Of course, there are still some skills, as imperative as they are, that can’t be gleaned from an 800-page textbook or countless hours in the classroom. Instead, many of these qualities are inherent. Meanwhile, others come with experience.
Curious to learn more about these unofficial offshoots of medical expertise, we sat down with both NY Med star and emergency room physician Dr. Debbie Yi and former colleague Katie Duke to have a little chat.
Together, these accomplished women crafted a list of six all-important qualities that a physician or nurse, especially one braving the ER, will call upon daily to get the job done.
Here’s what they had to say.
1. Bull**** detector
Patients are constantly trying to fool doctors and nurses in the ER. Sometimes it’s rooted in embarrassment, other times addiction…the list goes on, but the outcome is almost always the same:
That’s because many a patient fails to recognize that ER nurses and physicians come equipped with highly efficient internal lie detectors—lie detectors that function well beyond the realm of the pregnant “virgin.”
2. Common sense
You can refine your judgment, you can accumulate experience, but you can’t exactly learn common sense. If you could, the hospital would no doubt be seeing far fewer patients—especially those whose decision-making process looks a lot like this:
Fortunately for them, doctors and nurses have more than enough to go around, even when they don’t have enough of themselves to go around, which is critical, especially in the ER.
“People hate the emergency room because they hate the loss of control,” says Debbie. And it’s true—everybody knows the emergency room can be a real wellspring for pandemonium.
Who’s first? What’s next? How is that even possible?
It’s a melting pot of questions and needs, but with lots of logic and levelheadedness, physicians, nurses and aides can work together to navigate even the most turbulent of waiting-room waters.
Which brings us to our next quality….
3. Being okay with chaos
It’s nearly impossible to envision a frazzled Dr. Debbie, but there’s a reason why the imagination comes up short. “If you’re going to succeed in the ER,” she tells us, “you have to be okay with a lack of control.” Beginning, of course, with the patients.
In a rapid-fire, back-and-forth exchange, both Katie and Debbie describe a familiar scene:
“The patients are everywhere. They’re not in a room; they’ve dragged chairs into the hallway, they’re at the bus stop, they’re outside smoking.”
Everywhere and nowhere all at once…
Then, of course, there is the information. Or, to be more precise, a lack thereof. “The ER is a team sport, and we are all detectives,” Debbie explains. “It could be something so simple, but we are always detectives.”
A patient in critical condition with no medical records? No known name? It’s up to the doctors and nurses on duty to sort it all out—and sort they do.
“It’s fascinating,” Katie adds, “because other people in that same situation would lose it. They would completely lose their minds.” But not in the ER, where there’s no such luxury. Not if you’re okay with chaos.4. Trusting your gut
Knowledge is key, and so is skill. But instinct? Instinct is the secret weapon that good physicians and nurses rely on (both inside and outside of the ER) to make the most out of all that knowledge and skill…even when they’re sometimes at odds.
“In the ER, we’re visceral people,” Katie explains. “You just have a feeling.” When skeptical of a diagnosis, a seasoned nurse or physician knows to listen, and listen intently, to his or her gut—to dig deeper. And if they’re convinced that something isn’t quite right, they stick with their guns. They’re patient and they observe.
The result? A combination of intuition and critical thinking that looks a lot like this:
Which is to say, a whole lot of hard-won wins.
5. Ability to block out sounds
When the pace really starts to pick up in the ER, everybody needs you, everything is important and nobody wants to wait.
Voices, pagers, sirens, chaos…it takes a well-trained ear to tune out all the clatter and home in on a single, sleepy heartbeat. Luckily, ER nurses and physicians are masters when it comes to selective hearing, so that the sounds being heard are in sync with the priorities of that moment.
6. Great (maybe even too great) sense of smell
Sometimes, an accurate assessment can be as quick as…
“Yep, it’s the kidneys.”
That’s because a nose belonging to a nurse or a physician is like no other. Just as an engineer can actually hear flaws in a new design, or a chef’s palate can detect too much of this or too little of that, a nurse’s sense of smell (though often unwittingly) can play a key role in identifying the source of a patient’s complaints.
From body odor to breath, the funkier the smell, the clearer the cause, and a nurse’s willingness to get up close and comfortable has expedited many a long (and expensive) process of diagnosis elimination.
What do you think? Share your thoughts in the comments section below.
This article was republished with permission from SCRUBS Magazine.
I just look into someone’s eyes. There is a different look for CHF, pneumonia, altered glucose, infection, delirium and so forth.
33 years in the er. My gut is worn out. The man in triage complained of a strange pain in his upper abdomen, radiating to his back. I plopped him in a wheelchair, raced him to the resuscitation room.15 minutes later, he ruptured hi aneurysm. He didn’t make it.
My gut still works.
Never worked in the ER, but the Oncology unit can be very similar. My gut, common sense & sense of smell has served me well. Never knew the nose could be one of my best assessment tools, until I met my first case of c-dif
The classic understatement “I feel funny” is the worst sign. The calm before the storm. Assess as much as you can and get some help. Treat it much like a rapid response don’t be afraid or doubtful. Almost every time it will be right.
Started nursing in 1969. Nurses Aid in newborn nursery, while going to college for RN. As an RN, Critical Intensive Care, including Pediatric, neonatal, Cardiac, Neuro, Medical Surgical. Experienced in Labor and Delivery, Dialysis, Post Anesthesia, and 15 years in the Emergency Dept. and Trauma. 46 years total.
My intuition has saved many many lives. At times, arguing, or bugging a doctor, until they responded to find I was right. I was taking care of that person for 8-12 hours, sometimes for days, or sometimes just started taking care of them. I knew when things were going bad. All my senses were heightened in an emergency, and my experience and guts pulled me through. Sometimes not knowing what was happening, but a quick detective, and not afraid to speak up. Proud to say, I helped save many lives. 🤗
I would add the team “short-hand” communications. Within a caregiving team, we can convey a lot quickly and succinctly. This especially includes aides and other unlicensed personnel. Open communication, respect and trust allows for homing in on patient needs, observations, and working in rapid tandem easily.
Unfortunately, there are ER doctors and nurses in the ER who have become “anal” over the possibility of a patient being there “only for the drugs” and are so focused on the “label” instead of the “gut feeling” or the obvious symptoms of a patient, that they ignore or are quick to slap a minor diagnosis on them, or prematurely discharge the patient. Unfortunately, this sort of action/thinking usually leads to the patients demise.
At the ripe not so old age of 61; I’ve learned to use my 6th sense/gut feeling in nursing & personal life. It’s helped me in so many ways. Many years ago I had to tell a doctor my gut instinct was telling me something wasn’t right with his patient…no symptoms of any kind…the doctor basically blew me off. The patient died later that day. After that the doctor never questioned me and my gut.
Always listen to that internal voice. It’s rarely wrong.
You forgot a really important one: the poker face. I can keep a straight face when the girl I’m giving a nuero check on tells me the reason she passed out is because she got hit in the head by a flying stingray while piloting her boat (true story, and after seeing the damage to the wheel, I’m amazed she didn’t have more serious injuries). I manage not to laugh when someone tells me “I honestly just fell in the shower. And it slipped in and now I can’t get it out”. I’m mixed race, and managed to keep my face blank when the guy with the Nazi tattoos called me a racist epithet as I gave him pain meds. I can be in a pediatric code for an hour, and not show my emotion when my other patients chastise me for not bringing them that blanket they asked for. Especially in ER, the poker face is vital.
Yes. So much is the abikity to think on one’s feet in the middle of seeming choas. This you cannot learn from Nursing 101- you have to be in the trenches. Learn from everyone.never think you know everything- you should be learning every day during your entire career.
Best advice I ever got during nursing school was from an instructor who had been a nurse since the beginning of time…..she said “you have a good gut, never ignore it, it will lead you in the right direction”. Not sure if nurses develop intuition, or people with intuition often become nurses but I see it all the time, something just tells them something and sure enough it comes to fruition!