Jeffrey Ballard, R.N. and Army Veteran, began his medical career as an emergency medical technician (EMT). After gaining experience as a paramedic and a licensed practical nurse (LPN), he became a registered nurse in the Emergency Department at a Level 1 Trauma Center. He was deployed to Afghanistan two years later as an infantry medic, where he sustained injuries in combat. Following a year and a half of surgeries and physical therapy back home, Ballard returned to emergency nursing, but his struggle with PTSD prompted his departure within a year.
Ballard received care at the Manchester VA Medical Center, and he decided to continue his nursing career there. “I wanted other Veterans to have the same comfort I experienced,” he said.
Today, Ballard has been working with the VA for nearly five years and serves in a program that helps elderly Veterans maintain their independence. Working alongside compassionate nurses and caring for combat Veterans like himself has helped Ballard rediscover his passion and flourish in his career. With his experience, he’s been able to better understand and build trust with Veterans in a way that generates comfort and healing for both parties. Recently, Ballard won the title “Red Sox Nurse Hero of 2018” and was invited to throw a game-opening pitch at the historic Fenway Park.
VA offers Veterans not only life-changing care but also life-changing careers. Join our team and discover the unique rewards that come from serving our nation’s heroes. To get started, search for opportunities near you and apply today.
This story was originally posted on VAntage Point.
VA Palo Alto nurse Karen Wall saved a woman’s life on a cross-country flight, applying the CPR techniques she learned and taught in a Basic Life Support class at her health care system.
Here is her account of the experience:
If you have ever wondered if it is a good idea to learn CPR, here is proof that it works. On August 11, 2017, I was returning home from a conference I had attended in Washington, D.C. During the Southwest flight from Baltimore to Las Vegas, I became involved in a medical emergency on board.
Whenever I travel, I always let the crew know I am a nurse in case anything happens where they need medical assistance. On this particular day, I was sitting in my seat relaxing with my shoes kicked off and talking with my seatmate, when I heard a commotion a couple rows behind me.
I heard the flight attendant say “Nurse!” I turned around, and she saw me and remembered who I was from boarding. She called me over and there was a lady in the window seat of the aisle passed out.
After grabbing my pocket mask from my carry-on (yes, I always have it with me), I went to her seat after the other people in the row cleared out. When I got to her, I tried to arouse her and get her to respond, but she was gray and cold, had vomited, was not breathing, and had no pulse when I checked her carotid artery.
I called a “code blue” and called for someone to get an Automated External Defibrillator (AED) while the flight attendant alerted the pilot so he could call for help on the ground. My seatmate, also a Veteran, jumped into the row as we worked to get the lady lying down in the row across the seats, as we had no other place that was flat enough to lay her out to begin CPR.
As we were doing this, suddenly two more registered nurses and a doctor came from their seats to help. One of the nurses (who also happened to be a VA nurse) began chest compressions (counting out loud) as I gave breaths—it was two-person CPR in action and by the book.
Once the AED arrived and was turned on, I applied the pads as directed by the AED and then plugged it in. The AED analyzed her and gave the shock just like I had recently learned in a Basic Life Support (BLS) class at work. We continued CPR and eventually got a pulse. She was breathing again! We monitored her vital signs, placed her on oxygen, and turned her on her side so she would not aspirate if she vomited again.
The pilot diverted the flight to Denver where we were met by EMT, who then took over the case and got her off the plane to take her to a hospital.
We need to continually practice our skills.
When I think of the many things I learn in class and the skills I not only learn for myself but also teach others as a BLS instructor, this experience reminded me that there is a reason we teach BLS and teach it the way we do. There is a reason for why we need to continually practice our skills and not take for granted it will never happen to us.
We never know when we will be “the one” who makes a difference in a person living or dying. When I had time to think back on the events of this day, it was as if we had taken the book out and literally followed the steps that lead to a positive outcome for real.
Never have I ever felt so proud to be a VA nurse than at the moment that passenger opened her eyes, looked at me, and smiled!
About the author: Karen Wall, EdD, RN-BC, OFS, LMFT, is a Geriatric & Dementia Care Coordinator at the Palo Alto VA Health Care System
This story was originally shared on VAntage Point.
If you’ve ever watched a series like Grey’s Anatomy or ER, you know that hospital scenes are always dramatic on screen. And if they’re in the emergency department—well, they pretty much always are. In real life, though, that’s not quite the case. Sure, there are times where the ER can get hectic. So to get the real truth in honor of Emergency Nurses Week, we decided to go straight to the source.
Sarah Emami, RN, BSN, CEN, CCRN, a staff RN in the ED at Sibley Memorial Hospital admits that she was surprised when she began working as an emergency nurse. “I thought working in the ER would involve a lot more Code Blue situations and ACLS [advanced cardiac life support] protocols. There are a lot of these situations, but mostly you’re preventing people from reaching a critical situation,” says Emami.
Emami, who has worked in the ER for six years, decided to work there because she loves a fast-paced environment as well as having a lot of autonomy as a nurse. Before working in the ER, she worked in the ICU and doing that gave her a lot of critical care experience, albeit at a much slower rate.
Even though she’s worked in the ER for a while now, Emami admits that there are still surprises. “Most people don’t think about the food that they eat: they eat junk food, processed food, and fast food a majority of the time, and they are surprised when they are tired, lethargic, and have GI issues,” she explains. Another surprise is that “people want a fast fix for chronic medical conditions.”
The biggest challenges for Emami about working in the ER are what she calls “boarders.” These are patients who are admitted to the hospital, but have to stay in the ER because there are no available rooms or there’s not enough staffing at the time. Emami also says that managing patient expectations can be tough—like the aforementioned desire for a “quick fix,” and teaching them that the best way to stay healthy is a combination of a good diet, exercise, and stress management.
When she can get through to patients about how to stay healthy, that’s the best. “The biggest rewards are when I can teach a patient something new about their diet, medication, or how to navigate the health care system,” says Emami.
As most nurses certainly are aware, this year’s flu season is exceptional. It has surged earlier than in previous years and as of mid-January is widespread across all 50 states. There has been a significant wave of flu cases in doctor’s offices and hospitals across the country, affecting everyone from children to the elderly. Emergency rooms (ERs) are inundated with flu patients, and in many cases patients line the hallways in overcrowded facilities without space or beds available due to additional patient volume. Patients are boarding and holding for inpatient beds in the ERs, which exposes additional patients, visitors, and staff to the flu.
Below are some friendly flu reminders, tips, and tricks to keeping yourself and your patients healthy and safe this season and beyond.
Hand hygiene is the most effective way to stop the transmission of the flu. Flu spreads via droplets coughed or sneezed by infected persons onto shared surfaces. Washing your hands thoroughly and frequently and using alcohol-based gel sanitizers is an effective way to prevent flu. But one thing we often forget about is our patients’ hands. Especially when I work in triage, I’ve started asking my patients and their visitors to use hand sanitizer before triage and before they enter their patient rooms as well.
If your hands are feeling the burn after so much vigorous washing and sanitizing, reach out to your infectious disease department to see if it can provide some hospital-approved pump-style lotions for your cracked hands. At home, try using Bag Balm or deep healing lotions and placing mittens on before bed to help salves and creams absorb overnight.
If you have flu symptoms, you should stay home from work. Not all employers have the same regulations regarding sick leave and doctor’s notes, and some are certainly more rigid than others. But the best thing you can do for yourself, your patients, and your colleagues when feeling under the weather is to stay home. This doesn’t just help you get better faster, but also prevents you from endangering your fellow nurses. The flu can spread so rapidly through a department that it can quickly decimate staff numbers and leave no one else to care for other ill patients.
You should feel empowered to communicate with visitors about the flu. It is imperative that nurses educate family members and patient visitors about their role in flu prevention. If your facility hasn’t already done so, consider limiting visitors to your patient rooms, especially children. It is wise to limit visitors under the age of 12 to protect this vulnerable age group from germs. You should feel empowered to ask ill-appearing visitors not to enter a patient’s room if you are concerned for their health. The safety of patients is the utmost priority.
Tamiflu is not for everyone. Most cases of the flu do not require treatment with antiviral medication such as Tamiflu. Clinical judgment will determine whether a patient fits criteria for treatment with antivirals. In most cases, treatment is most effective if given within 48 hours of symptom onset. If you have cared for influenza patients and are starting to see symptoms in yourself, reach out to your employee or occupational health department as soon as possible. In some cases it may be taken prophylactically.
It’s not too late to vaccinate. Make sure to teach patients that even though the flu vaccine has been less effective this year, it still helps save lives by reducing the severity and duration of the influenza virus. Remind patients that it is not too late to receive their flu shot. Everyone six months and older should get the flu shot, especially children, the elderly, and pregnant women.
Mask yourself, mask your patients. If you suspect someone has the flu, you should immediately begin droplet precautions. Place a mask on the patient in triage or when leaving his or her room, and keep yourself protected with a mask and gloves at all times. Remind patients to cover their coughs to help keep you safe.
Resort to basic teaching. Effective discharge teaching can help prevent repeat doctor’s office or ER visits and can help patients stay healthy. Remind patients that the best place for them to be if they are feeling sick is at home. Most people who get the flu will have a mild illness that does not require hospitalization. Fluids, rest, and over-the-counter antipyretics are effective in treating most cases of illness. People with suspected flu should stay home until at least 24 hours after their fever has gone away. Emergency symptoms that require immediate evaluation in an ER include shortness of breath, difficulty breathing, sudden dizziness or confusion, severe or persistent vomiting or diarrhea, or pain or pressure in the chest or abdomen. In children or infants, watch for signs of dehydration, fast breathing, lethargy, and rash.
Keep yourself as healthy as possible. In addition to washing your hands frequently (while at work and not), you should also try to boost your immune system by eating nutritious foods, including fruits and vegetables; staying hydrated; and getting exercise and sleep. Staying well rested and well hydrated can help keep your immune system in good shape to combat this flu season.
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.
As 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.
Our Nurse of the Week is Joseph Bruno, 36, who was the nurse in charge of the trauma unit at University Medical Center (UMC) in Las Vegas, NV on Oct. 1 when Stephen Paddock opened fire on a concert crowd from his shooter’s perch on the 32nd floor of the Mandalay Bay hotel, ultimately killing 58 and injuring hundreds of others.
“I know that we did everything we could to save the men and women who came to us. I hope the families of the slain that passed in my unit can take comfort in that.”
Bruno recalls receiving a call from emergency dispatch around 10 pm informing him that there had been an active shooter on the strip and more than 20 critical patients were headed their way. He quickly mobilized the nursing and surgical staff, giving them what little information he had and warning that they would soon begin treating patients in very bad shape.
UMC’s emergency department began receiving their first wave of victims in non-emergency vehicles within 5 minutes of the dispatcher’s call. Thankfully many surgical staff were still on hand from treating earlier patients and were able to jump in and help as the shooting victims began to arrive. Patients continued to arrive until 4 AM with varying degrees of injuries. The most critical patients were rushed to operating rooms to have life-threatening abdominal injuries repaired surgically while others had tourniquets applied to control their bleeding or IV fluids and blood transfusions started.
Bruno tells the Las Vegas Review-Journal, “There were times when patients pleaded with us to help others first, that they could wait. The only time I’ve ever seen that happen before is in the case of a husband and wife or parents with children after a car accident. But these were people with horrific injuries telling us they could wait in line for treatment so complete strangers could have surgery first.”
The pain and sorrow of treating the victims that night is still ongoing for Bruno, but he emphasized that one message be delivered loud and clear: “I know that we did everything we could to save the men and women who came to us. I hope the families of the slain that passed in my unit can take comfort in that.”
To learn more about Joseph Bruno and his courageous acts as the nurse in charge of the trauma department at UMC in Las Vegas on the night of the worst mass shooting in modern US history, visit here.