Behind the smile: The people behind emergency care

Official Statements

• Carl R. Darnall Army Medical Center, November 9: “When patients walk into an emergency department, they see nurses caring for patients, providers making decisions, and staff working to get people the help they need. What they don't always see is everything happening behind the scenes to keep the department moving. For Shadyne Scholl, an emergency room registered nurse and Certified Emergency Nurse (CEN) at Carl R. Darnall Army Medical Center, that's where much of her work as a charge nurse takes place. "I like being the resource for my coworkers," Scholl said. A nurse for 11 years, Scholl has spent the past four years as a charge nurse. Her path into nursing started long before she earned her registered nurse credentials in 2015. She began working as a certified nursing assistant at 17, a job she held for approximately eight years before becoming a medical assistant. While continuing to build her experience in healthcare, she pursued her nursing degree, eventually graduating in 2015. Her inspiration came from someone close to home. "My Grandma was a nurse and ever since I can remember I have wanted to be a nurse. It was a calling," she said. Today, Scholl's responsibilities go well beyond caring for patients in a single room. While staff nurses are assigned patients, the charge nurse oversees the entire emergency department, keeping track of who's coming in, who's receiving care, and who needs the most immediate attention. That can mean helping a coworker start an IV, coordinating a hospital transfer, taking a patient to X-ray, or cleaning and preparing a room for the next person. "You are in charge of the flow of the department," Scholl said. The job also requires constant anticipation. At the beginning of each shift, she receives a report from the outgoing team, reviews laboratory results and radiology reports, and checks rooms to make sure supplies are ready. "The entire job is anticipation," she said. "You see a patient and you know whether they will need labs or radiology and starting the process before the provider ever lays eyes on the patient. You need to be ready for the trauma or the code before they ever hit our doors." That preparation becomes especially important when several patients arrive at once. Nurses assess patients during triage and assign an Emergency Severity Index (ESI) level based on the severity of their conditions. During a mass-casualty event, the team uses a separate color-coded system to quickly identify who needs immediate attention. "When a MASCAL or several emergencies hit at once your training really kicks in and you go into an auto drive mode," Scholl said. Even without a major emergency, keeping the department moving can be challenging. Long wait times can frustrate patients, but Scholl said the team works together to follow up on test results, coordinate care, discharge patients, and prepare rooms for those still waiting. Much of that work happens out of sight. "Your nurse may have just got done doing chest compressions on a patient that did not make it and they may not have went to the bathroom for the past six hours, they have not had anything to eat for eight hours, but they come into your room and smile at you and act like none of that has happened to them," she said. "We do our best with what we have at all times," she added. Scholl describes emergency nurses as people who do a little bit of everything. "We start the IV, transport the patient, clean the floor, watch the kids, clean the room, help the doctor with decisions for care, we locate supplies, we stock the rooms, we make it work even when we are short staffed, make the phone calls, and help with the floors when asked." Despite the demands, the moments that make a difference keep her coming back. "When you are able to save a person from the brink of death, you have that one person who is genuine when they say thank you, or maybe the one person who truly understands that you are doing the best you can for them," she said. After a difficult shift, it's the opportunity to help people, the unpredictability of emergency medicine, and the chance to keep learning that motivates her. Her only request: "Try and be patient with your nurses. We are here to help you even if the world is falling apart around us, and we try and make it where when we are with you that you are the only patient we have."