Nurses who work in Emergency Rooms/Emergency Departments often deal with incredibly stressful situations on a regular basis. Angela Fennington, RN, CEN, works in the Emergency Department (ED) at the University of Maryland Upper Chesapeake Medical Center (UM UCMC) in Bel Air (Harford County), Maryland. Fennington also assumes the role of a charge nurse as assigned by the ED leadership team. She took time from her busy schedule to answer questions about what it’s like to work in the ED. And although there’s no George Clooney around, she loves her job anyway.

Angela FenningtonAs an emergency nurse, what does your job entail? What do you do on a daily basis?

My job as a nurse in the ED entails a lot of decision making and presence of mind. Patients in the ED can arrive with a wide variety of symptoms, and it’s my role to assess these patients in a timely fashion. On many occasions, several patients may arrive at nearly the same time. As an ED nurse, I have the challenge of assigning a priority level to each of them, all while trying to make people understand the triage process (assigning priority level) and why they may have to wait while others are taken into a room immediately. Identifying life-threatening events and responding promptly to them requires presence of mind, substantial expertise, and a lot of compassion.

Always being prepared is an essential characteristic of an ED nurse. It’s important to anticipate the worst-case scenario when patients arrive for care. We strive to provide prompt attention with the compassion and expertise that we have developed through the years.

Being prepared is vital and makes us thrive at being effective in what we do. It’s a daily norm to face the unknown every time we take care of a patient who presents with non-specific sets of symptoms. When patients arrive in full cardiac arrest, we have the task to be quick in our response and to restore signs of life even though we do not have all of the information about the event. We work through the pieces of information that we get from EMS and other sources.

Why did you choose to work in the ER/ED? How long have you worked there? What prepared you to be able to work in such a stressful environment?

I choose to work in the ED because I like the challenges that the setting provides to nurses. I like the unpredictability and the adrenaline-pumping scenarios that we encounter on a daily basis. The degree of autonomy that we assume to take care of our patients fuels our self-esteem and can be gratifying in so many ways.

I have been working in the UM UCMC ED for nine years. I went through rigorous preparation to be an ED nurse, including attending a “boot camp” for nurses where I was exposed to didactics and scenarios to prepare me cognitively and psychologically for the role of the ED RN.  During training in the department before I became an independent ED nurse, my mentor and preceptor provided me with the right blend of freedom and supervision so that I could develop my critical thinking skills for the role.

Reflecting on my journey since I started the ED nurse role, I see that my teammates are so instrumental in my success in this setting. In times of crisis (patient is crashing etc.), there are always available hands willing to help and provide the best care for our patients. Teamwork is deemed integral towards a positive experience of an RN in the ED setting.

How do you keep yourself from bringing the stress of the job home? What do you do to relieve your stress?

ED nurses thrive with stress. The experiences that we have had in the ED made us who we are now—caring and strong nurses. It is necessary for an ED nurse to be able to manage the stress of the job—not everyone can handle what we see and do every day.

Stress can be overwhelming in the ED. I had to figure out what worked for me so that it would not have a negative effect on me when I go home to my husband and children. If I have a particularly stressful night, I go home and sit in my driveway for 5 to 10 minutes and listen to music to calm me down and help me relax.

What are the biggest challenges of your job?

The most significant challenge that we face in the ED is accommodating everyone, even those who should be seeing their primary physicians for their health problems. Because of lack of health insurance, a significant number of people continue to crowd the ED for these non-emergent health problems.

Another challenge we are seeing is related to the narcotic epidemic. It is challenging to see so many people, especially young ones, losing their lives to this problem. Witnessing and dealing with the family and friends of these victims is heart-wrenching.

It is always a challenge for ED nurses to try to make patients who are asked to wait in the ED waiting room understand that there are others who are sicker than they are. Patients who are brought back to a room as soon as they arrive usually have signs of a life-threatening condition that with even a little delay may bring an adverse outcome.

What are the greatest rewards?

I feel privileged every time we save a life in the ED. Helping people and witnessing positive changes happen—a heart regaining its rhythm after a standstill or long pause, or when a blue and cyanotic face turns pink and the chest starts to move up and down—are rewarding experiences that fuel us despite a hectic and tiresome day.

When a patient’s family hugs me and thanks me for an excellent job, I feel all my aches and pains disappear. Those sincere appreciations are all it takes to alleviate the rigor of a busy day in the ED.

What would you say to someone considering this type of nursing work? What kind of training or background should he or she get?

It takes a particular breed of a nurse to thrive and be successful in the ED. Some nurses first start in a medical or surgical unit before considering moving to the Emergency Department. Persistence and determination are critical. Things may be difficult at the start, but it will get better as they become familiar with the art of emergency nursing.  Becoming an ED nurse requires patience and a lot of receptiveness to learning—we deal with a wide range of specialties. Even though I have been an ED nurse for nine years, I still learn every day.

Is there anything else about being an emergency nurse that is important for people to know?

We believe with great conviction that we can make a difference to someone’s life every time we provide care. If someone has to wait in our waiting room, I hope they know that is often because we may be saving someone from the brink of death and that we will take care of them as soon as we can.

Michele Wojciechowski

Michele Wojciechowski is an award-winning writer and author of the humor book Next Time I Move, They’ll Carry Me Out in a Box.

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