Letter to "ER" from Barbara Weintraub

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Letter to "ER" from Barbara Weintraub

Dear Sirs and Mesdames,

I invite you to become a part of the solution to the nation's nursing shortage, rather than a part of the problem. As a prime-time show, ER has a huge effect on people's perception of both nurses and ED's. As we sink farther into the worst nursing shortage the nation, and even the world, have seen, nursing is becoming an endangered species.

I believe there are multiple reasons why people are not going into nursing, but that one prime reason is that nurses are seen as non-independent decision-makers, whose only job is to carry out the orders of the physician. Having been a nurse for 18 years, I assure you that nothing is farther from the truth. In emergency departments all over the country, nurses do the initial assessment of a patient's condition; initiate the lab work, radiology orders, IV therapy, all before the doctor has seen the patient.

The doctor comes in and does his exam, and then the nurses watch the lab work come back and alert the doctor to the abnormals. The nurses monitor the patient on an ongoing bases, detect subtle changes in a patient's condition which could signal disaster, and initiate therapy while the doctor is with another patient. Let me illustrate this for you with a personal anecdote. I was working in a busy ED, and had the usual 6-8 patients. One of my patients was a man in his mid-40's who had come in with a syncopal episode (fainting). Although his labs and EKG were all normal, he was being admitted because his history was suspicious for being of cardiac origin. The patient was stable and awaiting a bed upstairs, and I was working up another patient. The doctor, in an attempt to be helpful, came and told me that that gentleman had needed the bathroom, so he had helped him. I knew the patient was on bedrest, so I thanked him for giving the patient a urinal. He indicated that the man needed a bedpan, and not a urinal, and immediately alarm bells went off in my head. The urge to defecate is often associated with inferior wall MI's, and most people will hold it rather than use a bedpan in a crowded ED. I rushed into the room to check the patient, and sure enough, his EKG was now abnormal. I did a stat EKG, redrew his blood and sent it to the lab, alerted the physician, had the on call cardiologist for the cardiac cath lab paged, started another IV, etc, all by the time the physician re-entered the room (because of my call).

We got the patient to the cath lab, where he had emergency balloon angioplasty, and he ended up doing fine. Afterwards, the doctor (who is a good doctor, by the way), was a little stunned. He thanked me, as he knew it was my nursing assessment and interventions which had saved this patient's life. Scenarios such as this are carried out many times every day in every E.D. If people knew the extensive training, critical thinking skills, and education required to be a good nurse, I think more people would be interested in nursing as a career.

Again, I invite you to become a part of the solution to the nursing shortage, rather than a part of the problem. Portray nursing in its true light. In one lecture that I give, I joke about the way ER portrays nurses. In the real world, the cardiac arrest victim arrives, and the nurse directs initiation of CPR. The physician will turn to the nurse and say "75 mg of lidocaine", and the nurse will say "I gave it already". The doctor will say "we need a CBC and a chem. 7", and the nurse will say "I sent them an hour ago, here are the results, and here's the potassium rider the patient needs because his K is low". This is the real world of nursing. And I think your viewers would love to see it.

Thank you,

Barbara Weintraub, RN, MSN, MPH, CEN
2003 President
Illinois State Emergency Nurses Association

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