An Ode to You, ED Nurse

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There are many people who work in health care. There are patient care technicians, physician assistants, custodial and housekeeping staff, dietary, patient transporters, nurse practitioners, and yes, doctors too. However there is truly, in my humble opinion, one individual in the hospital who does the majority of actual medical care. Yes, physicians, nurse practitioners, physician assistants, technicians, they all contribute important activities for patient care. Physicians, and their teams, intubate, place central lines, deal with complex medial situations and make decisions that change the course of their patients’ lives.

You may have guessed it by now. Yes, this is going to be about nurses.

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Nurses are the heroes of healthcare. No ifs, ands, or buts about it. Anyone who tells you otherwise is in denial. My purpose in sharing my opinions on nurses is simple: they are never, ever recognized enough for their tireless, selfless, genuinely caring efforts.

Don’t get me wrong! I am not saying that all those who work in healthcare don’t deserve accolades. They absolutely do! But truthfully, I have never been able to thank the nurses I work with for their hard work and efforts enough, and this is my attempt.

A wise nurse I worked with at the Baltimore VA ED taught me last July, when I was a brand new intern, that patients don’t go to hospitals to see doctors – they go to receive nursing care. It was profound, and true. Doctors get the glory for good outcomes, but though they are essential in the delivery of healthcare, most doctors are pretty useless without the nurses they work with to deliver actual medical care.

Look around the hospital. Who is giving patient’s their medication? Who cleans patients when they soil themselves? Who dresses a patient’s wounds? Who takes the patient’s vital signs? Who assesses patient’s more frequently than anyone else in the hospital – universally? Who deals with problems with patient care as they arise more often than anyone? If you answered anything else but nurses, you’re wrong.

All nurses, wherever they work, whatever their area of expertise, deserve recognition for their tremendous efforts. I thank the nurses I work with each and every day. I have learned from my mentors that whenever I leave a shift in the ED, before I leave for the day, to share gratitude with the nurses and other staff that helped deliver care that day (including housekeeping, administrative assistants, transporters, literally everyone!) It sounds silly, but don’t be mistaken, it’s so important to recognize those around you for their hard work.

That all being said, there is one kind of nurse that I have tremendous respect and admiration of. If I had to be stranded on an island and needed medical attention, I would want this type of nurse there to care for me – an ED nurse!

ED nurses work in a chaotic, stressful, and unpredictable environment, day in, and day out. They never know what they will deal with. They are often the first people in the hospital to see the sickest, most helpless patients – even before the ED physicians! ED nurses are tasked with the often challenging and sometimes impossible – take care of everyone, address all of their problems, with what resources you may have.

Do you have too many patients to take care of? Did your patient tech call out sick? Is the nursing staff short for the shift? Do you get to call for help, or ask administrators to reassign nurses from other departments? Nope. The answer is a resounding, “Deal with it, friend.”

The CDC states that in 2011, there were 136,000,000 ED visits in the United States. Each of these patients were cared for by at least one, often multiple ED nurses. That means more than 1/3 of the entire country’s population has essentially been cared for by an ED nurse. Not all ED visits result in admissions, so you must accept that ED nurses are the most seen nurses in the entire field. Let that sink in. (I may be wrong on that, and if I am, please let me know. I just don’t see it being any other way.)

I have witnessed, since I first set foot in a hospital as an Emergency Department volunteer clerk back in 2003, ED nurses exhibit such unwavering dedication and commitments to their work. They are cursed at, spit on, yelled at, and sometimes even physically attacked by their patients. They are responsible for taking care of multiple undifferentiated patients with often uncertain medical diagnoses all at once. Furthermore, if we as physicians have any issues with patients, their care, or anything related, we frequently rely on nurses to help guide us to the next resource we need.

The best physician advocates for a patient in the hospital are frequently ED physicians, because they see the patients earliest, and are tasked with deciding what the ultimate plan for a particular patient is. However, the ED nurses who work with those ED physicians are even stronger advocates for their patients, because they are the first to bring up issues with the physicians they work with. I’ve lost track of the instances when nurses were concerned about a patient’s condition, whether it was because they were complaining of worsening pain, their breathing was becoming too rapid, they had abnormal changes in their vital signs, or some other reason, and they brought up their concerns with the physicians they work with. Most of the time, in a good ED, the physicians will learn to respect the ED nurse’s assessment. Good ED physicians know they should trust and rely on the ED nurse colleagues for their clinical gestalt, or “gut feeling.”

Just to be clear, as well, ED nurses have an awe-inspiring ability for versatility and resilience. They often deal with the sickest patients before we know exactly what’s going on. They take care of patients that should be in an ICU, where the nurse to patient ratio is often 1 nurse for 3 patients or even 1 nurse for 2 patients, BUT, often carry 1 or 2 ICU level patients AND 2 or more patients. ED nurses are efficient, quick thinking, and a TON of fun to work with. They are smart, they are compassionate, and they are incredibly fun. I am so lucky that in the ED where I spend most of my time, not a shift goes by when I don’t laugh with the nurses I work with, and they have made me feel better about difficult patient encounters or helped me deal with suffering I have witnessed more than I can ever thank them for.

This is why, for the rest of my career, I will be sure to show my gratitude for and advocate for ED nurses everywhere.

I thank you, ED nurse, for the tremendous work you perform.

I thank you, ED nurse, for the role you play in public health and wellness through your role in the ED.

I thank you, ED nurse, for the sacrifices you make to take care of the entire country.

I thank you, ED nurse, for being the ultimate troubleshooter, the “MacGyver” of all nurses.

I thank you, ED nurse, for putting up with me, my colleagues, and aiding us in taking care of our patients.

I thank you, ED nurse, for somehow finding a way to get it all done, while maintaining a smile on your face, and keeping me laughing too.

I thank you, ED nurse, for coming back day, after day, after day, after day, to see so much hardship and suffering, often in a broken and dilapidated healthcare system that makes it harder and harder for you to do your work.

Never, ever change!

To everyone else, #thanknurses! I encourage you all to share gratitude with nurses you work with. Let’s use the hashtag #thanknurses to let them know we appreciate them. Spread the word, get your colleagues in on it, and share the love!

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