Emergency Department Nursing from a Nurse’s POV
When I tell people I'm an ER trauma nurse, they usually follow with “Oh, wow. I can’t imagine doing that. Tell me the craziest thing you’ve seen or done.” I then normally tell them the story about the patient who had a crazy injury, a freak accident, or the patient who was yelling and running in the hallway.
But what I want to tell them about are the emotions that come with being a nurse in the ER and witnessing death, darkness, and trauma almost every shift. The days when it’s hard to leave your shift at work. The days when you are emotionally and physically exhausted from being your patients’ and their family members’ punching bag. The range of emotions nurses go through in 12 hours is more than most people experience in a week, month, or even a year. Nurses are created differently from the normal person. In the ER, you never know what the next minute or hour may bring. You need to be prepared for whatever happens at any minute and whatever emotion might come with that.
One moment you are getting a turkey sandwich or water for your patient, and the next you are on top of someone’s chest manually making their heart beat for them with compressions. You're tired, sweating, and praying they will make it while the family members are at the head of the bed, crying and begging the patient to fight and come back to them. While you’re doing compressions you know, deep down you know you have exhausted all options and there is nothing else you can do to save the patient - the father, the husband, the brother, the son or the mother, the wife, the sister, the daughter to the people at the head of the bed.
But you keep going, you keep fighting with death. You keep giving it all you have. You don’t stop until the family tells you it's okay to stop. And then the time of death is called. You gave it your all, but you lost your fight with death. No matter what you did, it wasn’t enough. The patient you fought so hard to save is gone. And another life has been lost.
You take a second to compose yourself. You try to clean up the room as much as possible in the quietest way to respect the family as they continue saying goodbye to their loved one. You gently cover the patient, and you walk away. You walk away fighting tears as the family continues to cry and say their goodbyes to the life you just fought to save. You walk away like you didn't just fight with death and lose.
As soon as you walk out that door, you have other patients who need you. The patient next door is upset because you didn't bring them their warm blanket or water you promised an hour ago. They have no idea you’re fighting every urge to cry because of the life you just lost. To them, you forgot about them, and their needs weren't being met. You might get yelled at or cussed out by them because “How dare you forget about me?” As a nurse, you're expected to smile, apologize, and help them as if nothing happened and no one died a minute ago in the room right next to them.
Four hours later, you have different patients. They all want all their needs met. Each patient has their own set of needs, problems, and trauma. You meet a patient who no longer has the will to live. They lost their significant other, and the funeral was earlier that day. You look at them and you see their pain, their hopelessness. You try your best to help them, but can only do so much. While in their room, they look you dead in the eyes and ask, “So are they coming?”. You know who the patient is asking about, but pretend you don’t. You ask the patient who they are talking about. The patient looks at you with tears in their eyes and says, “My partner”. As the nurse, you fight back your own tears and remind your patient that their partner died and won’t be coming to get them. Then you stand next to your patient as they process what you told them. And you watch as they cling to their partner’s memorial card and cry themselves to sleep.
As you walk out the door, you pretend the whole conversation didn't happen. You see the emptiness in your patient’s eyes. You can tell they have no hope and no will to live. You can tell they feel like they have nothing left to live for. It breaks your heart. You keep fighting back tears. But you walk away and move on to your next patient and your next conversation with your coworkers. You don’t take the time to process the pain you just saw. Instead, you keep pushing through and helping others the best you can.
As a nurse, you feel all these emotions and more within 12 hours. And then you leave and are expected to go home to your loved ones and act like nothing happened. You didn't fight death and lose. You didn't look someone in the eyes who had no hope or will to live. You weren’t yelled at, cussed at, or assaulted. When someone asks you how your shift was, you reply with “It was okay” or “It was a little rough, but I’m okay.” And you move on. You go back to your life and whatever you’re facing, all while trying to forget what you witnessed 12 hours ago at work.
As ER trauma nurses, what we see and what we do is not normal. But we are expected to “leave work at work” and go about our lives like nothing happened. But something did happen. The things we see and do change us. We are not the same people we were the first day we stepped into the emergency department as a brand-new nurse. We might seem a little jaded to some people. We have a dark sense of humor and may seem rude or rough around the edges. We do what we think we need to help us cope with what we witness. These experiences change us and make us realize how short life is. We know that one minute a person can be healthy, alive, and well, having a conversation with someone, and the next they're gone. And as their nurse, you are fighting with everything you have to save that life. And yet, at the end of our shift, we share a dark humor joke with our coworkers and go home to the people we love like nothing ever happened.
So, if you know an ER trauma nurse, give them grace. Show them you care. Listen to them when they need to vent or decompress after their shift, even if you have no idea what they are talking about. Give them space to sit in silence if they need it. Don’t bombard them with questions or demands after their shift. They just spent 12 hours making decisions for their patients, they don’t have the energy to make decisions for you, too. And above all, know they will love you with all they have because they know how fragile life can be.
And to my fellow ER trauma nurses. I see you. I respect you. I love you. I know there are hard days - days when you question if you can keep doing what you’re doing. If you feel like you have reached your breaking point and can't handle all the trauma and emotions. It's okay. Take a break. Take a vacation or time off work. And if you need to change departments, that's okay too. Do whatever it is you need to. You and your life are just as important as the patients you care for. You are not a failure if you need a change. You are a human with emotions. And sometimes we all reach our breaking point. If you decide to stay in the emergency department, I thank you. Thank you for showing up on the hard days. Thank you for pushing on, even when it feels impossible. Thank you for showing your patients the love and compassion they deserve. Thank you for being you. You are not just a jack of all trades. You are a master of doing the unimaginable, pushing through when it's hard, showing kindness when it seems like you can't, and facing whatever comes through the doors in your 12-hour shift with a smile on your face and a heart ready to serve.
