Monday, February 8, 2010

Tribute to Emergency Department Nurses (All of you)

The emergency department runs on nurses and a good nurse is worth his/her weight in platinum. While the EMPs (emergency medicine practitioners) go from patient to patient, taking histories, doing exams and ordering diagnostic studies and therapeutic interventions, it is the nurses that do the majority of the actual work by far. Not only do we depend on them to do this work, we also depend on them to keep us apprised of our patients’ conditions and to prompt us to make an appropriate disposition when our phase of care is complete. I have long held that ED nurses are the probably the best in the hospital.

In my 30 years in emergency medicine; EMT to PA, I have become acquainted with many excellent nurses. I’ve even married a couple, but I digress. Most of the ED nurses I have worked with have been RNs in my latter years of practice. Often overlooked are the contributions of LPNs, now a minority in ED. I have noticed that many of these fine nurses have been “phased out” of ED’s as time has gone along. This is largely driven by the concept that one can expect a higher level of competency from an all-RN nursing staff, but I am aware of no objective data that supports this view. My personal experiences, as both an EMS provider and PA, have shown me that an experienced ED LPN is at least as competent as their RN counterpart. In either case, the variety of experience the ED provides, the opportunity to hone skills, or the constant close relationship with providers somehow combines to produce a group of highly competent nurses.

One nurse in particular that stands out in my mind was Bobbie. Bobbie was an EMT, as well as a nurse and was one of the most intelligent and capable nurses I have ever worked with. When I was a basic EMT and EMT-I working on the Outer Banks in the early 1980’s, nurses from the local medical center (basically a free-standing ED) would occasionally accompany us on transports of the more critical patients. Bobby accompanied me on the transport of a patient with an acute AMI headed into cardiogenic shock. There we were, an EMT-I and a nurse with this patient on a slow slide South loaded up the ambulance with a portable cardiac monitor/defibrillator, a drug box and three IV med infusions. The patient deteriorated en-route and required medication adjustments. He thrashed about and pulled out the IV lines and required restarts. In the end, we and the patient made it to the hospital alive. On that and many other occasions, Bobbie never ceased to amaze me with her poise and professionalism. Bobby was an LPN.

I work with some fine LPNs in my current ED. Again, they are highly skilled, caring, experienced and professional. Both of those I have recently worked with are pursuing their RN credentials. Ultimately, they will be better compensated and have vastly more career opportunities available to them. Regardless, I cannot imagine that they could be any better nurses than they are right now. In the grand scheme of things, I think I would just rather have the most competent nurses taking care of my patients than rely solely on the letters behind their name. RN or LPN, the emergency department nurse is a breed apart from the rest. For all that you do, this blog is for you.

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