The real stars of the show

It is always busy this time of year, really busy, in the ER. When I came on shift recently the lineup of charts waiting to be picked up was almost falling off the desk. To be expected, I thought.

“We divided the charts into two piles, as one was getting to be too big. Do you want me to put them into single file?” asked the charge nurse. I looked up to see a second long lineup of charts on the shelf above my computer station. Wow, this was a new level of congestion, even for me. As I started moving from bed to bed I noted that every patient had been waiting more than 5 hours to be seen. They all were patient and polite, likely more than I would have been in their shoes.

I am continually amazed at how the nursing staff carry on with patients waiting in every nook and cranny of the department, keeping them safe and cared for before and after the physician attends. All eyes are upon the nurses as they work in the ER, assessing patients, updating the physician, giving medications. It is a fishbowl-like environment and the constant scrutiny is intense.

It’s the nurses who often bear the brunt of patient frustration when waits for care are long. How many times have I been gently prepared for a frosty reception in the exam room? But when I finally walk in to see the patient I sense not a bit of impatience. It certainly isn’t the result of extraordinary interaction skills on my part. The nurse has done his or her utmost to defuse the situation and be compassionate, usually with excellent results.

As an intern 30 years ago, I got the usual orientation to the wards: writing admission orders, call schedules, who to consult with. But the best advice was the following: “Listen carefully to the nurses—if they are concerned or uncomfortable with how you are going to approach a patient’s care, think twice, and then think again. If the nurse doesn’t feel the patient should be discharged, you are likely missing something!” I had good sense enough to heed the advice, my patients benefited, and I stayed out of trouble. That advice has stuck with me after all these years and has remained invaluable.

It is so satisfying to watch new grads develop into seasoned ER nurses. Not only do they have to learn new skills, they develop that “sniff-test” ability—being able to sense when something is just not right with one of their patients despite the information at hand. In addition, they have to get used to all our individual physician idiosyncrasies. As one of our veterans explained to a younger colleague, “You will get a feel for which doctor likes what, as there can be a lot of differences sometimes.” You have to be very special to accomplish that steep learning curve, and incredibly patient.

Health care has always been a team sport, but not all members get the attention they deserve. We physicians are accustomed to getting a lot of credit for successful outcomes, but we know that our nursing staff contribute a huge amount to patients getting the care they need. Grace under fire might be the best way to put it.
—AIC