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Behind the scenes of every shift in the emergency room (ER) is a group of nurses and physicians working together to ensure that the patients who arrive at the hospital doors receive the best care possible. I have been a nurse at Vanderbilt Tullahoma-Harton Hospital (VTHH) for four years and my experience is that with teamwork, almost anything is possible and much more achievable.

My normal day starts at 6:30 a.m. when I receive the overnight report from the night shift charge nurse before I assume the same role for the day shift. This update covers any major events that occurred, including any critical patients that may need immediate attention or additional monitoring. No two shifts ever begin exactly the same but the goal is to round on the current ER patients first and then begin preparing the ER rooms for the day. My team and I check crash (code) carts, IV pumps, suction lines, oxygen regulators, bedside monitors and any other essential emergency equipment we may need throughout the shift. By anticipating patient needs and being prepared, we ensure patient care is streamlined with minimal delays once they arrive in the ER.

As a rural ER, we see a wide variety of cases throughout a typical shift ranging from respiratory problems fractures, lacerations to the more severe emergencies such as trauma, strokes and chest pain most commonly. Patients arriving at the ER for treatment are prioritized and triaged by ER nursing staff based on severity of illness. For example, if an individual comes into the ER with chest pain, our triage nurse or any nearby ER nurse responds quickly to retrieve the patient from the lobby, obtain an EKG and take vital signs within the first five minutes of arrival per protocol. The physician reviews the EKG immediately. This swift action allows us to determine their immediate needs and provide the overseeing physician with any critical information needed to determine the course of treatment and urgency. While each nurse is typically responsible for four patients at a time, everyone on the team jumps in to support one another so that the appropriate care is started as soon as possible.

We rely heavily on each other for support and assistance when there’s a trauma or critical case, and time is of the essence. We may only get a minute or two heads up, if any, before the patient is brought through the ER doors. Then it’s go time. Adrenaline kicks in, my focus intensifies and so does the trust in your team. Everyone has a role. The primary nurse is usually at the bedside, others are grabbing supplies, making calls and documenting without needing to be told what to do. It becomes second nature to us. We move like a well-oiled machine, reading the room and assessing for any additional needs to avoid duplicating efforts.

Unsuccessful resuscitation attempts for any age leaves me with a heavy heart. Over the last year we’ve faced multiple pediatric codes which can be particularly difficult when young lives are on the line. As a team, we collaborate to ensure we have done everything that could be done and exhaust all possible efforts in these situations. Each ER team member may have different coping mechanisms to get through the next few moments and the rest of the shift. I often find myself needing a quiet moment of reflection and prayer in these instances before I resume care of my other patients. It is imperative that we give ourselves, as well as the other team members, the grace to have these brief moments before moving forward. It is my experience that in doing this, we provide the best version of ourselves to the remaining patients also needing care. The power and privilege of working at a community hospital with a tight knit group of nurses and physicians means they understand. We become very familiar and know each other well enough to offer support and understanding when a fellow staff member needs to step away to reset.

What many people outside of healthcare don’t see is the emotional rollercoaster we ride every 12-hour shift. It takes its toll at times. And yet, if I ever stopped feeling the emotions associated with that rollercoaster, or empathizing with my patients, I’d know it was time for me to step away from bedside nursing. Thanks to the strength of our team and our shared purpose we are able to keep going one shift at a time. For me, even after 36 years of nursing, every day as an ER nurse is not only an adventure, but a blessing.

Angela Sylvester, BSN, RN is an emergency department charge nurse at Vanderbilt Tullahoma-Harton Hospital in Tullahoma.