In the early months of the pandemic I watched innumerable TV news shows interviewing exhausted articulate, heroic nurses, complaining about the lack of equipment and their emergency wards being overrun by patients they had difficulty offering quality care to.
They never indulged in self-pity, but continued to feel it was their duty to save lives amidst this onslaught of disease and death. However, I never fully understood the nature of emergency nurses’ work. Doing a bit of research I discovered their medical knowledge and range of activities is immense, including triage, taking vital signs, monitoring patients, providing treatment, charting and discharge. The nurses also act as translators, advisers, educators, assistants, organizers and, most importantly, as amateur therapists calming patients down and just providing an ear and a sense of human connection for frightened and anxious patients.
In addition, nearly half of all medical care in the U.S. is delivered in emergency departments and nurses are on the front lines of that care. The ED is the midpoint between inpatient and outpatient care. Besides doing a bit of research, I learned a great deal from a documentary film “In Case of Emergency” directed by Carolyn Jones and produced by Lisa Frank the same team that made “Defining Hope” and “The American Nurse.” The film explores the role of emergency department nurses in seven urban and rural settings around the country from Burlington, Vermont to Dallas, Texas, observing them dealing with a myriad of problems, mostly pre-pandemic.
The ED nurses are women and men and they come from diverse ethnic and racial backgrounds. The most striking and articulate figure, amidst a group of deeply committed nurses, is Cathlyn Robinson, who is a veteran nurse and teacher in an ED in Paterson, N.J., a poor, heavily immigrant city. The film opens with Robinson, who is exhausted and stressed serving COVID patients, sitting on her porch having a moment of quiet before the day begins.
She sits with her coffee and says: “No one really understood how overwhelming it would be. I have to be strong — not just for my kids, but for my coworkers.” Subsequently, she pulls herself together to work another day.
The film then flashes back to a year earlier where Robinson serves as a kind of chorus about what emergency nurses do and feel about their work pre-pandemic. We learn that the EDs act as safety nets for patients who have no insurance, and that they deal with problems ranging from gun violence and alcoholism to opioid overdoses. In many poor communities the ED is forced to provide primary care for patients who have no insurance. (They deal with medical problems that in countries with fully developed national health systems they would never see.) The nurses are on the frontlines working under intense-sometimes crushing- pressure, and they often enter into the personal lives of their patients.
more than just physical care
In fact, they offer them sympathy, even empathy, that they can’t get anywhere else. In one instance a caring nurse soothes an anxious patient by singing “Country Roads.”
One nurse admits: “We’re drawn to the adrenaline rush, the trauma” involved with the job. And that’s what the job offers. For no day is the same as another day, and they are often confronted with life and death situations. They see the worst of the worst.
The film follows a flight nurse who offers emergency critical care and hospital care to people who live miles from hospitals in isolated rural areas. They often perform their care during rescue operations aboard helicopters or propeller aircraft.
Other nurses work in Detroit, where gunshot victims abound, and they often must operate as an extended family with one another just to survive what they see daily.
Toward the film’s conclusion we return to Robinson, who has been struggling with the pandemic, and is dealing with devastating suffering — for the patients are sick in ways she had never seen before. During the pandemic the nurses are left alone with the patients, since the family is not allowed to enter the hospital. A nurse like Cathlyn is there from the beginning to the end with patients who come in with little time left. It’s hard for me to imagine what she has endured. We learn the result is that she is so broken up that she can’t face her children after work.
Robinson is an exemplar of the dedicated and sensitive nurse. But even if this is a selective portrait of ED nurses and leaves out those nurses who are either cynical or falter at work, it’s a luminous collective portrait of essential workers who save lives every day. It’s also a cry for a change of an inequitable medical system that has to make do when dealing with the uninsured, the impoverished and even the insured.
So when the American Nurse Association states that “nursing is the protection, promotion, and optimization of health … and advocacy in the care of individuals, families, communities and populations” — it doesn’t feel like empty rhetoric, but an accurate description of what they do.