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.
The emergency department (ED) presents a set of unique challenges for patient care, not the least of which is unstable patients who are at great risk for falls. I once heard a nurse educator proclaim: “Everyone is a fall risk in an ED.” From the elderly to the acutely ill, most patients in the department are at possible risk of falling, whether due to their age, their complaint, or the medications and treatment they are receiving. Additionally, many EDs do not have bed or chair alarms available for gurneys to assist with patient falls. Fall prevention is almost solely in the hands of the busy ED nurse.
Here are six ways you can help prevent patient falls in the emergency setting.
1. Use universal falls precautions.
All patients—from the 30-year-old with abdominal pain to the 65-year-old post–total knee replacement—are at risk of falling. In your own practice, using universal falls precautions can be helpful. Treating all patients as though they have the same risk for falls is a good start. Additionally, performing individual fall risk assessments on each patient at the beginning of his or her visit is important to both assessing risk and documenting that risk in the medical record. If completing a falls risk assessment is not mandatory at your facility, consider printing out the Morse Fall Scale and attaching it to your ID badge for quick reference. A standardized tool can help you quickly quantify the risk of patient falls so you can intervene accordingly.
2. Plan your interventions.
My personal favorite fall prevention intervention is the call light. On patient care whiteboards in the ED rooms, I write my name and the phrase, “Please use your call bell for ANY reason” on the board. I orient patients to the call bell immediately and make sure that it is in reach. I explain to them why both side rails need to stay up. Additionally, you may place fall risk socks (or grippy non-skid socks) on your patient as soon as you get them undressed into a gown. Use a fall risk yellow arm band if they’re available to you.
3. Orient your patient.
“I’m going to be your nurse today, and the best way we can work together is for you to help me keep you safe.” I remind patients that even if they feel fine, that trying to get up after laying down or after receiving high-risk pain medications can cause them to feel weaker or dizzier than they might imagine. I encourage patients to use the call bell so I can help assist them out of bed for any reason, but it is also important to set expectations. “It may take me a few minutes to respond, but I will be there as soon as I can.” Try to point out IV lines and oxygen tubing to patients as well as their EKG cables and monitoring leads to remind them that they will need to stay in bed and cannot get up without assistance.
4. Active toileting.
One of the biggest reasons that patients fall is because they have to use the bathroom. For male patients I always place “just in case” urinals at the bedside, and I encourage female patients to use the call bell as soon as they think they have to use the restroom. It is also recommended that you offer toileting as frequently as possible so that you are able to prevent the “have to go right now” urge that draws patients out of their beds.
5. Teamwork works.
It would be impossible for a nurse to be able to be in all of his or her patients rooms at all times, especially within the environment of the ED. If you have a patient who is a high fall risk, who perhaps has dementia or is uncooperative, notify your charge nurse and your colleagues on the unit. Try to move the patient to a room in sight of the nurses’ station or near a hallway. Keep the curtains to the room open if possible to allow as much sight as possible from passersby. If staffing allows, perhaps you could request a safety sitter to help watch the patient to keep them safe.
6. Speak up.
If there are conditions on your unit that continually put patients at risk for falls, report them to your manager and supervisors. It is everyone’s responsibility to help prevent patient falls.
Our Nurse of the Week is Jordyn Pennington, a junior in the Chamberlain University College of Nursing who jumped in to help treat victims after witnessing a disastrous ride malfunction at the Ohio State Fair in July that killed one and injured seven others.
The Fireball, an 18-year-old fairground ride that spins and swings passengers in a pendulum-like motion, collapsed due to “excessive corrosion,” ejecting passengers from the ride. Letting her nursing school training take over, Pennington jumped in to help and later shared her memory of the experience with us.
To learn more about Pennington’s lifesaving nursing care following the ride malfunction, read our full interview with her here:
Can you briefly describe your experience witnessing the ride malfunction at the Ohio State Fair and what motivated you to jump in and help?
I did not personally witness the accident, my husband did. We were at a food stand when he saw the incident happen and yelled, “Jordyn, that ride just broke and people flew out!” When I first heard what he said, it didn’t click that something that awful had actually happened. I looked around and saw police officers and fair workers all running over to where the accident happened.
Within seconds of the ride malfunction, my husband and I ran to help. I walked up to where the police officers were pushing the crowd back and said, “Hi, I’m a student nurse, can I help?” From there I was led back to where the victims were, given gloves, and sent on my own to help in any way that I could. I knew those people needed help, and I was determined to help as much as possible.
How has your nursing education thus far prepared you to help in this kind of emergency situation?
Chamberlain University has done such a wonderful job of educating students on safety, assessment, and prioritizing. At first, I entered the scene and looked around to see where help was needed. I checked to see if anyone needed CPR (none was needed at the time), and moved on to who I felt would be a priority. When I was working with the patients and the two other wonderful nurses (who I didn’t know at the time were nurses), my Chamberlain training all came flooding back and I started working on instinct. I wanted to help in every way possible so I worked to find the people who needed help the most, and took immediate action.
What triage or first aid skills did you use to help those injured by the ride malfunction?
I helped coach breathing and applied pressure to stop bleeding (along with the other people, two wonderful nurses who I’m proud to now call friends). I held and stabilized a limb that I thought was broken, used communication to calm the victims down, prevented what could have been an additional life or death occurrence, helped hold arms for IV insertion, and helped keep the victims calm and still as much as I could. The two other nurses and I stabilized the victims as much as we could until the paramedics arrived.
While assisting in helping the victims still trapped in the ride, some people tried to manually open the seats that were stuck. From education I’ve received, you never move a trauma patient unless their life is in further danger. Since the people were not in any additional danger, I instructed them to stop trying to open the rides since the patients were safer in place than being moved which could cause further injury. I feel lucky to have stopped what they were doing, and honestly believe that my speaking up potentially saved lives.
What are your future plans for a career in nursing?
Honestly, I feel lucky to just be in a nursing program and in the future, to become a nurse. After this horrific incident, I know now that my heart belongs in trauma. I also have a huge soft spot for oncology as well. I currently serve as the president of Chamberlain’s College of Nursing Columbus campus Oncology Nursing Student Interest Group and couldn’t be more proud to help represent such a wonderful group!
Is there any other information you want readers to know about yourself, your nursing career, or your experience helping during a public emergency?
I’m just your average person who was in the right place at the right time to offer help. I’m a mother of two beautiful kids, and am married (4 years) to my high school sweetheart. Caring for people has always been a passion of mine, and I feel so lucky to be able to earn a degree in a field that I love.
Please lend a hand if you’re able to, and speak up if you know something is wrong. You never know what you’re truly capable of.
Hurricane Harvey made its first landfall on the southeast coast of Texas Friday evening as a Category 4 storm and continued to bring devastating amounts of rain to the state throughout the weekend. Many cities in the hurricane’s main path ordered evacuations ahead of the storm but Houston, the fourth-largest city in the country, was unprepared for the rain and flooding which left countless residents trapped in their homes.
The health care infrastructure in Houston has since found itself gridlocked by the hurricane. With ambulances unable to travel in floodwaters and helicopters grounded by the high winds, many hospitals struggled to treat storm victims throughout the weekend.
“We can be dry and open but if you can’t deliver patients to the medical center, that’s our biggest concern.”
Thanks to required hospital engineering improvements following Hurricane Katrina in 2005 and Tropical Storm Allison which damaged southeast Texas in 2001, most major hospitals in Houston were able to protect themselves against the flooding. This allowed them to continue operating throughout the storm and protect patients already inside, but hospitals were left cut off from patients trying to reach them. William McKeon, president and chief executive at Texas Medical Center in Houston, tells The New York Times, “We can be dry and open but if you can’t deliver patients to the medical center, that’s our biggest concern.”
Law enforcement officials have begun identifying safe routes to hospitals and sharing them with emergency medical service agencies to coordinate the rescue of hurricane victims. This coordination and teamwork seen during Hurricane Harvey shows how healthcare networks have learned from other incidents and put practices in place to prevent hardships experienced during previous storms. To learn more about Houston’s hospital efforts to treat storm victims of Hurricane Harvey, visit here.
Our Nurse of the Week is Darren Moon, a staff nurse in the Loma Linda University Medical Center emergency department, who recently received the 500th Healing Hands Award for his lifesaving care. When patient David Colwell was admitted after experiencing symptoms of a heart attack, Moon stepped in and took the necessary steps to ensure that Colwell received the lifesaving medical care he needed.
Moon was reunited with the patient whose life he saved after Colwell nominated him for the Loma Linda University Health Healing Hands Program. Surrounded by emergency department colleagues, Moon was recognized for his actions as the 500th Healing Hands Grateful Patient Program recipient.
According to News.LLU.edu, Colwell addressed Moon at the awards presentation with the following: “Thank you for your expertise and quick action to address my situation. I understand you were also part of the team in the cardiac cath lab who attended to me. I’m glad you are part of the Loma Linda family.” The nomination came as a surprise to Moon, but he was honored to receive the 500th Healing Hands pin.
The Loma Linda University Health Healing Hands Program provides patients a way to recognize staff members who have provided exceptional care, according to their website. The program allows patients and their families to give a gift of any amount, and direct it to supporting the campus in any way they choose along with a note to the caregiver.
Connie Cunningham, executive director of emergency services at Loma Linda University Health, praised Darren with kind words: “Darren is an amazing nurse, skilled and well-rounded. When David arrived in the emergency department, Darren was focused and calm as he sifted through all of the symptoms.”
Time is of the essence with patients like David who exhibit cardiac-related indicators, and thanks to Moon’s lifesaving care, Colwell is now in good health. To learn more about Moon and Colwell’s nurse-patient relationship, visit here.