Real Nursing Stories: Life in the ER

The real life of an emergency room nurse might not be exactly what's depicted on TV, but there can still be plenty of drama.

Everything from birth to death comes through the door, and nurses are the ones who manage every step with hands-on care. An ER nurse never knows what to expect, yet he or she must handle everything and everyone quickly and effectively while acting as the "eyes and ears" of the attending physicians.

Adam Spurlock, DNP, RN, AGACNP-BC, CNL, works as a charge (lead) nurse in the emergency department at Rush Oak Park Hospital in Oak Park, Illinois. Spurlock knew he wanted to work in the fast-paced environment of the emergency room as soon as he had his first rotation there.

"I liked the constant turnover and change; the inability to plan your day. It just clicked," he says.

While working in the ER for five years, Spurlock earned a Doctor of Nursing Practice (DNP) degree at Rush University College of Nursing. This degree helped him assume a leadership role in the emergency department. "The degree also allowed me to sit for licensure as an Adult-Gerontology Acute Care Nurse Practitioner, which is the next step in the progression of my career."

"I'm in charge of making sure things run smoothly in terms of staffing, communicating with other departments and helping out with overload," he says. He basically functions like a medical traffic cop, monitoring the flow of patients' progress in and out of the department.

A typical night — Spurlock works from 7 p.m. to 7 a.m. — starts by taking over for those nurses clocking out. That means taking stock of where patients are in their treatment, discharge or admission process. As the night goes on, hospital staff gets thinner, but the ER can get busier with more acute cases. There is only one attending physician from 9 p.m. to 7 a.m., and one advance practice provider until midnight or 2 a.m., plus the nurses.

"It's usually pretty full. We are up and down — there's not too much sitting. We do get our steps in on our pedometers," Spurlock says.

ER nurses have a lot of autonomy to make decisions and advise physicians, which is something most people don't realize, Spurlock says. ER nurses also must be willing to do the dirty work, from cleaning up feces and urine to putting in IVs and drawing blood, along with monitoring the patient's vital signs. They are also the front line of communication with the patient's family.

Dr. David Manno, D.O., one of Spurlock's attending physicians, says teamwork is essential in the ER, and nurses must be true team players.

"It's a close work association," Manno says. "We rely on each other to observe the patient. Often they will see something I might have missed because I can't be with the patient the whole time. A good ER nurse will alert you to a change in the patient and know how to manage them so you can step away for a minute."

This is important because doctors can be responsible for six to eight patients at any given time, Manno says.

"The best ERs run like a team where people play well with others," he says. "A good ER nurse must be smart, adaptable and able to handle a large amount of stress. We see people at their worst, and we work in an environment where nobody's happy because nobody makes an appointment to come to the ER. A good ER nurse must have a thick skin to take the abuse that is laid on by patients sometimes."

Manno is not just speaking figuratively. Spurlock's shift often sees intoxicated patrons from nearby bars after closing time, often accompanied by police.

"They can cause a ruckus," says Spurlock, who has been assaulted by angry patients. In those situations, he follows crisis intervention procedures and attempts to de-escalate the situation — and, of course, calls security.

"That's why I like my job, because it's not boring," Spurlock says.

"Even if you've been here for 20 years, you think you've seen everything and you haven't," Manno adds. You're always learning."

Originally published in the Chicago Tribune special section Nursing In Action on May 23, 2016.