I am not a Nurse, in fact even after having worked in the ER for the last year I still refer to myself as a “Scrappy Street Medic“. While I have learned so much here in the ER that I never would have learned on the streets in the back of an ambulance, I know very well there is still so much more that I have yet to learn. As I sit here and think about all that I have learned in the last year working alongside these ER nurses I begin to feel a lump in my throat. That lump forms as I recall the last six years I’ve spent working in EMS and as I look back on those years I regretfully think about all the times I gave nurses crap along the way, most of the time as rumblings in my head, but still nonetheless the thought of those rumblings forms a lump. The lump in my throat feels hard to ignore as I am ashamed to admit that even up until a year ago there was a time in which I failed to acknowledge all that is an ER Nurse. I know I don’t speak for only myself when I regretfully acknowledge these feelings, and I don’t sit here saying this intentionally calling out my fellow brothers and sisters of EMS. I say this because my eyes have been opened to the other side now, the side that I thought I knew before and felt I had a right to grumble about, but know now that while I thought my eyes were open back then they were actually closed. Closed not by choice of course, but rather by situation, I thought the dozens of trips to the ER each day told me all I needed to know about that place and the people that worked there. I was blind to the reality, maybe in part due to situation, I too was busy and overwhelmed in my own job that I never slowed down enough to consider those also caring for the same patients, albeit in different roles, but still nonetheless a very important role. Wether ego or just habit got in the way, somehow I too found myself feeling emotions that I now look back on and regret, the kind of emotions and frustrations that formed the now lump in my throat. I will repeat it again that I’m not picking on my friends on the streets, because I still work on those same streets too, I’m simply stating that I did not have the respect I have now for Nurses, especially ER Nurses, and I feel ashamed for ever thinking that way. As I sit here acknowledging the lump in my throat, I myself, someone who works in emergency medicine, I cannot help but think of those who have no relation to healthcare at all and I think that if I failed to see what I now know, I cannot begin to imagine all of the things that the everyday person fails to see when it comes to Nurses.
Because y’all, after spending the last year working in the ER as a medic I am here to tell you that working in an ER, especially in a pandemic, is no joke. I do and always will have a huge sense of appreciation for those that choose to work in EMS, after all those people are my fellow brothers/sisters, but for right now, let me put them aside, and let me tell you about the nurses, the ER Nurses. Because these ER Nurses, my goodness- they took my scrappy street medic self and they whipped it into shape, they gave me a dose of reality that extends beyond the back of a rig, and I am now a much better medic because of it. I thought I worked hard on the streets, and don’t get me wrong I did and still do work hard out there, but not in the way I’ve worked in here, not in the way I’ve watched ER Nurses work the last year. I thought I was tired and exhausted after a 12 hour shift on an ambulance, and I’m sure I was, but then I worked a 12 hour shift alongside ER nurses and I’ve come to know a type of exhaustion I didn’t know existed. (Like the kind of exhaustion that after my 12 hour shift I had blisters all over my feet and quickly determined the tennis shoes I was wearing were no match for the type of exhaustion in there. No worries though those Nurses set me straight and I had a pair of Brooks tennis shoes ordered the very next day.) Had I never found myself working in the ER, I likely still would be completely unaware of that exhaustion (and also never would have come to appreciate and adore Brooks tennis shoes). Over the last year I’ve come to know these nurses well, like really well, they have become some of my best friends. I’ve watched as they’ve worked tirelessly, selfishly, and bravely. And as I’ve gotten to know and love these coworkers of mine I’ve watched the cheerful, positive, upbeat Nurse I once knew slowly turn into a shell of the Nurse they once were. I now look at these sweet and selfless people I call my friends and I see them exhausted, defeated, and burnt out. I know their career has never not been an exhausting one, but over the last two years it has gone from an exhaustion that was capable of being rested off to a constant never ending continuous cycle of exhaustion. They are still showing up and they are trying to be the nurse they were two years ago but the shell has continued to harden as the months have gone on. It’s heartbreaking to watch someone that once had such a passion for their job now show up and watch the clock- waiting for the end of the shift to arrive, so that they can escape, even just for a little while and breathe, so that they can get away for even just a short amount of time only to have to show back up and do it all over again.
I read an article the other day, an article explaining how BRAND NEW nurses, baby nurses that have just graduated are completely leaving the profession entirely after only 3 months on the job. They aren’t going to a different hospital or different area of nursing, they are completely leaving the profession, the one they’ve spent years training for, the one they’ve dreamed of- many of them wanting to be a Nurse since they were little, they’ve had a passion and true desire to care for others- a gift not everyone can say they have, and those people- these Nurses, after working so hard to earn their title, they’re already packing their bags, and leaving for a different profession. That’s heartbreaking y’all. Truly think about that for a second. And what about the veteran nurses, the ones everyone knows in the departments, the ones that can calm even the craziest of seas. The ones with knowledge that extends far beyond what most will realize, the ones you know could very well be Physicians because they’ve been around so long they’ve seen it all. The ones that will tell you the stories that start out with the sentence “when I first became a nurse, back then…” Those nurses that would once tell you they would continue caring for patients until they physically were no longer capable of doing so, those nurses that worked into their 70’s, yes you heard me they were that dedicated to their patients, those nurses are retiring early now, they’re hanging up their badges. In the last year I’ve watched more nurses come and go than I could begin to explain. I stood next to my Charge Nurse the other day and watched the raw reality of the situation continue to unfold in front of me and it left me speechless, it was a moment that I will never forget, it was that moment that caused me to open up my computer and begin writing this post. It’s been several weeks now since that moment and I still can’t seem to forget about it, it continues to pop up in my mind, and I continue to find myself finding that lump in my throat each time I think about it. I’ve written and re-written this post several times- I’ve spent more time on this one post than any I’ve ever written, trying to convey all that I want to say, in a way that does it justice (because it’s that important), and I’ve struggled knowing I will never completely be able to convey all I want to say in the best way, but this moment I’m about to tell you about, it’s something you need to hear, it’s something I definitely needed to hear. So bare with me a little longer, I know you’ve been reading for a while already, but give me just a little more time would you? I want, no- I NEED you to hear about this moment. The moment starts out like this- I was rushing around the department a thousand miles an hour as I normally do, as were my fellow coworkers; the Nurses and the Techs, the Physicians and their Scribes, the RT’s, the Pharmacist, Imaging Staff, and even our incredible Custodians, and Registration staff- EVERYONE was hard at work doing their part (as they always are), caring and providing for patients in their individual roles, that together make up the workforce of an ER. It was a busy day, as it always is (and has been the last two years). As we were all rushing around in different directions I lifted my head and saw my Charge Nurse standing at one of the nurses stations- I have come to consider her a dear friend and respect her very much, she too like the rest of us is usually also going a thousand miles an hour, so when I saw her just standing there and noticed a look on her face it caused me to slow my speed walking through the department, one of those stop you in your tracks kind of moments if you will. I made my way over to her, and stood beside her and attempted to focus my view on whatever it was that had caused her to stop in her tracks. I asked her what it was that we were looking at as I was struggling to find anything out of the “norm”. Usually amidst the hustle and bustle of the ER it is easy to pick out when something in particular is different than the usual, but in this moment I was struggling to find what that might be- I looked around and saw what I normally saw, staff hard at work doing several different things to care for their patients, nothing out of the “norm”, the usual hustle of the department with the familiar background noises I’ve become very shall I say “attuned” to- the dinging of the call lights, monitors going off, IV pumps screeching, bed alarms alarming, that one patient that is always hollering, the clicking of the keyboards and humming of the printers, phones ringing, Voceras chiming, it was all there- as it ALWAYS is it’s the soundtrack of the ER constantly on replay *insert eye roll emoji because my lord it’s never quiet in there* (hence the reason for the word “accustomed” to it all) whoops I’ve gone on a tangent and gotten off track, you get the point though I’ve set the scene for you, back to the story. So as I searched for whatever it was she was acutely aware of, that I couldn’t seem to find, she looked at me, she sighed, and I noticed the look on her face, one that I didn’t recognize, and hadn’t seen her show before, it was a look of hopelessness and desperation. (It’s important in this story to know that this Charge Nurse I’m talking about is one that is strong beyond words, she is a “solver” capable of fixing and finding a solution to almost any problem. Her presence is a reassuring reminder that she believes in her team, and she leads in a way that encourages and believes in her staff. It is very rare to ever find her at a loss for words because she is just that good at what she does. I think that’s why I noticed that situation on that day, because of that look on her face, it’s very unlike her.) She pointed out another Nurse to me, a Nurse that everyone in our department knows and adores. She is the Nurse that always shows up with a smile on her face, with her makeup on and hair perfectly done in her curled ponytail signature style, (something I envy and strive to accomplish as I’m pretty sure I show up to work everyday looking like I’ve been run over by a semi and tossed through a garbage chute) and an energy that is contagious. She is the ER Nurse you would be honored to have caring for yourself or your loved one. She is the ER Nurse that is always willing to help another Nurse even when she herself is busy. She is the ER Nurse that precepts new Nurses and helps to mold them into truly incredible new Nurses. It took me a second to figure out why my Charge Nurse had pointed her out in that moment, to realize why we were observing her. But then I saw it, I saw what she was observing, and I too found myself standing still, for once not moving a thousand miles an hour, and I would imagine if I could have seen my face in that moment it probably would have also had that same look of hopelessness and desperation I saw on hers. She didn’t have to explain what I knew she was seeing, because I now saw it too, but somehow hearing the Charge Nurse I know and respect and look up to say those words, well it caused me to open my computer and type what you are now reading. “Look at ____, she’s so exhausted and so burnt out you can tell just by looking at her. She’s tired. It’s just so sad seeing these great Nurses become so over it all and knowing there isn’t anything I can do to change it, because I too feel that way. It’s just really really sad you know?” Yeah I do know, I might not have a year ago, but I do know now. *and the lump in my throat formed* For a few seconds more we watched as that Nurse we all love buried her face in her hands. You could feel the exhaustion she was feeling from a thousand miles away, the hard swallow of exhaustion as you attempt to bury the scream you just want to let out, or the tears you feel forming in your eyes- but you’re at work and you don’t want your coworkers to notice you are struggling, and so you bury your head in your hands instead in attempts to hide the reality of the burnt out emotions you are feeling. We sat down next to her and without either of us saying a word she looked at us, and I noticed she too had the look of hopelessness and desperation and she said “I have to leave this place, I can’t work here anymore, I don’t love it anymore. I have to quit, this place is destroying me”. And in that moment I hung my head, unable to find the words, my Charge Nurse was right, of course I knew she was right, I’ve known for a while now what these Nurses are going through but for whatever reason that moment, hearing her say those words, it stuck, it was a moment that felt hard to forget, one I kept thinking about throughout the day, and continue to think about even today. These nurses are burnt out, they are hanging on by a thread, their cups are overflowing with no room left to hold anymore, they have been overflowing for two years now. They are at their breaking points and they still keep getting pushed over the edges, over and over and over again. It never ends, their cups haven’t stopped overflowing for two years now. Over and over and over again.
How did we get here? Where have we gone so wrong that we are losing these special people that once had such a passion to serve and care for others, and now struggle to even find the strength to show up to their shift? How did this happen? How have we stood by and allowed these incredibly selfless people to become a version of themselves they barely recognize staring back at them in the mirror anymore. How have we allowed ourselves to simply stand by and watch them pack their bags and hang up their stethoscopes, and we’ve seemingly seen nothing wrong with it? Why haven’t we been crying out, fighting for them, fighting for the very people that have fought for us, and our loved ones, the people that fought to care for us? Why do we keep turning our heads the other way? How have we let this happen? How did we get here? Yes we’ve been in a Pandemic, yes these are unprecedented times, but let’s stop being naive and blaming it solely on the pandemic, because that’s not the case, this has been going on far longer than before there was ever a Pandemic. These nurses trained for working in stressful times, but this is far more than just a stressful time. How bad does it have to get before we finally open our eyes, before we finally start to pay attention, finally listen to their cries for help? Because it is bad now, it is really bad, and it sure as hell isn’t going to magically just get better, we need to open our eyes to their everyday reality. Allow me to attempt to, in the most simplest of ways, describe to you what these ER Nurses are showing up for, their everyday reality, because I see it now. These nurses are showing up for a 12+ hour shift, they are walking in the door to a waiting room that is already full. They start their day being briefed on the patient statistics of the day before, how many patients our department saw, how many we admitted. They are given a run down- there’s no ICU beds open, we’re holding this many people in the department right now waiting for beds upstairs, we’ve run out of this supply item so use it sparingly, this weekend we are short staffed, please pick up if you can help. They grab their PPE and head out onto the floor to get report from night shift, an idea of what is in store for their shift. Maybe the morning will start off nicely, maybe the department will have been cleared out by night shift, it won’t be as full, the Nurses will only come in with two patients to care for. It’s a breath of fresh air when a shift starts out this way, staff has a chance to breathe and prepare themselves for the 12 hours ahead, but it also brings with it an “eerie” feeling, the type in which you find yourself almost waiting “for the shoe to drop” or the “flood gates to open”. Even if the morning starts out with a chance to breathe, maybe they even get to actually finish their coffee for once before it’s cold, but everyone knows it won’t last long, it’s always just a matter of time before the department fills up, because it always does, it has every day for the last two years. But those calm before the storm kind of mornings are few and far between, especially as of recently, there is no chance to breathe, these Nurses are getting thrown straight into the storm the minute they step foot onto the floor. One look at the board is enough to make one sigh as they realize the sheer exhaustion they have awaiting them. They are showing up to an assignment of 4+ patients. Might I add patients that are sicker than we have ever seen before. They are showing up and caring for patients that aren’t ER patients, they are patients that have been boarding in the ER for 20+ hours, waiting for a bed upstairs. There’s so many of these patients that the ER’s are starting to look like inpatient floors. And while this in itself is a topic that deserves its own blog post entirely allow me to slightly rant on this as well while I have you here, because surely I haven’t typed enough already *insert winking face emoji*. Do you know how hard it is to try to care for ER patients while also having to act as a floor nurse and fulfill all the inpatient orders for an admitted patient at the same time? It isn’t easy. ER’s aren’t designed for inpatient care, it is less than ideal, but then again what about any of this is ideal? And what about the Critical Care and ICU patients because if an ER isn’t an inpatient floor for the most basic of admitted patients, it most definitely IS NOT an ICU, but this isn’t just one section of the hospital that we are talking about, this is the entire hospital, it is all full. And so the intubated patients, they’re waiting for hours down here too, so the ER nurses are also holding the role of ICU Nurse. There are three ways that a patient waiting in the ER for a bed will get one: 1. Someone upstairs is discharged 2. The patient is transferred to a different hospital (but those are all full too so that likely is never the case) 3. Someone upstairs dies. Do you know how awful of a feeling it is to care for an extremely sick patient in the ER and to know that despite your best efforts the patient is not receiving the full care they need because the ER isn’t designed for that, and you look at them and desperately hope they get a room sometime soon, and then the thought crosses your mind on how chances are someone else has to die first for that to happen. What a horrible thought to even have to consider. But I digress, there aren’t any beds anywhere, every hospital across the country is experiencing this same nightmare, there’s no room anywhere for anyone. Hell nowadays there isn’t even enough room in the damn morgue. THE MORGUES in the hospitals are overflowing with dead bodies, it’s a nightmare. IT IS THAT BAD. Between the patients in the overflowing waiting room and those boarding in the ER waiting for beds upstairs one would be correct in saying these Nurses have their hands full, but wait I’m not done yet (are you surprised)- because what about my people my fellow brothers/sisters of EMS, that’s right the ambulances, you can’t forget the ambulances because boy oh boy they just keep showing up too! The ambulances are just as busy, there is a constant line of them out the door wether we have gone on diversion (requested ambulances go elsewhere) or not. So make sure you add them into the equation too! The Nurses are caring for their 4 patient assignments and still taking hallway beds with patients because there simply isn’t enough room to put the ambulance patients and they are too sick to sit in the waiting room. People are sick with COVID, really REALLY sick, but there’s still also patients that are also REALLY REALLY sick experiencing Heart Attacks, and Strokes. The radios don’t stop humming of the ambulance bringing in the next Cardiac Arrest. There’s also the dozens and dozens of patients that continue to abuse emergency rooms as primary care doctors for nothing more than a Covid test, a Pregnancy Test, Toe Pain, or even a Belly Button scab (you read that right)- the list goes on, and yes there are very many reasons this happens (insurance, lack of appointment availability, etc) but it still doesn’t make it right and it only contributes to the mountain of issues. It’s a revolving door for the Nurses, as soon as one patient is discharged theres barely time to clean the room before there’s a new patient being placed in it. There’s medications to be given, blood to be drawn, call lights to answer, monitors alarming, phones ringing. Where in any of this mess is there even time for these Nurses to take a bathroom break, let alone lunch? Lately I’ve found myself reminding my coworkers to stop what they’re doing for a second to simply take a drink of water. Do you know what it’s like to run yourself so thin caring for others that you forget to take care of yourself? Oh and how dare I forget the one thing Nurses never signed up for, the thing that isn’t part of their job, yet somehow is one of the most frequent things they deal with- abuse from patients and their family members. That’s right, it’s real, and it happens daily, and no it is not something these Nurses should EVER have to deal with. You would think that in the middle of a PANDEMIC, the least we could do is be patient and respectful of the healthcare workers literally working the front lines to care for us, but that is rarely the case. It’s so very rarely the case that I was left in shock the other day when a patient thanked me, you don’t hear that very often now a days, it’s far more common to be yelled at and treated disrespectfully. I could explain the abuse they deal with daily in detail but that’s not the point because there shouldn’t even be any abuse for me to describe. It is not a part of their job to allow you to harass them for simply doing the best they can with what they have. It shouldn’t happen but it does. They are juggling all of these things with very little help, very few resources, and under incredibly stressful situations. The Emergency Room cannot close its doors simply because it is overwhelmed. Despite the staffing shortages, no matter how many Nurses leave their local hospitals for a traveling nursing position (and you and I can’t blame them for that, why get paid a lousy salary when you can go travel to a different state and make a local nurses entire annual salary in just 3 months) despite our very own staff falling ill themselves, despite every other obstacle that gets thrown their way, the doors will always stay open. More times than I can count I’ve seen these Nurses step off the floor to cry because it’s just so much. So yes, yes it is bad. While we can blame a lot of those things on the Pandemic there are also a lot of things that go beyond the Pandemic and at the end of the day can be chalked up to a broken healthcare system. We have and have had a broken healthcare system for decades now, and we are expecting nurses and all the other vital caretakers in healthcare to accept that the system is broken, but to continue to show up and work in that system. Because long before we were in a pandemic we were still dealing with an overwhelmed healthcare system, maybe not nearly to the extent we are now, but still nonetheless broken. You can try to blame it on politics or pharmaceutical industry, or the pandemic, whatever excuse makes you feel that it’s okay for you to turn your head, lord knows we’ve been turning our heads for decades already. But I still will continue to ask what it will take for us as a country to wake up and stop putting the blame on things and start opening our eyes to the gravity of the situation. I know it is easy for me to sit here and list off all the failures and shortcomings of our healthcare industry, it’s easy to do so because I am just one tiny drop of water in the giant ocean that is healthcare. I too will admit I myself am to blame just as you and the person sitting next to you are. I will not wake up tomorrow and somehow have changed healthcare by the typing of this post, I know there are so many pieces of the puzzle at play that have caused things to be the way they are now, and I know it will take decades to fix the decades of corruption that have occurred in healthcare. I accept that I will likely continue to work in a broken system for the remainder of my time spent working in healthcare, I alone and even with so many others screaming for change will not be enough for the change to happen. So I don’t sit here typing this expecting a great revolution of healthcare, but I do sit here typing this pleading for you to consider the people working in this broken system, I plead for you to try to understand that these nurses, these ER Nurses are doing the very best they can, with the very little they are being given. I know you won’t ever truly understand the gravity of it all, I don’t expect you to, a year ago I didn’t understand it completely either. It wasn’t until I physically worked right alongside them that my eyes began to open to the reality of it all, and I know I still don’t understand it all. But I sit here with that damn lump in my throat that won’t go away and I write to you, whoever you may be, wherever you may be, and I ask you to acknowledge these men and women. I ask you to be patient, and to show compassion, and to just try to understand their reality for once. I know you also are frustrated and overwhelmed and annoyed. I know you feel as if you deserve better, because you do deserve better, and we wish so desperately we could give that better to you. Nobody signed up for this. So maybe after reading this, even if you don’t feel a similar lump in your throat, maybe you still might finally have even the slightest idea of how bad it is, and maybe you can join me and my fellow healthcare workers in standing up and acknowledging what we are going through, and maybe now you can find a reason to support these nurses. Because as my Charge Nurse said it best “It’s just really really sad you know?” I hope now that you too can begin to know…because my goodness these Nurses, these ER Nurses.
Living Life Upside Down 