkest moments, and being the calm in their chaos.
