I worked in Bellevue Hospital’s emergency department in NYC back in the 1970s. It’s where I “cut my teeth” in nursing and it has always been a source of pride. Bellevue ED nurses were considered to be top-notch, able to handle any situation that came through the door. We stood our ground with overbearing physicians and administrators; Lori Chiarelli, my Head Nurse, set a high bar. I visited there last week and met with Marion Machado, the Head Nurse of the Emergency Ward (EW). (I like that they still use the Head Nurse title—there’s no doubt as to who is in charge.)
Machado is a no-nonsense, roll-up-your-sleeves-and-get-it-done kind of person with a quick smile and sarcastic wit (a perfect ED nurse). She was wearing blue scrubs and a stethoscope around her neck; we sat at the work station in the middle of the EW, a large room with 10 beds around the perimeter. As we talked, her eyes moved constantly, scanning monitors and people and occasionally shouting instructions to staff. She returned to the conversation at hand without missing a beat.
Some things are different from when I was there. I had many patients in crisis from asthma and with massive GI bleeds. No more, Machado says, because medications are so much better. She sees “lots” of patients gravely ill from cancer who never sought treatment because they couldn’t afford it. More recently they are seeing “banker types and executives” who’ve lost insurance. But the rest of her clientele was familiar: cardiacs, strokes, residents from nursing homes admitted with dehydration and sepsis, alcoholics in acute withdrawal, a patient with AIDS in failure. Staff work 12-hour shifts; we worked eight hours but often did “doubles.”
I asked her to describe what she considered a bad day. “A bad day is a frustrating day, but not because you’re busy. It’s because you’re interrupted, because pharmacy didn’t send the meds, because the patient didn’t get the right X-ray, because you don’t have enough staff to give the care and do the job you want to do,” she said. That was very familiar, as was her complaints about administrators who focus on numbers rather than listening to staff, difficulties in working with people (nurses and physicians) who are transitioning from being a student to accountable professional, and not enough staff.
I took particular pleasure in one scene I witnessed. Machado cited recent research when she questioned a consulting physician and medical resident about an outdated therapy one of their colleagues had ordered. They changed the order. Machado also reminded them to please inform their colleagues about the new standard. Chiarelli would be proud.
—By Shawn Kennedy, MA, RN, AJN’s editorial director