Emergency Nursing

My Specialty

Emergency Nursing

Working shoulder-to-shoulder with physicians in a fast-paced specialty

By Keith Carlson, RN, BSN
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“Not long ago, a young woman came into the ED accompanying her husband who needed urgent care,” says Debbie Buffham, RN, MICN, CEN, who has been employed by Providence Saint Josephs Medical Center in Burbank  since 1995, and has worked in the emergency department there since 2006.

“Her baby had been born in the ED and was transferred to the NICU where he died three days later. She told me that everyone in the ED was helpful, but she specifically remembered me because I kept talking to her throughout. It had been two years but she still remembered me. I cried right then and there.”  

A Life-changing Event

Asked how this interaction with her former patient impacted her, Buffham replied, “it reminded me that patients are aware, and we have to treat them and not just their conditions. I made a difference, even though it wasn’t the outcome we wanted. That was very powerful for me, especially since this patient was pregnant again.”

Having earned her Mobile Intensive Care Nurse (MICN) certification, Buffham receives calls from paramedics in the field in order to guide them to their destination. As a base station for direct calls from paramedics, St. Joseph’s must always have a MICN-certified nurse on staff.

Buffham previously worked as a med-surg nurse, a nursing supervisor, and served as a pain educator who rounded on surgical patients and consulted on acute pain management issues. Always intrigued by emergency nursing, she sought out a position at the Providence Saint Joseph’s ED and never looked back.  “I like the element of urgency, the broad spectrum of experience, and the hands-on aspect of the work.”

Collegial Atmosphere

She points out that in the ED, nurses and physicians work side-by-side throughout an entire shift, which is different from other departments. “We have very good camaraderie at Saint Josephs; there’s a really collegial atmosphere,” she added. Buffham is ebullient about her work in the ED and about her identity as a nurse.  “I love being a nurse. I’m proud to be a nurse,” she exclaims.

“In emergency nursing, you are constantly making a difference and reaching out to the community in a very direct way.  You’re often the first impression that people have of the hospital, so it’s important to be your best.”

“Nothing I Don’t Like”

Veronica Crowley, RN, has nothing but positive words for her emergency nursing specialty. “I love the pace and the volume of patients,” she said. “When you get to turn patients around and send them home, it’s like instant gratification. There’s nothing about my work that I don’t like.”  

Emergency nursing is a specialty that many nurses find both personally and professionally fulfilling. From urban trauma centers to small EDs in rural community hospitals, emergency nurses handle a wide range of situations which require split-second decision-making.

Veronica Crowley has been a registered nurse for 16 years and has specialized in emergency medicine since 1996. Working in urgent care prior to coming to the ED, Crowley  is currently employed by St. Vincent’s Medical Center in Los Angeles.   

Primary Care in the ED

Crowley says that economics are a major factor impacting emergency medicine and the patients whom she sees on a daily basis. Many Americans receive their only medical care in the ED, and she laments that some people simply wait too long to seek treatment due to their lack of insurance or money to pay what will most likely be a sizeable bill.

St. Vincent’s is a standby ED, so it does not receive 911 runs. There are two designated trauma centers in downtown Los Angeles within several miles of one another, so St. Vincent’s receives a different population through its doors. “Our hospital sees a lot of renal patients due to our history of doing transplants,” Crowley explains. “We also get a lot of cardiac patients that we refer directly to the cath lab right next door.”

Back to Basics

The patients who come to the ED at St. Vincent’s are relatively high acuity, with 80 percent being 4 or 5 on an acuity scale of 1-5, and their admission rate is approximately 50 percent. Asked if working in emergency medicine can be frightening, she is philosophical.  “Most things are scary the first time around. When we precept nursing students and new grads, we remind them to follow the basics and ABCs. Everything else is teamwork.”

Crowley loves to work with nurses who are experienced, who have a lot of energy, common sense and know when to ask questions. “When there’s good teamwork, it’s like a dance with everyone knowing their part.” Wrapping up our conversation, Crowley responded to questions about stress and self-care with down-to-earth advice that could be applied to nurses in most any area of specialty.

“You have to really take care of yourself. Eat well, sleep well, and decompress on your days off. Don’t stretch yourself too thin, and continue your education and learning of new skills. Emergency nursing demands a lot. You have to be ready for whatever comes through the door.”

Leading By Example

Holly Nagatoshi, RN-C, MSN Ed, BSN, CPEN, CEN, Manager of Emergency Services at Providence Tarzana Medical Center in Tarzana, California, brings much more than her impressive array of credentials to the table. She is also a visionary manager who strives for exceptional patient care while wholeheartedly supporting her staff in their own development.

“You lead by example,” she said. “Your role is to develop leaders in the staff around you.” Nagatoshi believes that if a manager becomes more knowledgeable about best practices, evidence-based practice, personal and professional growth, it inspires staff to grow and ultimately impacts patient care in myriad positive ways.

She certainly has a hefty job. As Manager of Emergency Services, she is responsible for every aspect of the emergency department, including: quality control, regulatory issues, human resources, financial management, staff development, clinical resources, EMR implementation, IT oversight, collaboration with the physician leadership, and acts as liaison to the pre-hospital setting and other departments.  

Prior to her current position as a manager, Nagatoshi worked on the front lines as a paramedic, a flight nurse and as a staff nurse in a Level 2 trauma center. Thus, her exceptional management of a busy emergency department is informed by her years of experience delivering quality patient care in a variety of high-intensity clinical settings.

“I think our healthcare environment is very challenging, and managers must be as driven toward self-development as their staff.” Nagatoshi said. “My most valuable resource is the staff where I work, and it’s what keeps me here. I see myself as a partner with them and I try to create an environment where they can grow and thrive and improve. This only serves to improve patient care and nurses’ job satisfaction.”

Career Advice    

When it comes to jobs and the economy, Nagatoshi explains that new graduates are currently having trouble finding positions since seasoned nurses are staying longer in the field. Just recently, Nagatoshi’s facility received 149 applications for one posted new graduate ED nursing position. This illustrates the situation nationwide.

Asked what she looks for in a potential employee and his or her resume, Nagatoshi enumerates a thoughtful list that could apply to any nursing specialty: What have they done to show they are interested in this specialty area? Have they joined a specialty organization? Have they volunteered or worked in the ED, or in an area related to the specialty? Do they have ACLS and PALS certification? Are they driven enough to know their role and their chosen specialty?

Her optimal employee is able to think clearly and make decisions autonomously, show leadership, and take charge in critical situations.

Go the Extra Mile

Nagatoshi urges nurses interested in emergency nursing to pursue the certifications that will bring their skills to the next level and demonstrate their keen desire to enter this specialty. Belonging to the Emergency Nursing Association, seeking ACLS certification, PALS (Pediatric Advanced Life Support) certification, TNCC (Trauma Nurse Core Curriculum) and ENPC (Emergency Nursing Pediatric Course) training, reading professional journals, and joining related list-serves all will assist the interested nurse in developing a broad knowledge base particular to emergency nursing.

“Working in a California emergency department, you have to be as ready for an 8.0 earthquake as for the birth of a baby,” Nagatoshi says knowingly.

Constant Challenge

“Doctors get to know you well when you work in the ER,”says Katie Bruels, RN. “When you’re standing next to a neurosurgeon as he drills a hole in a patient’s skull for an urgent ventriculostomy, you’re partners in that care. It’s an exciting learning experience.”

Bruels explains that this interdependence with physicians and surgeons is one of the keys to her job satisfaction. Her excitement about her work is contagious, and Bruels reports that nursing students who she precepts in the ED often remark how she makes her job look fun. She enjoys the fact that emergency has  “all of the specialists coming in: plastics, neurosurgery, trauma surgeons.”

Bruels began her career in 2002 as an LPN. While working as a Med-Surg nurse in North Dakota, she earned her Bachelors degree in 2005 and landed a position as an ED nurse in Juneau, Alaska. Currently employed by Sunrise Hospital in Las Vegas, Nevada, Bruels works in the Adult Emergency and Trauma Department.

“I always knew I would work in a department where I had to be versatile,” Bruels stated as we began our conversation. “In the ER, I maintain my skills and am constantly challenged, whether it’s wound care, rashes, trauma, ostomy care, trach care, or whatever happens on any given day. The physicians, mid-levels and other experienced nurses all help me to increase my critical thinking skills.”   


The Emergency Nurses Association            
California Chapter of the Emergency Nurses Association
The Society of Trauma Nurses
Emergency Nursing World
The Journal of Emergency Nursing            
American Academy of Emergency Physicians

Suggested Certifications  (all available through the ENA)

ACLS: Advanced Cardiac Life Support
TNCC: Trauma Nursing Core Course
ENPC: Emergency Nursing Pediatric Course
CEN: Certified Emergency Nurse
CATN: Course in Advanced Trauma Nursing
PALS: Pediatric Advanced Life Support

Keith Carlson is a registered nurse, writer and blogger. He writes for a variety of nursing and health websites, and has been included in several nonfiction nursing books by Kaplan Publishing. He is editorial contributor to BlackDoctor.org. His own blog can be found at digitaldoorway.blogspot.com.

This article is from workingnurse.com.

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