Being the new person in the ED is not exactly a picnic. Think about it. Do you see a new staff member and think, “That person is new, so maybe he has something important to say?” Would you think, “She looks like she has all the answers?” No, you don't. You avoid new people like a fecal-impacted patient.
I've been the new person in many EDs over my 10 years in emergency medicine and nursing. The atmosphere is not always welcoming. I know a decade is not long when it comes to being a seasoned provider, and knowing what, when, and who to ask for advice has become a true art and asset to my profession. I still need questions answered and problems solved.
I used to look for the oldest provider in the bunch when worried about a patient. I thought the flashy, chatty, overzealous provider would just confuse me. But I have learned an important lesson about working with people, providers, and patients alike: We all experience uncertainty on a daily basis. This feeling is not unique to emergency medicine, but it has a special affinity for our profession. The reality is any one of us may not be welcomed with open arms.
My very first shift as a nurse practitioner was in a busy ED. I remember a difficult attending saying to me, “What makes you think you know how to do that?” The tone of her voice always made me question my career choice. I was new, and I didn't really know what to do so she was mostly right, but I always wished she had said, “Let's do this one together; you look ready.”
The ED is a scary place, and we forget that our colleagues are important players in the game. The more we play nice, the better the outcome. As my father says, “bees to honey,” or as I say, “I gotta bring the doughnuts.” One day, I was in a room with one of my attendings. We were strangers, but the dying patient didn't know that. I wasn't sure of this attending's abilities, and I had heard rumors that she was not the most heartwarming. The patient and the family looked at me when she entered the room, fearful of what was going to happen. And not knowing much, I turned to them, and said, “Oh! Dr. F. You are so lucky.” The patient looked at me, and said, “Why is that?” And I responded, “Because she is the best.” Dr. F. looked surprised and gave me a crooked smile.
The patient seemed so grateful, and for what? All I did was introduce her and smile. After that, I noticed something special about this provider. Every time we worked together, patients received amazing care. Dr. F. was more confident, proud, happy, and reassuring. We treated complex patients together and made small talk about our fears. We even found time to make jokes about our uncertainties. Our patients were happy, healing, and motivated. And so were we.
When I became an NP, Dr. F. was the first attending I reported to on my initial shift. Many other providers found her occasionally complex, but I thought she was fantastic and fascinating. Dr. F. was willing to teach me the things I didn't know. She let me see many things, do many things, and then teach things back to her like a welder and her apprentice. This woman was a wealth of knowledge, and I felt that everyone else had missed out for not harvesting her energy and dedication. I was nervous when I greeted my first patient as an NP. I will never forget her words of encouragement. Dr. F. addressed the patient as she walked into the room: “Oh, you're so lucky,” she said. The patient looked confused. “Why is that?” the patient asked. “Because you have Ms. Roberts. She is the best.”
Patients who feel reassured by their team feel better about their care. What is more interesting is the confidence that ensues and how patients receive better care when caregivers collaborate, respect, and like one another. Even if you don't particularly care for a provider, let the patient know she is in good hands. Reassurance is occasionally half the battle. It's a war zone out there, so be kind to your associates. Provide patients with the hope your team will take care of their problem no matter how simple.