Emergency Room Nurse, Emily Brown

[00:00] Michelle: If you're interested in becoming an emergency room nurse, you came to the right place. My guest for this episode, Emily Brown, tells us the ins and outs of this seductive nursing specialty, especially if you are an adrenaline junkie like her. We discussed the skill set ER nurses need and the many certifications she has. We touched on new grads in the ER, the disciplines she works with, and the importance of a well-oiled code team. She's cross-trained for pediatric emergencies, charge nurse, triage nurse, and she's an assistant manager for the Wellness and Engagement committee who is passionate about recognizing burnout in her colleagues and doing something about it. And then she does this little thing on the side, except it's not a little thing, it's huge. She is the mom to two beautiful labs, Moose and Rhino, (who have their own Instagram page, BTW) and who are first responder therapy dogs. Moose and Rhino help address the mental health needs of first responders by providing emotional support. And if there's one thing that earns my deepest respect, it's dogs and nurses helping other nurses and healthcare professionals. In the five-minute snippet: dirty words, not diet tips. Here is Emily Brown. Well. Hi, Emily. Welcome to the podcast.
[01:49] Emily: Hello. Thank you. Glad to be here.
[01:52] Michelle: I'm so glad you're here as well. Thank you so much for answering the call when I put out the call that I needed to talk to an emergency room nurse because I think you just are going to have so much to offer my audience. So I like to just kind of jump right in and why don't you talk about how you got into nursing and then how you became an emergency room nurse?
[02:23] Emily: I don't think I had the most traditional path, but I guess I was bound to be a nurse. My grandfather on both my mother's and my father's sides are general surgeons. My father is a general surgeon, and my oldest brother is a paramedic firefighter. I always thought I wanted to be a sports equine vet. I competitively horseback ride to this day, and that's the kind of vet that I wanted to be. And so I had a lot of science classes under my belt and was heading in that direction. I ended up volunteering, I was lucky to volunteer at a clinic in Germany for a very prestigious vet and realized I actually could not be a sports equine vet. Most people treat, nothing wrong with this, I just couldn't deal with it. Most people treat their horses as a tool and part of the sport, and I can't look past the fact that they are an animal we should love and take care of. So I actually followed my brother at Oakland Kaiser emergency department because he said, "ER nurses kind of remind me of you and your attitude and your skills and your drive" and I never looked back, and I knew I wanted to be an ER nurse after one day volunteering there.
[03:54] Michelle: Wow, that is a really cool story. So you obviously have medicine in your family, and you've been exposed to that all your life. And it just takes somebody else saying, sometimes, I see this in you. And I've talked about this before on this program where we get into different specialties because maybe a friend that we have works in that, and they say, I think you would be a great hospice nurse. So they see something in us. So a very cool story.
[04:27] Emily: Yeah.
[04:29] Michelle: So working in the emergency room, I will tell you that as a NICU nurse, I consider myself a critical care nurse. That's a critical care specialty. And I just have always looked in awe at emergency room nurses whenever I see them running around, and they're always running, and they're running on their very short breaks to get a coffee or something to eat. And then they're running back to the emergency room. And it just seems like they do that all the time, but just I have such a high respect for emergency room nurses. And I think part of the respect comes from all the training that you go through, all the certifications that you get as nurses. You're very highly trained. So can you just talk about some of the certifications that you need or some of the training that you would need to work in the emergency room?
[05:31] Emily: Yeah, of course. Well, first off, we look at ICU nurses as a whole other breed. You guys do all sorts of things too, so I think we all have our skill set. I couldn't manage those drips. I just could not. Most certifications for an emergency department depends if you're an adult and a pediatric or one or the other. I currently have advanced my ACLs, my BLS, and my PALS at Stanford. We require both because we do see pediatric patients. Even though we have a separate designated pediatric emergency department, they're still within the same campus. So we have a lot of crossovers, either people not sure which department to go to, or perhaps a 17-year-old who follows pediatric guidelines. Sometimes we have very chronically ill patients who are technically aged out of pediatrics due to their age, but they're still following the pediatric guidelines. So we have a lot of what we call hybrid nurses who work comfortably in both the adult and the pediatric zone. For example, I actually have my certified pediatric emergency nurse. I do not have my certified emergency nurse certification for the adult side, but I do have it for the pediatric side. That is not required by our hospital. But it was something that I was interested in because I think we see some really sick kids in our ER and so that was a certification that I chose to get as well.
[07:14] Michelle: So do you float back and forth between those departments?
[07:18] Emily: Yes, I personally do. When I was working Charge more often, I would do usually one of my three shifts in the pediatric zone.
[07:27] Michelle: Okay. Do you guys have your neonatal resuscitation?
[07:33] Emily: It is not a requirement. Many of the Peds nurses do have it though.
[07:38] Michelle: Okay. Yeah, that's a lot. Definitely ACLs BLS, PALS,  maybe NRP, all those things.
[07:49] Emily: And then in the adult side well, on both sides, we're required to have TNCC because we are a Level I trauma center for both adult and pediatrics. And then on the adult side, we are a stroke and a cardiac. So we have to have the NIHSS comprehensive Stroke certification annually and we have to have a certain number of cardiac hours to prepare for our Stem patients.
[08:19] Michelle: That's a lot.
[08:20] Emily: Yes.
[08:21] Michelle: Do you need a scribe just to keep track of all your certifications and when they're due and all that? That's a lot.
[08:29] Emily: It is complicated. It makes renewing your license easier because you almost always just have enough hours with your certification.
[08:37] Michelle: Exactly. Yeah. You don't have to take any other courses. Have you worked as a triage nurse?
[08:45] Emily: Yes, we do work in triage as well within our department. Not like intake triage via the phone. But we do have a designated triage session that requires extra training in our department.
[08:59] Michelle: How do you triage? Obviously, you have the people that come in that are not very sick. Maybe they could have been seen by their physician or in a clinic, something like that. But then you have other people that maybe they're similarly sick. I mean, how do you make those distinctions?
[09:21] Emily: That is a tough one. And I would have to say no matter how many training lessons you take and skills you take, that is really a gut feeling. And I think that is learned after a certain amount of time in the ER. You just see people differently. Sadly, our hospital is very over-impacted these days, like many are. So the other day I left work and there were 47 people waiting in our waiting room to get a room. So you have to be able to really catch small details. We have a large psych population and they'll also often come in for completely unrelated things and it's hard to distinguish what they're really in need of that day. So I think we have an interesting population, but you kind of just learn to look at people and get a sense and pick out pieces from their stories that either don't make sense or make you a little bit nervous, and then things that you expect. Vital signs are very important. Past medical history, we have a very complicated patient population at Stanford. It's never just a person with abdominal pain. They have abdominal pain with a history of X, Y, and Z. So it can be tough. There's a lot of people who don't appreciate the triage system. I think they think it was a first come, first serve, but unfortunately, that is not how it works when we're limited on beds.
[11:01] Michelle: Yeah, I think you're totally right on that. People just think that I'm going to go to the emergency room and I'm going to be seen right away. And going back to your you had 47 patients waiting for beds. I know. In our emergency room, we're a Level III and we've had in our busy seasons, we've had many people like you waiting in the emergency room, not just for hours, but for days, where it actually turns into kind of like a medical unit. And have you worked in those environments where you've had patients for days? And how do you manage that?
[11:45] Emily: We are currently living that. When I went to work yesterday, I believe we had 30 admissions. We're approximately a 60-bed emergency department. We have taken over a waiting area that was intended for admitted patients to be able to wait for families to pick them up. And we have placed eight gurneys there temporarily. And then we have taken over a radiology space that also has eight bays. It's used for, I believe it was intended for ultrasound. So it's kind of like a pack you set up in terms of three solid walls and then curtains in the front. When we're really in crisis, we are able to ask for help from the float pool nurses, but it is mostly staffed by emergency department nurses. So we have definitely experienced some staffing issues in recent months and it's not what we're good at. We became ER nurses because we want to kind of treat and go and solve problems and I don't think morning meds for us is exactly not our skill.
[13:04] Michelle: I'll admit that you're like, now I'm reminded why I don't work on the floor.
[13:11] Emily: Exactly.
[13:12] Michelle: I don't prefer that.
[13:14] Emily: Exactly. We're fortunate that we at least have some spaces, but just this week, we had to have patients waiting in the hallways for their admission beds. And you're right, some of them stay one, some stay two days, some never make it upstairs and they're discharged home from our emergency department. So it has been an adjustment period for sure for most of us ER nurses.
[13:41] Michelle: Yes, I could see that. So, emergency room nurses, you guys have to be able to think quickly and make decisions under pressure because obviously you're dealing with life-threatening situations and so is there anything that you do? Do you have a method that helps you do that? Do you have algorithms? Are you just by nature a person that really thrives under pressure? Talk about that.
[14:16] Emily: Probably it is more nature for me. I would definitely say I'm an adrenaline junkie.  I enjoy fast-paced life. I want to make decisions quickly. I think it is where I was meant to be as a nurse because of those reasons. Again, I admire you ICU nurses. I just could not deal with the amount of thinking and effort you guys put into a lot of your decisions. I just want to kind of know what I'm doing and make a decision. And so I think the ER really matches my personality. I think a lot of people, especially when you're starting out, you write all the notes that you can and you learn algorithms for bradycardia and cardiac arrest and all these things in our certifications, but it really comes down to just learning a few really key life saving things and whatever that is for. You always remember to put oxygen on, or always remember to call a code blue or I think everyone kind of has a different style of how they approach a critical situation. But yeah, I think you have to want to move fast if you want to work in the emergency department.
[15:41] Michelle: Yeah, I just don't see any other way. And the thing about ICU and NICU is I think what you guys are so good at is kind of like automation. It's like, you know your job so well that you don't have to put like you said, a lot of thought into it. It just comes naturally because you've done it a million times before, whereas a lot of times and with seasoned nurses in the NICU and the ICU, they've obviously gotten their skills to a point where they're sort of automated as well. But I would think starting out in either place would be really challenging. Does your emergency room do you hire new grads?
[16:36] Emily: We used to stop, and then we stopped for quite some time. And this year, actually, we ran our first new graduate program since I've been there in ten years. And the other program that I really like is we do, we call it an ED transition program, and we take inpatient nurses who are interested in the emergency department. And similarly to the new grad program, instead of getting a three to four-week orientation, they get a twelve-week orientation that has class time, it has case studies. It follows a pretty regimented orientation schedule to really provide them with a lot more information to set them up for success in the emergency department.
[17:25] Michelle: That's fantastic. Let's talk about teams. Obviously, you work with physicians. What other disciplines do you work with in the emergency room?
[17:38] Emily: Oh, man, everyone in our emergency department, we're very lucky. I think the greatest gift to be given is a pharmacist. We have 24-hour pharmacists and pharmacy technicians, they help us with everything. Questions about medications, and changing dosages. They come to all our codes, they come to all our traumas. They help us pull medications when we need them emergently. They come with, we call it an RSI rapid Sequence intubation box that has all the medications we need. So, man, I don't think I could survive without a pharmacist anymore. We are very lucky to have them, and they're available 24 hours in both our adult and our pediatric emergency department. We have case managers and social workers that we work very closely with. We have a pretty large population of geriatric patients, so sometimes discharges can be tricky to skilled nursing facilities or making sure we get a ride home if we're discharging in the evening and patients might have started sundowning and having confusion and how to get them home safely. We also have not as large as other places, but we do have a homeless population. So we need to make sure that they have everything they need to go home. California law requires that they're given a warm meal, given appropriate clothing, given appropriate shelter. So that can be quite a discharge process. We are also very lucky at Stanford. We have a 24-hour Spanish interpreter that works in our department with us and a human person in Live that works with us. Again, they come to most of the traumas when they're called. They come to consults for consents or procedures, and discharge conversations with families. What else do we have? We've got a little bit of everything. We have a registration team that is ours. Specifically, we have what's called guest services at Stanford. It's kind of concierge. So if you need help with questions with your family members, or difficult conversations, they can help with that. Honestly, our campus is so huge, so a lot of people just come to the emergency department looking for their family members when they're actually admitted to a completely different building. So they will help with situations like that. So we're very fortunate in those that we have around us in our department.
[20:15] Michelle: That's great. That sounds like you just have everything that you need. And I loved how you talked about that. You have a real human that says so much because we've all worked with those video translators and they're great in a pinch, but there's just nothing like a person in the moment that is making eye contact and really getting to know the family and yeah, that's great. And the pharmacist, we were so spoiled in the NICU. We had our pharmacist. And you really rely on those experts, right?
[21:00] Emily: Definitely.
[21:01] Michelle: Well, code teams, talk about the importance of just a really well-organized code team.
[21:09] Emily: Well, that is a life and death situation. The code teams respond to our emergency department but actually don't usually do much. But they get the calls and they'll come and kind of be a backup. We have a department float nurse that's 24 hours that can help respond to anything. And then again, we're very lucky at Stanford. We have an incredible role that we actually created maybe five years ago in coordination with the medical team wanting to trial this. We have what we call an emergency critical care nurse, and they are cross-trained ICU and ER nurses. We have a matching attending, an ECC attending that is also ICU and ER cross-trained. So this nurse is never in a patient assignment. They're always in a float role to also be able to help, really guide and teach. We don't want them to take over a patient assignment because we don't want to ever take away from a primary nurse. And that's a really great learning opportunity, but they're always there to support in every code situation and provide experience to less experienced nurses. We have the trauma team that we work very closely with, and they come down, and I believe it's organized every other day. Either the trauma team or the emergency department team runs the trauma. So we have a very close relationship with them, and it can really make a difference which attending is running it in terms of the kind of vibe that's in the room. When we have a Trauma 99, that's our highest designation. We get the trauma teams, we get respiratory therapy, we get pharmacy, we get OR nurses because they hold an OR for us, they hold the CT's for us. So there's a lot of people, and it can be rather chaotic, if not well led. And I think we actually control it pretty well most days. Sadly, sometimes they have to learn, and I love them, but sadly, sometimes in the summertime, the new residents get a little overzealous and want to come watch and learn everything. So we have to do some crowd control every now and then. But, yeah, a good code team is really a game changer in terms of not only the patient outcome but how you feel you handled the situation. Did you feel like you did everything? Did you feel supported? Did you feel confident in your decisions? I think it's really a group effort, and it's a big difference when it's run well versus not absolutely.
[23:54] Michelle: Do your code teams respond to codes in-house?
[24:01] Emily: We have a code team that is for the inpatient, and then the emergency department has kind of a code team, and we respond within a certain vicinity. So we would go to the CT and Radiology wings and kind of places close to us, but hospital-wide, we do not go.
[24:21] Michelle: Okay. It can't be said enough how important teamwork is. I mean, so much research has been done on teams working together and outcomes and all of that, and there's so many different personalities that can affect things, too. So working as an emergency nurse, your patients are having a really bad time, most of them. So they're at a time where they've suffered an injury or they're very ill, whatever the situation is. And as a nurse, one of the things you do is provide emotional support to those patients and their families when they are experiencing a crisis. As a team, do you guys undergo any instruction or classes on the best things to say to patients or how to provide emotional support? How does that work?
[25:37] Emily: We actually don't. I wish we did. The one class, sadly, we have to take is how to protect ourselves physically when those conversations don't go well. That is a requirement of our hospital to keep us safe. We don't have those classes mandatory for conversations. There is one that is offered by our hospital and it's called Crucial Conversations and it's aptly named. It's to kind of facilitate these difficult conversations. Luckily, I would say again, we usually have social work or case managers to help us in these really difficult family situations. We usually come in as a team and make sure that we're all on the same page and providing that kind of support. I do think some nurses do it better than others. It's hard to balance the time requirements of a fast-moving department with spending enough time emotionally at a bedside, letting someone process something. But it's very important, both for the patient and the family members and for us as nurses to be able to process that and be able to appropriately move forward.
[27:00] Michelle: Yeah, absolutely. And, I imagine, social workers. I know in the NICU, we relied on them so much to help us deal with what the families were going through and to "be a container and not a sponge" and to not take all of their, if it was an infant loss or whatever, to not take their grief on, but to help them move through that grief. And so they were very instrumental for us. And I think, as you said, a lot of nurses, they just are. We're naturals at that and we can definitely hone those skills over time. And you touched on the fact that unfortunately, we have to think about our safety as medical professionals and what's being done in terms like, do you have security there? Do you have metal detectors? What do you do to protect yourself?
[28:14] Emily: Yes. So if you come in via triage walking as a patient or a visitor, there is a security officer and a metal detector that you have to go through. Our patients, if they arrive via ambulance, are wanded by a security officer. I haven't seen too many occasions where luckily people have brought in items with the intent to hurt nursing staff. Usually, sadly, for us, it is our patients who are intending to hurt themselves. That's what I've seen the most. That being said, I believe we have some issues with the opioid epidemic that people know about in California and there's quite a bit of meth use. It's getting a little bit more popular here again and so sometimes those patients can just lash out at you, schizophrenics who are unaware. Sadly, old dementia patients can become pretty aggressive, so you never really know where it's going to come from in the emergency department. And there have been cases where we have broken bones and nurses have serious injuries and need to be going home. So there's not a lot you can do and I wish we could change that. And I think as nurses, even in those situations when you want to protect yourself, you still catch the patient that's falling, even though if it's going to hurt your back and if it's that sweet old demented lady who's sundowning and swings at you, you still don't want her to hurt herself. And so I think it's a tough situation to be able to protect yourself but still get it out of your mind that you need to put yourself first. I don't think we're very good at that.
[30:06] Michelle: Yes, I agree with that. I feel like we should not be in a place where we don't feel safe. And I feel like organizations, and institutions need to do everything they can in their power to protect us so that we can practice in safety. So how do you approach patients who are using the emergency room kind of as a clinic?
[30:37] Emily: That's tough. I would say it's pretty common. I think for us, we try to just approach it as a teaching experience. I think we obviously always offer care, the best care that we can, but we try to provide some information upon discharge about maybe more appropriate uses of the emergency department. That being said, it's very understandable. I recently had a patient who wanted to complain and talk to the charge nurse about the wait, et cetera. So I went to talk to them and his wife had recently undergone surgery for cancer and had a Foley, and the next appointment they had to take the Foley out was a month away. And he just kept saying, this is horrific and she's going to get a UTI and she's going to get septic. In that kind of situation, I thought you're completely right and I apologize and we're here to take out that Foley and take care of your wife the best we can. But in that situation that wasn't their fault. But we see that a lot in our area where there's a real lag and the ability to make a follow-up appointment. So we get a lot of follow-up appointments, to be honest. And it's hard to not be frustrated because you don't need to go to an emergency department to take out a Foley, but you also shouldn't have a Foley in for a month that you're not supposed to have in for a month. So I think it's a balance of education and just kind of supporting them. They're usually as frustrated as we are. It's a balance in our area for sure.
[32:26] Michelle: I share your frustration on that because occasionally like you said, there are these outliers where they really do need care. It's not necessarily emergency care, but I think some of the systems are broken. I know in our area we have one OB group that decided that they didn't want to take call anymore. So if a pregnant patient, or a patient in their care calls after hours, which is 5:00 p.m., they have on their answering service, "If you need care, go to the emergency room." And I feel like that's very irresponsible and it really puts the patients in a bad pickle as well. Because nobody, I always think this, but I don't know if it's true. I always think nobody wants to go to the emergency room and spend five or 6 hours waiting to be seen. I guess it's because I see everything through my lens and I certainly wouldn't want to do that. But I have heard that some people don't care, but I think we need to fix some of those broken systems.
[33:48] Emily: Definitely.
[33:49] Michelle: Yeah. Keep the emergency rooms for real emergencies. I know one of the biggest fears of emergency personnel is that they're going to have a friend or a relative come in as a trauma patient. Is that true? And have you experienced that where you've had somebody come in?
[34:15] Emily: Yes, both for me, I think maybe it depends. I grew up here maybe 6 miles from the hospital that I work in from the time I was four, four years old onwards. So yes, there are many times that I see patients come in that I recognize, not always critical trauma patients. Sometimes there are other things. It puts me in a tough situation also because I've had someone come in complaining of a site complaint and that's not something that a lot of people want public. So you kind of have to excuse yourself from the room and make sure that the patient is comfortable. But on the other hand, I feel very blessed to be there in a family member's time of greatest need and to be able to know the charge nurse and call and say so and so coming in and this is their history. Let me know if you need anything. Sadly, two years ago my mom had a horrific accident and actually fell sleepwalking and ruptured her globe, and it was incredible to know that I could call and it was during COVID and I was allowed in to be with her. So it has its pluses or minuses.
[35:46] Michelle: Sure.
[35:47] Emily: It can be shocking when you see a name pop up on a board and HIPAA obviously is a very big thing. You can never go there. So sometimes it puts you in a very uncomfortable position. But I do think if you really truly live in the area where you work, I moved here a year ago, so I don't know a lot of people. But for me, it is a very real thing that I often know people that come into the emergency department as patients.
[36:16] Michelle: Yeah, I would imagine, especially if you're growing up in that area. And the world, the saying it's a small world, it really is true when you start talking to people and you see all these different connections that they have and it's the same with me. I. Worked at the same hospital for 40 years and watched it grow from 600 employees to almost 6000 within the district. And you do recognize people, you do see people. And just like you said, sometimes you got to step out and sometimes there's perks. My sister, when I had my surgery, my sister was really good friends with my anesthesiologist and she got to come in the PACU and normally they don't let family in there. So there are some benefits for sure, yeah. Are there any areas where you would like to improve your skills? Do you feel like you need any brushing up on anything?
[37:28] Emily: I'm sure I do. I would say in general I feel pretty comfortable with our traumas and our Stemies. I think we run those very well. I wouldn't say that neurology and drips are my favorite. I think stroke codes and the massive amount of monitoring that goes on with those is not my most comfortable zone, I think, personally and for the nation, if not for California, for sure. If not the nation, I think all of us ER nurses probably need to brush up on our psych skills and identifying people at risk and really how to actually treat them instead of just keeping them safe. I think that's a big gap there that I think a lot of ER nurses really could probably,  I know I could improve upon it, but I think that's something that's really missing in a lot of emergency departments.
[38:34] Michelle: Who do you go for when you need help? So I feel like as nurses, we're mentors to others, to our colleagues, but I feel like we also need mentors. So who do you go to if you have a question?
[38:55] Emily: I have a really great relationship with a few of the doctors. One has been in, she was actually a resident at Stanford and has been in attending since residency. And she is close to retirement, so she's been there forever. And she's approachable at work. She's approachable after work. Any questions you ask, whether it's her patient or not, she's an incredible resource. The nurse that I was telling you about that was cross-trained at ICU. One of the day shift nurses I think is one of the smartest people I've ever met. And she's an ER nurse first that went through special ICU training. So I think that she thinks like us versus the ICU nurses that come down and cross-train to ER so she's really great to bounce ideas off of, and then still my dad and my brother for kind of running case studies with is that what you would have done? And I'm very lucky to be able to have literally family, not my chosen family, but my blood family, to be able to kind of run situations through with them as well.
[40:04] Michelle: That is a wonderful perk, I will say. There are eight kids in my family and six of them are nurses.
[40:12] Emily: Oh wow.
[40:13] Michelle: Yeah. So our holiday get-togethers are probably a lot like yours, where it's a lot of talking shop. And I was a teenager when my older brothers were in nursing school and watching them come home, and they were both surgical techs at that time and talking about the operating room and just nursing school, and it just was so exciting. I was like, and I already knew I wanted to be a nurse, but I was just so excited to get into it. Yeah, it's so much fun talking about all that. What kind of shift do you work?
[40:55] Emily: Typically, I work the day shift, so usually start at 7:30 till 08:00. P.M. We do 3-12 hours.
[41:03] Michelle: Okay. The twelve. Okay. We talk a lot about burnout in our profession right now because I think we're all experiencing it on a really grand scale. And first of all, what do you do to protect yourself against burnout? And have you recognized some of the signs in colleagues? And if so, what have you done about it?
[41:31] Emily: I'm glad you asked that. I am actually the assistant manager in charge of what we call our Wellness and Engagement Committee, and that is my greatest job responsibility is to try to battle burnout on a daily basis, and I try to tackle it on all fronts. We have implemented a lot of day-to-day ideas and processes that make small differences after a patient expires. In our emergency department, we have what we call a pause, and we stop and acknowledge that this was a human, this was a brother, this was a wife, this was a person. And we really take a moment to acknowledge that, and we actually write condolence cards and send them to family members as a closure for both us and them. We have a team that comes in. It's a trial that we're hoping to get fully funded. They come in once a week and do almost any kind of physical therapy, like the Theragun and heat help to kind of battle the physical signs of stress. We have support groups once a month where you can call in and talk to a therapist, and it's kind of a guided session for us to process the traumas that we see every day. We do fun gatherings. We just did a sunset booze cruise just so that you kind of have a deeper, more communal relationship with your work family. And then my greatest passion in terms of reducing burnout is my two therapy dogs who come to the emergency department at least once a month to work with hospital staff, and they do patient visit as well. But my biggest goal with my therapy dogs is to focus on hospital staff and providing them with therapy.
[43:27] Michelle: Yes, I really loved seeing that you have the first responder therapy dogs, and so I definitely want you to talk more about that in a moment. And I'm really happy. The whole time you were talking in my head. I was like, yay, that more attention is going towards protecting us against burnout. We have to do something. And I just think all those things that you talked about, they're small, but they're so huge cumulatively.
[44:07] Emily: Yeah, they really add up.
[44:09] Michelle: Wow, I'm really happy about that. I did want to touch on some professional organizations for emergency room nurses, and there were quite a few. So there's Emergency Nurses Association, and then there's the California Chapter of Emergency Nurses Association, the American Academy of Emergency Nurse Practitioners, the American Association of Critical Care Nurses, and the Society of Trauma Nurses. So are you familiar with those and are you a member of any of those?
[44:40] Emily: I was a member of the Society of Trauma Nurses. I believe I've let that lapse. I am a member of the California ENA,  Emergency Nurses Association. The president of the San Francisco chapter is actually one of our staff members, as is, I believe, the secretary. Cool. So we have a lot of involvement in the San Francisco chapter ENA, and we have a lot of staff that belong to them.
[45:10] Michelle: That's awesome. I talk a lot about the benefits of being a member of a professional organization, and I'm a big fan, so I always like to touch on those. What do you just love about emergency nursing?
[45:27] Emily: I love that it's different every day. You never have the same day twice. I really love I think it provides nurses with a lot of independence. I'm not saying that we are more skilled or more trained than any other nurses, but I do believe in the ability of us to put in order per protocol. And I think we have a lot of independence, which I really appreciate. And I really appreciate how we work alongside doctors. They are in our department all day. They're a part of our team. They're with us whereas I feel like sometimes I think they feel more detached when they're on the units because they have to float to different units. They are ours, and they stay there. So those are really the aspects that I love most about the emergency department.
[46:22] Michelle: If you had ultimate power, what would you change? Oh, gosh, that's loaded.
[46:31] Emily: Yeah. I would have a much bigger building with a lot more beds. I would really advocate for a separate Psych emergency department because I think they deserve that care and are not provided that in California. I would make sure that nurses are always safe in our department. I'm not sure we are, and I'm not sure how to achieve that, but I think we deserve to be safe in our profession.
[46:59] Michelle: Absolutely.
[47:00] Emily: Yeah.
[47:02] Michelle: Those are worthy goals. So let's give Emily ultimate power.
[47:08] Emily: Okay.
[47:10] Michelle: Well, talk more about Moose and Rhino and the First Responder program and just what it's about and the benefits and what you do, all of that stuff.
[47:22] Emily: Well, they're the best caregivers in the family. We laugh sometimes. We take family photos at Stanford because we're all somehow medical. Moose and Rhino are my two wonderful Labradors. As you mentioned, they do have an Instagram if you guys want to follow them. They are certified therapy dogs. Moose actually has an extra certification and he is certified to work at Stanford with patient care as well. Rhino is a little bit more enthusiastic, and I'm not sure he'll love patient care. So he has a different certification that allows him to work with the staff members, but not with the patients. It's a certification that I have to upkeep nationally every two years. And they are trained to just really behave very well in almost any circumstance. They're used to people with walkers, they're used to small children hugging them, they're used to weird environments. And then our dogs are trained above that to deal with, specifically things that present with First Responders. We go to police stations, we go to fire stations, we go to dispatch call centers. So there's a lot of very weird sights and smells, turnouts after a fire, smell very weird. The computers and the noises at the dispatch centers, emergency departments where there are sirens and call bells and weird smells and they can't lick anything off the ground. So they have extra training that's provided by the owners on top of that. And what we work with is to battle the stigma against mental health awareness issues among first responders. First responders have some of the highest suicide rates in the country, and it's because we're always supposed to take care of everyone else and we are afraid to ask for help. And you don't have to ask a dog for help. They know and they read people and they come. And if you're needing to play, they play with you. And if you're needing a quiet hug, they sit with you and put your head in your lap. I could talk about this forever. This is probably one of my greatest passions in my nursing career, my dogs in particular. Here in California, we battle wildfire season almost all year long, and I travel with them to the wildfire base camps where people are away from their families for two to three weeks at a time, living under constant stress, working the fire lines for 24 hours straight without sleep. And we go up there and go up for a couple of days and just provide comfort for everyone who's away from home.
[50:04] Michelle: How do they respond to that? What have you seen?
[50:10] Emily: Sometimes people cry. A lot of people will just kind of crumble on the ground and just everything kind of comes out of them. What I think is really fun about my dog, Moose, is what you would think about as a typical therapy dog. He's very quiet, he's very calm. He kind of sits and just wants to snuggle. And Rhino is very enthusiastic and interactive and plays with people and plays tug of war. So I think they make this really amazing balance of providing for both aspects. Sometimes you want to wrestle with a dog and forget what you're doing, and sometimes you just want to sit and cry. And I think it's really cool to see both sides of that. I definitely did not see Rhino as a therapy dog until I saw him at his first base camp. And these guys are 20 years old, and they're younger than we are and fit, so they feed off certain energies, so you get all sorts of emotions, and it's a really incredible experience.
[51:23] Michelle: Yeah, I checked out, well first of all, I'm following Moose and Rhino, and definitely I'm going to put their Instagram link in the show notes because just going to that page and going to all the links of the media and seeing them interacting with the firefighters, and it's so heartwarming. It's so emotional because dogs just have this, like you said, this 6th sense where they know what you need, and sometimes we don't even know what we need. So for an animal to be able to see that in us and provide it, it's just so powerful.
[52:13] Emily: Yeah. There are days I come home from work and I think I've handled it well, and one of them will just kind of put their head in my lap and I immediately break down and think, no, okay, I didn't process that today. Yeah. I just think it's incredible the way that they can read our emotions and sense what we need before we're able to realize it.
[52:39] Michelle: Yes. Gosh, that's wonderful. Well, is there anything else that you want to talk about? Anything that we haven't touched on about Emergency room nursing?
[52:52] Emily: We need more nurses. Don't be afraid to come work for us.
[52:57] Michelle: Yes. Right. Oh, my gosh, yes. Okay, that's great. That's a great place to end on. We need more nurses.
[53:05] Emily: Yeah.
[53:07] Michelle: Okay. Well, thank you so much, Emily. This has been very educational for me, and I know for many of our listeners and love the first responder program. And like I said, I'll put all those links in the show notes for people that want to check that out. And of course, yeah. You know, at the end, we do the five-minute snippet.
[53:31] Emily: Okay.
[53:31] Michelle: So it's just fun. It's a chance for everybody to just see Emily with her hair down and just relaxed off duty, all of that. And it's just five minutes.
[53:46] Emily: Okay.
[53:47] Michelle: Are you ready?
[53:47] Emily: Sure.
[53:53] Michelle: Would you rather be forced to shower in stilettos or a life preserver?
[54:00] Emily: Oh, gosh, probably a life preserver. Stilettos don't sound very safe right?
[54:06] Michelle: In a shower.
[54:07] Emily: Yeah.
[54:08] Michelle: Oh, my gosh. Okay. If you could make one of your hobbies into a profession, which one would it be?
[54:17] Emily: Probably my therapy work or something with horses.
[54:20] Michelle: Okay. Where do you go when you need to blow off steam?
[54:26] Emily: Yosemite National Park.
[54:29] Michelle: Oh, beautiful.
[54:31] Emily: What do you do? Beautiful places. Sometimes I just sit and look around and listen to the quiet. I'm a big hiker, but a lot of times I'll drive down there, honestly for the day and just sit by the river and enjoy the quiet.
[54:48] Michelle: Very peaceful. Would you rather always have a clean house or a working car?
[54:57] Emily: A clean house, I think. Yeah, I really love my house clean and organized.
[55:04] Michelle: Oh my gosh. I was wondering, I wonder how she's going to respond to this. And I thought you were going to say a working car because I don't know. For me, I love both, but I think I would have to have a working car because I just have this fear of breaking down somewhere and being stranded.
[55:25] Emily: Well, then you're on a new adventure.
[55:29] Michelle: Is there a word that you always struggle to spell correctly?
[55:34] Emily: Oh, probably some medical terms. I'm not sure I can think of one offhand, though.
[55:41] Michelle: It's kind of hard on the spot.
[55:44] Emily: Yeah.
[55:45] Michelle: I always have to say whenever I'm spelling like a piece of candy or something, I always have to do the I before E except after C. Yeah.
[55:58] Emily: I would have probably said something with the I's, like choose and lose. And loose.
[56:04] Michelle: Oh, gosh, yes. Let's see. Do you put up a boundary in any area of your life to keep people out?
[56:15] Emily: Yes, I think we do that every day at work in the emergency department.
[56:20] Michelle: Yeah, I think we're good at that. What gives you butterflies in your stomach?
[56:31] Emily: Probably competing with my horse in a good way. Traveling gives me good butterflies. Things that give me butterflies in a scary way at work are ambulance ringdowns, which sound really scary. Not much else bothers me at work.
[56:49] Michelle: Would you rather replace fortune cookie fortunes with dirty jokes or diet tips?
[57:00] Emily: Definitely dirty jokes. I don't want any diet tips from a cookie.
[57:05] Michelle: It's kind of counterintuitive. Right, right. I love it. I'm like typical ER nurse, dirty jokes.
[57:12] Emily: Yeah, definitely.
[57:14] Michelle: There's one question that I didn't get to ask you. I'm going to ask you in the five-minute snippet because it's kind of funny. So I've seen a lot of memes about ED nurses that are giving report to floor nurses and it's always the same thing. It's like the ED nurse goes up to the floor and she's got stuff scribbled all over her arm and the floor nurse is like, ready there with pencil and paper to take report and has all these questions about did you do this, did you do that? So is there any truth to that?
[57:49] Emily: Definitely. Sometimes my favorite is when I hand walk a patient upstairs and everyone's in contact isolation gowns, and that's when I discover their contact isolation and I've been working with them for 4 hours.
[58:04] Michelle: Yeah.
[58:04] Emily: You're like, oh, what are you guys nervous about? I would say that's very true.
[58:11] Michelle: They're all great. Wow.
[58:14] Emily: Yeah.
[58:15] Michelle: All right, well, our five-minute snippet time is up and you did really well.
[58:21] Emily: Thank you.
[58:22] Michelle: Yeah. This has been so much fun. I really appreciate you being here and just providing so much value for my audience.  Yeah, it was definitely a pleasure.
[58:35] Emily: Yeah, it was a great conversation.
[58:38] Michelle: All right, well, you have a great rest of your day.
[58:41] Emily: Thank you. You too.