10 Things That I’ve Learned in the ER

I have loved working at my current hospital, and I’m very sad that tonight is my last night there.

When I first started looking at jobs in South Bend (this was when we were still in Massachusetts), I knew that I wanted to work in an ER.  I was one year post-nursing school and had some good experience under my belt, but I wanted a bigger challenge.  The idea of working in emergency nursing was intimidating, but that fact only made it more appealing.  You may not know it to look at me, but I love a good challenge and I’m very competitive.  Chris doesn’t like playing Scrabble with me because, in his words, it brings out my “victory cackle”.  Can I help it if I’m a better speller than he is?!

I’ve learned some great things from this job.  I want to put some of them out there for those of you who have ever had any experience in healthcare.  This is pretty much everyone.  Even if you don’t work in healthcare, odds are that you’ve been a patient, have taken medication, or have had family or friends who’ve been in a hospital.  Some of what I’ve learned has been hilarious, and some of it has been heartbreaking, but all of it has made me a better person.

  1. Have a plan.  Coming to the ER is a scary experience for most patients, and it’s reassuring to know that at least one person has a plan in place.  I’m very upfront with people and tell them, “This is the plan…”.  People appreciate that.
  2. Be honest.  If you tell a patient that you’ll be back in 30 minutes, then be back in 30 minutes.  People will trust you and believe that you have their best interests in mind when you do this, and they’re nicer.
  3. The call light can be your worst nightmare, but it can also be your best friend.  Don’t try to keep everything in your head.  It’s OK to ask the patient to press their call light when they have a urine sample/need more pain medicine/are feeling nauseated.  Always make sure that the call light is within reach and make sure that people know what it is.
  4. Introduce yourself.  I would be so annoyed if someone came in and started telling me what to do or asking me questions without telling me who they were.  I always tell people my name, and before I leave the room I remind them of it and point to the dry-erase board where it’s written.  I think it’s important to say your name both when you introduce yourself and again when you leave.  I’ve found that patients are overwhelmed, and they don’t remember a lot of what you tell them at first.  People in the ER have a lot on their minds, and knowing which nurse is their nurse is relieving.
  5. It’s alright to employ what I’ve termed “therapeutic firmness”.  Sometimes, you need to be firm and assertive with a patient.  Going back to #3, where I said that the call light can be your worst nightmare – if a patient is using their call light every 5 minutes to remind you that they’re in pain or to keep asking when the doctor will be in, it’s OK to tell them, “Look, I have gone over this with you, and pressing the call light is not helping your case.  I’m not going to lie to you, and I’m not going to forget about you.  Having me come back to your room every 5 minutes to speak with you means that I’m not able to take care of other patients, which means that I have less time to take care of you.  I told you that I would ask the doctor for more pain medications, and as soon as she/he is available, then I will ask them.  You can trust me on that.”
  6. Use the Charge Nurse when you need them.  If you have a patient who is pushing you right to the edge, be professional enough to recognize it and ask someone else to go in there and talk with them.  Being frustrated and annoyed doesn’t make you a bad nurse – being frustrated, annoyed, and then lashing out in an unprofessional manner time and again does make you a bad nurse.
  7. If you work in healthcare, then you’re a public servant.  This doesn’t mean that you’re a waitress.
  8. Prioritize and think critically.  If you can’t do those things, then you won’t survive.  One of the physicians in my ER asked me, “Jenny, when you’re in the middle of a code blue, who’s pulse do you check first?”  The answer is, “Your own”.  You need to take the time, even if it’s only a split-second, to think, breathe, and plan!  After awhile this comes naturally, but until then don’t rush headlong into a situation without knowing what you’re doing.
  9. Be nice.  Don’t you hate it when people come across as superior and annoyed?  Be respectful and compassionate to others.  This includes the drug-addicts, the drunks, the gangsters, the prostitutes, the lazies, and the jerks.  As my mother once told me, “The only person who’s behavior you’re responsible for is your own”.  I may be as annoyed as all get out with some ridiculous, rude, horrible patient, but I know that I sleep better at night when I can say to myself, “Yes, but at least I was respectful to them even if they were horrible to me”.  This doesn’t mean that you’re a doormat, though.  Sometimes, the respectful thing to say is, “Sir/Ma’am, there’s no reason for you to speak to me that way, and if you’re not able to do so, then I’m going to leave the room until you are”.
  10. You’re the patient’s advocate, not the patient’s parent’s advocate.  If you feel that a patient is at risk, talk to your Charge Nurse and don’t ever feel guilty about calling Child Protective Services.  You know that voice in the back of your head that says, “Something about this doesn’t add up”?  Listen to it, and discuss it with your coworkers.  If it calls itself a horse but looks like a fish and smells like a fish and swims like a fish, then it probably is a fish.  Healthcare workers come in contact with all aspects of society, and we’re one of the great ways at catching domestic violence and child abuse.  You might be the only person who asks the “uncomfortable” questions.  It can be awkward, but it’s worth it.  I know.

I could go on and on, but I told myself that I would stop after listing 10 things.  I’ve learned so much from this job, and I would love to continue to work here.  I’m sad that I’m leaving, and I have to remind myself that I’m doing it for a good cause (my husband!).  I hope that some of what I’ve learned is helpful or enlightening to others.

Tonight is my last night, and they’re throwing a huge party for me.  I’m overwhelmed at the number of doctors, nurses, secretaries, nursing assistants, security guards, respiratory therapists, ultrasound techs, and X-ray techs who have come up to me, both privately and publicly, and have told me how sad they are that I’m leaving.  Everyone should have the opportunity to leave a job where they’re loved, if only to hear all of the wonderful, kind things that others will say about them.  I’m very proud of the fact that every job that I’ve worked at has been hard for me to leave and that I’ve always been able to find something redeeming about it.  I also know that I’ve got God to thank for a lot of that.

I hope that tonight is incredibly busy.  That might sound odd, but I don’t want to have a lot of time to think about the fact that I’m willingly leaving another job that I love to move over 8,000 miles away.  No one at work knows about this blog, but if they did and they were reading this, I would tell them thank you for making my time in the ER such a great one.  I couldn’t have asked for a better group of people to work with!

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  1. Tami says:

    I hope your last night was great! You deserve a great farewell party:)

    I loved your whole list. I especially agree with “Introduce yourself,” I know there have been times when I’ve been a patient and had NO idea the names of any of the people taking care of me. Sometimes I wonder if people don’t give their names in case you have a complaint!

    I also had to laugh at #7, because oh how some people act like you’re their waitress!

  2. Sharon Struck says:

    True, you do not know me. But I am a follower of your blog. While you do have to leave a job you love, the opportunity you have to experience New Zealand is amazing. I wish you all the best!

  3. Jane says:

    I hope you have a fabulous night tonight!

    Maybe someday we’ll end up getting to work together and you can teach me everything you know. I printed this out and put it in my folder of things I need to remember to make me a good doctor!

    Thanks for sharing!

  4. Elle says:

    I hope your last night goes wonderfully well! and I think it’s very admirable that you’ve always been able to find something redeeming in your jobs… it says a lot about your character, and its a trait I wish I had!

    I can’t believe how soon you are going to be in New Zealand… I’m nervous and excited for you!

    Thanks for all the tips… I’m going to file this away and remember it when I’m a resident… so far I’ve heard about a million horror stories about residents getting an earful from an angry patient and this is a good reminder that I can be prepared to respectfully stand up for myself even if I am only a lowly resident (granted that won’t be for another four or so years… but ya know…. gotta have a plan 🙂

  5. USCEmily says:

    I hope your last night goes well! I know it is bittersweet having to leave a place you love, but I know that you and Chris will have a great time in New Zealand- what a wonderful chance you have to live somewhere like that!

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