estimated reading time: 9 mins.
In my early days on nursing I was lost and could not determine what specialty area I would fit in. I discovered a profound sense of belongingness in the Emergency Room. I learned and develop my core competencies through working here, reason why it will always have a special place in my heart.
Fast forward, I was burnt out and decided to rest from it and prioritize my overall well-being. When the Emergency Nurses Week started, I initially don’t want to be associated with it but here I am, reliving the dopamine and writing away for the love of all my emergency nurses friends and in honor of what we live for:
serving the people.
I realized I’ve been avoiding to call myself a nurse because I always had the fascination to be labeled as an artist. I always wanted to work for the creative side and not with science and the so-called ‘normal jobs’. But one good thing about this creative pursuit is that self-discovery is part of the process. And as I embrace my creative self, I am also learning to embrace all of the versions that made me, me. Serving others is the one thing that I will always root for. The fact remains that I am a nurse and working as one is still possible in the future.
how it started
I desperately wanted to work for a prestigious hospital (a facility that nurses are known to aspire to be part of) back in my hometown. I applied to this specific hospital 3-4 times and fast forward when I finally made it to the last stages of the hiring process, the HR said that there are no vacancies in the area I try to specialize in. After finishing months of unpaid hours of their rigorous training program, I do not want to delay my chance to secure a position. Immediately I bargained that I am very much willing to start as soon as possible in whatever area that is in great need.
Guess which area. The Emergency Room. Surprise.
There were three [of us] interviewees, and the managers said they only needed two candidates to fill in their roster at the time. Whoever is in the 3rd spot after the interview has to wait for maybe a month before the next vacancy. With sheer amount of luck, I’m the 3rd person they wanted.
I went home, thinking about requesting to be interviewed for a different area because — I’m broke. I seriously need to start doing paid work. Later that day the HR called me to let me know that the 2nd candidate was not ready to accept the job position, so I can fill in for her instead to start ASAP.
I said ‘Oh, now they need me? They didn’t like me, I don’t like them either.’
Kidding! Of course I said ‘sure’ straight away. I had no idea what I signed up for.
inside the emergency department
The area. 85% of the time the ED is wildly busy and the remaining 15% belongs to just being the normal busy, to the few eerie hours of night shift and to a smooth as a holiday kind of day. People come in and out nonstop, ambulances roll in and patient cases could be acute or chronic, non-urgent, critical or emergent.
People and their temperaments. If only ER nurses could just focus on managing the patient’s disease process, it will be easier. But they deal with people and people have different characters that nurses also need to muddle through. Patients and their families are generally distressed due to their current medical situation, which might heighten their emotions and reaction towards others when coming to the ED. From the patient’s behavior, the relatives involvement, some social issues – processes can either be easier or more complicated to execute depending on people’s temperaments and cooperation.
The working environment. Surrounding the ER staff are noises coming from machines, pumps, patients shouting for whatever reason (or singing), someone running, child crying, patients groaning with pain, moving crash carts, ringing phones, call bells, printers, ambulances, overhead hospital speakers and announcements.
The scent is not always bad. But it can be bad. I would say that the smell is uhm… diverse, the kind that can either stop you in your tracks or send you sprinting in the opposite direction. It’s safe to just expect different scents from different places in the ER because of the areas’ exposure to various bodily fluids.
The temperature varies, critical areas tend to be warm and others are just like freezers transformed into a room.
inside the 12-hour shift
The shift typically begins with a team huddle where we receive our bed assignments for the day, followed by a handover report from the nurse who handled the same assignments from the previous shift. During nurse endorsement is where initial prioritization usually takes place. Depending on how hectic the current workflow is, this is when we can quickly assess the severity of each of our patient’s conditions and attend first to whoever is in dire need.
Whatever happens in the next minute or even during these initial interactions are never guaranteed. Conditions in the ER can change rapidly and we, nurses are required to adapt and pivot our care strategies. Some days we might need to take over an impending emergent situation the moment we step in the area (even before receiving report), and receive updates simultaneously while moving. It is expected that patients will continue to stream in the ER and the pace will remain intense the whole day.
All throughout the shift we juggle multiple patients, administer medications, monitor vital signs, start IV lines, draw blood, collect specimens, perform nursing procedures (EKGs, catheter, set up pumps, suction), clean a patient, or assist with medical procedures. On top of that we are expected to respond to an ambulance rolling in, answer phone calls, respond to patient’s shouting, call lights and still be aware of what is currently going on to each of our patients.
We collaborate and help each other as much as we can. Since we often deal with traumatic injuries and life-threatening situations, it is imperative to communicate with other members of the health care team to maintain the flow of information. We are also expected to provide emotional support to patients and families by giving reassurance, comfort and explanations to make an uncertain time more tolerable.
Breaks are taken at the nurses discretion (usually when the situation allows us to squeeze it in.) At the end of the shift, we close our charts and provide handovers to the incoming team. We almost never went home on the dot to ensure the transition is seamless.
how it felt working as an ED nurse
Words are limited to accurately describe how everything is simultaneously happening in the ED. No wonder why we got used to delaying breaks or holding our urine for later.
Me and my colleagues talked about how many times we felt being pulled in all directions. With every ‘NURSE!’ plea, there is a necessity to be present for everybody. Our attention has to be spread out thinly between every demand, machine alarms, due meds, phone calls, emergency codes — while holding our self altogether. We are required to multi-task AND not lose focus.
We cry for one patient AND smile for the next one. We see death, and on the next second has to show up like we didn’t. We feel bad for a family and be happy for another. The switching of our fight and flight responses is one hell of a ride, a roller coaster of emotions which we barely had time to process.
But at the end of the day, it really is a fulfilling vocation. I personally felt that we are doing something noble and valuable. It’s a beautiful experience to allow ourselves to be a part of someone else’s wellness journey. To be able to work in a field where caring for other people is normal, it responds to the humanity within us.
Serving others felt right, humane, good and natural. In a way, it is an honor to be entrusted with someone else’s life. It is a privilege to witness a person in their most vulnerable state and to be in a position where can we help them regain their strength. Their humanness is presented to us and the opportunity to pull them away from the edge and guide them towards healing and restoration felt like we are the last guardians of life. For that, I am grateful. That kind of opportunity is a gift. I felt that being a nurse (in general) is a gift.
final thoughts
The Emergency Department caters to everyone from all walks of life; from a baby to the really old, a pregnant lady, people from the nursing homes, the jail, the abandoned, the homeless, and anyone in between. ED is the one place that never chooses who to tend their care. It’s open for everybody, 24/7, all year-round.
I have no regrets on experiencing all this; the fun, the hard, the camaraderie, the adrenaline rush and the tears that fell down our face when no one is around. On behalf of all the emergency nurses, may this blog shed some light to what a typical day might look like for us, in the hope that the people we meet on our next shift will choose gentle words and to always be kind. Every smile and act of kindness is highly appreciated and definitely goes a long way.
Do you know someone who works for the emergency department? Share nice words to an ED staff today.
Aylaveeet! I miss you, baks! 💙 I am happy for you whatever path you choose.
Thank you so much baks! 🩵🥹