Meet an ER Nurse Practitioner

This episode of "Workplace Confessions Behind Closed Doors" features a nurse practitioner who shares candid stories and insights from her career in emergency medicine. The conversation covers the journey from a first job at Hoagie Yogi to working in the ER, the adrenaline and critical thinking required in emergency care, memorable cases (from wild injuries to bizarre patient stories), challenges faced by healthcare professionals, and the impact of compassion fatigue. The guest discusses both rewarding and heartbreaking moments, as well as coping mechanisms and thoughts on changes needed within the healthcare system.

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Transcript

SPEAKER_02 0:02

Welcome to Workplace Confessions Behind Closed Doors. I'm Elsa Barbie. And I'm Don Andrews. We have been friends since sixth grade. Somewhere between a car wash job, a few questionable boy choices, and 40 years of friendship, we became the kind of people who always want to know what's really going on, including at work.

SPEAKER_00 0:21

Don spent 25 years as an employment lawyer digging into workplace drama from the inside out. I built a long career in the beauty industry as a brand educator with a few TV cameos sprinkled in for fun.

SPEAKER_02 0:33

We came up in very different industries, but we have the same passion. Meeting new people and asking how they got their jobs, what they love, what they can't stand, and what happens behind closed doors.

SPEAKER_00 0:45

Every episode, we talk to a new cast about their lived experience in the world of work. And because our guests stay anonymous, they can spill the truth without the fallout.

SPEAKER_02 0:54

We get into the choices they made, the tiny cruelties, the surprise kindnesses, and some of the moments that never make it into human resources reports.

SPEAKER_00 1:03

Equal Parts informative and titillating. This show serves up all the tea while honoring the incredible, complicated, often messy work people are doing across the industries and across the map. Welcome to Workplace Confessions Behind Closed Doors. Let's get into it.

SPEAKER_01 1:25

So my first W-2 job was at Hoagie Yogi. I don't know if you recall Hoagie Yogi, but it was a chain of sandwich shops that also had frozen yogurt. So that's the Hoagie and the Yogi. And it was super fun because not only do you get to work with teenagers and whatnot, but we got to eat a lot of frozen yogurt. Amazing.

SPEAKER_02 1:50

And then tell us what you're doing now and what were the steps in between? How did you get from Hoagie Yogi to where you are now?

SPEAKER_01 1:56

I am now a nurse practitioner and I work in the ER and I also do urgent care as well. I to get from Hoagie Yogi to here, I went to a lot of school. And so I started out with just going to college and wanting to go to medical school. And then coming out of college before medical school, I sort of started to get cold feet and wasn't sure if I really wanted to work that hard or dedicate that many years to school and education. And so I started looking at options, what I could do instead of going to medical school, but still really knew I wanted to do healthcare. And I was always really drawn to working in the ER from kind of young years. I was always drawn to medicine and wanting to be in the ER. So then I looked at different programs. I looked at PAs and physical therapists and nursing. And finally, I kind of after I did all the research, I kind of decided that this would be the best path for me if I wasn't going to go to medical school.

SPEAKER_00 3:06

What was it exactly about the ER that kind of aligned to what you wanted to do as a future? Like what is what was it about being an ER that you liked that drew you?

Shifts, Aging, And Aha Moments

SPEAKER_01 3:16

I think for me, I've always liked the like adrenaline excitement. And when you combine that with the critical thinking skills that it requires, if you're someone who really likes to like figure things out, solve things, like we're constantly thinking on our feet. And I've always been kind of drawn to that environment. I get bored easily if I'm at a I could not, I could never do a desk job. I mean, I've always kind of known that about myself. Like I've always known like I'm not gonna be that person in a cubicle. It won't work for me. So I think that's kind of what's always drawn me to emergency medicine in an emergency room is just that kind of really think on your feet, constant, constant motion and constant stimulation. And then not only that, but like you never know what you're gonna get. You never quite know what the day is gonna bring or what problems you'll have to solve, or you just don't know. How many hours do you work? Now I work mostly days, but the ER requires all kinds of shifts days, nights, weekends, holidays, 24-7. So um in the early years, I was working a lot of nights. But now I've you know been around a while and so I have some seniority and I tend to only work the day shifts or the swing shifts that take me to like 10 p.m. or midnight at the latest. Because as you get older, these things wear you down. When you're young, you don't really realize it. Like you don't realize how much those leadershifts because they don't bother you. It doesn't, it doesn't phase you to work late. But as you get older, it does start to wear on you.

SPEAKER_00 5:07

Is there ever a moment when you were actually working in the ER that you were you realized this is my aha moment? Like I I made the right choice.

SPEAKER_01 5:17

Oh, I've had lots of days like that. Yeah. And I still do every once in a while, I still do sometimes leave work and I'm like, that was so cool. Like it was the coolest thing.

SPEAKER_00 5:28

You know what I mean? Anything in particular? Anything in particular? What makes that happen?

Outcomes, Teamwork, And Perspective

SPEAKER_01 5:33

Certain cases, like you someone comes in with like something unknown or like something, it sounds kind of morbid, but something really awful, or and then you're actually able to like not only figure out what's wrong with them, but somehow help to fix it. Obviously, it's a very collaborative environment. You're never gonna be by yourself fixing someone. It's a team of providers and nurses and specialists and you know, all the things. But at the same time, like being part of that is really cool. And a lot of times in the ER, we have these moments that are really life-changing for people, and sometimes in a good way and sometimes in a bad way. And sometimes when you're in those moments, you're like, man, it makes you appreciate your own life, it makes you appreciate the fragility of life and health. And some of those moments you're just like, man, wow, you know, and so you kind of leave work, whether it's good or bad, you sort of leave work like, wow, you know, it's kind of it's kind of cool to be able to experience this perspective of life when people are going through these why some of the situations are wild, like wild, you know, falling off the roof or you know getting hit by a car. Like they're these really like unusual life moments, and you get to be a part of hopefully making them better for whatever's going on.

SPEAKER_02 7:14

What's the best part of the job?

Customer Service And Burnout Pressures

SPEAKER_01 7:18

I think the best part is when you actually are fixing people. I had someone tell me the other day, and I was like, I'm gonna remember this quote. 80% of the people, if you look at the statistics in the ER, 80% of the people that come to the ER go home better. They actually get the help that they're supposed to get and the help that they need, and they go home. And only 20% on average have to come into the hospital and stay and and need additional care. And I was like, man, I I should really like think of my job like that more, because sometimes we get a little bit like discouraged or down, and we forget that statistic alone is a really good statistic.

SPEAKER_00 8:06

Any soft skills that you utilize a lot more in the ER that you are unexpectedly, you know, that you actually have to use?

SPEAKER_01 8:15

I mean, yeah, customer service. I mean, in every almost every industry, right? The thing about customer service and healthcare is it has gotten harder over the years. I think when you go into healthcare, that's not necessarily what you're envisioning, is that you're trying to give someone customer service sales-like experience. Going for five stars on Google is not what you think of when you go into healthcare. And it's maybe for the for good or for bad, it has turned into that model.

SPEAKER_02 8:56

What's the worst part of the job?

Abuse, Entitlement, And Post‑COVID Trends

SPEAKER_01 9:00

I think the the sad days, like you know, when you have bad cases, that's but I don't even know that that's the worst part. I would say the worst part is sometimes the abuse that we can take from our population. Most people that go into healthcare do it for altruistic reasons. They go in because they actually really want to help people and they want to learn the knowledge that medicine fascinates them. And so they they go into it for those kind of two main reasons, right? But then there's this whole other component that you don't necessarily take into account, which is we are dealing with society in really raw, hard situations. Everybody's going through some sort of suffering, whether it's physical, whether it's mental, whether it's sometimes it's a social suffering, like they don't have housing, they've been abused, they've there's all these different social factors that go into it too. And so sometimes when you're uh serving people that are under a lot of duress for any host of reasons, they're very they can be very not nice and they can be very abusive and aggressive even. And uh unfortunately, it seems like the trend has been, especially in the last decade, it seems as though those things are getting worse. It's i I think it's been a sharp societal decline since COVID.

SPEAKER_00 10:32

Harder to deal with the patient or the patient's family.

SPEAKER_01 10:38

Many times the family, um especially in children. And I'm not faulting any parents or anyone in general, but many times the kids are wonderful, but the parents can be really difficult. Um, someone who's just really upset because their kid is hurt is reasonable, right? You can talk to them, you can reason with them, you could say, I understand your child is injured and it's just super scary, and we're doing a lot of stuff, and this is a foreign environment, and I totally get it, you know, like I get how you feel. And then a lot of times they will like the decompress a little bit, right? But the people in the population who are like kind of entitled and self-serving and disrespectful, that's like a different. I don't know where that came from. I don't know where it started or where it tends to be kind of allowed. And it definitely seems like it's a shift. It's a shift in in a societal norm.

SPEAKER_02 11:42

Is it typically wealthier people? Is it based on socioeconomic status?

SPEAKER_01 11:48

A little. I definitely think if you go to your under underserved areas who less likely to be abused. Like I think it's a combination of like the probably partially the internet and the online abilities, and then partially kind of how they were raised and what they were taught as they were brought up. Because I know in our generation I don't feel like I feel it as much, but I have the last couple generations, I feel like I feel it more.

SPEAKER_00 12:28

Did you ever find it difficult to treat somebody who was just not a nice person to you?

SPEAKER_01 12:34

I think you have to really like approach it like I gotta treat this person like they're a family member. Like, what would I do? I use that line a lot, actually. If you were my family member, like this is what I would recommend. Not only to try to build rapport, but truly that's how I try to practice. Like, I if you were my family member, like this is what I would do. But I've had some weird situations, like I've had prisoners, and like I had a convicted child molester one time, like come in and cuffs. You have like obligation to treat your patients and treat them all the same. And so you just sort of have to like put it out of your mind, and you just take the patient and whatever their complaint is and try to push the rest away. Now, if they're like blatantly abusive, like if they're hitting you and you know, spitting on you and peeing on you and doing all those things which do happen, generally we have you know security involved. But yeah, we do as much as we can to like mitigate and and try to have, you know, some peace.

SPEAKER_02 13:47

Have you learned, other than than what you've shared so far, have you learned some techniques that you've maybe have surprised you that are effective in de-escalating?

SPEAKER_01 13:57

It's what we learned when we grew up. It's like treating everyone how we want to be treated, right? And then really trying hard to see things from their view, which is difficult because sometimes you're like, I have nothing. Like I'm, you know, I don't have any basis for knowing what you've been through or knowing what you come from, or but you just try to put yourself in that position so that you can sort of try to make some sort of a rapport or connection. But sometimes it doesn't happen. Sometimes it does. Sometimes you're like really pleasantly surprised.

SPEAKER_02 14:38

It's pain, maybe pain is the the great equalizer.

SPEAKER_01 14:41

Yeah. Yeah, pain and suffering. Yeah.

System Friction: Admin, Billing, Insurers

SPEAKER_02 14:44

Yeah.

SPEAKER_00 14:45

Anything to talk about as far as the industry on a whole, something that you would change about the industry that you work on, not the patient side, but on the internal business side.

SPEAKER_01 14:54

As far as the system, our healthcare system in the United States is rapidly declining. If there was anything I would like change, it would be to just be able to take care of patients and not have to do all of the extraneous things that we are required to do. The billing and then kind of the admin side of healthcare is really complicated. It's complicated who your actual boss even is, because you have like a technical boss, but then you also have all these other tiers and layers of people who you still have to make sure you do your job a certain way in order to maintain approval between HMOs, state-run healthcare, the big insurance companies, you know, Blue Cross, Blue Shield, United, all these really big conglomerates really control a lot of what we do and how we do it.

SPEAKER_02 15:57

Are you limited in how much time you can spend with a patient?

SPEAKER_01 16:03

They will never outright tell you that you are limited, but they will also say you need to see three to four patients an hour. And it gives you about 15 minutes. The problem with that is most people need more than 15 minutes.

SPEAKER_00 16:21

Well, along the lines of that, then what would be a myth that people believe about your job that just drives you nuts?

SPEAKER_02 16:28

How about all nurses are female?

SPEAKER_01 16:32

Oh, actually, that's a good one. That's a total myth, especially in the ER. So we like guys really like the ER because it's a lot of action and it's physical. We're always like moving patients, you know, doing CPR and like very, it's very physically interactive. And we have a ton of guys, and actually they're really good nurses. Like it's it's actually really awesome to see because I think it it kind of dispels some of the stereotypes of like men can't be caring enough to be, you know, at the bedside. They definitely have a little bit different vibe, like than women do at the bedside, but at the same time, they're kind of rock stars because you can really count on them to like just they're all about business, like what needs to be done, let's get it done, let's do it. I love working with male nurses.

Nursing As A Second Career

SPEAKER_02 17:25

Could that be a good second career for someone maybe who's laid off from another industry or their job becomes obsolete because of artificial intelligence? Would you recommend it?

AI In Charting And Care Limits

SPEAKER_01 17:36

Yeah, a hundred percent. Yeah. You, I mean, you definitely have to, you know, get loans to get through school, probably, but you you can make a really good income and you're extremely marketable. There's gonna be a nurses shortage for like decades to come because of all the baby boomers. You're guaranteed to have work. Okay, I'll give this twofold. AI is already in healthcare. Yeah. We are currently using AI for assistance with charting. We can have it like scribe our chart so we take it into the room with us and it will listen to our interview. And we can even dictate out loud our exam. So, like, you know, uh write forearm deformity and it will insert it into our charts. It's still pretty new, uh, but it did already replace jobs. As far as physical nurses being replaced by AI, I do not think that will happen except for some small subsect areas, like maybe your telehealth nurse might get replaced by AI, but your bedside nurse cannot be replaced by AI because someone has to start an IV, someone has to draw the blood, someone has to give the medication. That can't be done by AI.

SPEAKER_02 19:04

Yeah, artificial intelligence can't hold your hand while you're in tons of pain.

unknown 19:08

Yeah.

SPEAKER_01 19:09

It can't palpate, it can't palpate the mass in your abdomen. It can't listen to your lung sounds and hear there's something there, right? There's they can't look in your ears with an otoscope. It'll be interesting. It'll be interesting to see what the next, you know, even the next five years brings.

SPEAKER_00 19:28

You kind of alluded a couple of stories in the past, but okay, so now for the juicy part. Yes. What are what is the wildest, weirdest, or most unforgettable thing that you've witnessed at work?

Foreign Body Stories You Won’t Forget

SPEAKER_01 19:40

So the bleach bath story is an interesting one. It was actually a rash. The mom brought the kid in for a rash, and she just couldn't figure out why he had this rash. And it had been going on for some time. And I asked, you know, well, you know, was it any new lotions or soaps or any new foods? I kind of went down the laundry list of things that might have caused rash, and it was head to toe. It was all over. And it was kind of a dry, flaking red rash. And basically, when we finally kind of got through all the questions or whatever, it wasn't the first thing that she mentioned to me because I remember I had been in the room for quite a while. And then finally she said, Well, you know, I have been giving him bleach baths or whatever, because you know, he's dirty and we use bleach in the bath. And she told me how she, you know, spoons it in or measures it into the bathtub or whatever. And I was like, Oh, wow. Like it wasn't even the first thing that crossed her mind. It was like way down after lots of questions, did she finally say, Oh, I've been putting bleach in his bath? And so, of course, then I try to be very, you know, eloquent and not trying to talk down to her or make her feel, you know, awful that she was doing this. But I was like, oh, that's really what's probably causing this rash, you know, all of that. So there's stories like that where parents make interesting judgment calls. I had another one where a parent used, so her child had an earache. And this is like a two or it was a toddler age, like two, three years old. And she tried, had read somewhere online to use peppermint oil and put peppermint oil in the child's ear. And the child was like screaming hysterically, like levitating off of the bed in so much pain and discomfort. And so it was kind of similar. You ask, like, oh, well, what happened? Like, how long has the ear been bothering? Cause you're like trying to figure out like, what this kid is way like this isn't a normal ear infection. This is like way more pain than what a normal kid would be. And she had read online somewhere to put, you know, the essential oils, the Droplets of essential oils into this poor kiddo's ear. So we were able to wash, you know, wash the ear out and and give the kiddos some pain medicine and and and put give them the correct medication. So there's stories like that. And then there's also like, you know, people, I just had one the other day, a kid like jump, he had been drinking and doing some drugs with his friends. He's like 22 years old. And they decided to like film him jumping off the third story balcony. Probably he did quite well. He just had a calcaneous fracture, which is the heel bone. But I guess because the way the girlfriend explained it was there was like some bushes there that sort of like broke his fall. But of course, because he had been under the influence, he didn't even come in until the entire following day. It wasn't like anyone there called 911. They, you know, I was like, so what did you guys do when he was on the ground? Oh, we just picked him up and brought him back in. Like, and then the really popular stories are always like what went up the butt stories. It's really interesting. The general trend of people with things in their rear are usually middle-aged men. And it could be, I I mean, I have a list. One that I always crack up about was my colleagues, and he his patient had an actual summer sausage up there. And when he tried to remove it, so we laugh about it all the time, like at parties and stuff, we laugh about it because when he tried to reach in and get it, it actually like fell apart because it was like a sausage. So then as as he was trying to like pull it out, it was like falling apart in his hand. And we still laugh about it to this day. I'll I'll text him actually when we get off the phone and be like, I told your summer sauce story today. But we have seen lots of things. Other foods include like cucumbers, potatoes, non-food items, lotion bottles, shampoo bottles. One time, you know those travel toothpaste holders that are like yeah, that they like kind of click together or whatever. Yeah, exactly. Probably the biggest thing I've ever seen in there is a table leg. Yeah, not like your dining room table, but no, it was like a smaller, like maybe like a bedside table or like a little, maybe in the living room type table, like a small side table. And it was literally luckily the screw part was like out, and the rest of it was in. Oh my gosh.

SPEAKER_02 24:47

Oh my gosh. I can't even what what do these people say when you're like, excuse me, sir, you have a table leg up your yeah, because you didn't know, sir.

SPEAKER_01 24:58

He was yeah, he was walking funny, but some of them will walk in and you're like, I have no, yeah, you don't you can't tell anything, right? They they're walking in and will be there's fine. Oh, another one was blown glass. So they had been in town for a glass blowing convention, and they had blown it kind of looked like a Kong, like you know, the dog toy, like a Kong, like that tone, like so they had blown glass one of those up there.

SPEAKER_02 25:29

Oh my god.

SPEAKER_01 25:30

It was tie-dye, it was like fun colors.

SPEAKER_02 25:33

But what did these what do these people say? How do they explain themselves?

Heartbreak: Kids, E‑Bikes, And DKA

SPEAKER_01 25:38

I've heard all kinds of explanations. I remember the lotion bottle guy was with a couple other men, and they were at a party in which they were seeing what like the biggest thing that they could fit in there was, and so he won. It was apparently the larger lotion bottle. Well, just they they live life on the edge, they want to try new things, and sometimes it makes them end up in the ER. So we try really, really hard to get them out so that we don't have to call the surgeon. So yeah, that Mary Kay was like a party. The toothbrush one was like the toothbrush holder was actually a woman, and she told me she was preparing herself, like she was doing some prep work to try to like expand a little bit. And then the problem with her was is it came apart because you know how it like clicks together in the middle, and so as she was doing what she was doing, it came apart. So like the one half came out and the other half did not. I've had drug addicts I fished out, and like the woman one made me think of I've had a female drug addict that was hiding her stuff from the cops, and she put it up her vaginal canal, not the rectum, but the vaginal canal, and then she couldn't get it back out again. So she had kind of all of her paraphernalia stuck up there, but couldn't get it all out. She had gotten like the syringe out and she'd gotten the little baggie out, but couldn't get the the it was capped, but it was the needle part with a cap on it. And so she needed some help getting that out.

SPEAKER_02 27:27

Oh dear. Yeah. And then what do you do? Fish it out and go, here you go, here's your they usually always they usually always want it back. Even if it's drugs or something, you have to give it to them.

SPEAKER_01 27:39

I think I've only had well, I mean, like the table leg guy, I don't know that he took his back. The summer sausage, it fell apart. But like a lot of the dildos and stuff, because I kind of skipped all the dildo stories, those are more like you know, it happens, but like pedestrian, pedestrian, they usually all want it. Want it or take it.

SPEAKER_00 28:01

Wow.

SPEAKER_02 28:01

Wow. There are no words, just wow.

Coping, Boundaries, And Recovery

SPEAKER_00 28:04

You know, there's another side of healthcare when you have patients come in that have probably just like tugged at your heart and you want to like find out how is this person doing after the aftermath or anything like that. Any stories like that where it's like I just your heart just like or it was just a tough day at work because of what had happened.

SPEAKER_01 28:24

Yeah, those happen a lot too. Recently we've seen a lot of e-bike accidents, and there's always it's always kids. Like I think that those always the kid cases always stick with you because they're kids. And you know, they still have a lot of life ahead of them. And those definitely all like look in to see like how did they do, you know, through surgery. Did they, you know uh sometimes we don't have time to really look into where the patients end up after they leave us, but some do stick with you and you want to find out like, oh, how are they doing upstairs and and that kind of thing. I just had a recent kid who was new onset diabetic and in DKA, which is where they're really, really sick. And I was so worried about him that I, you know, checked on him a bunch of times, and luckily he's getting better. Child abuse cases are always really hard. I think that probably the ones that I leave and I'm the most like man, you know, that was really sad are always kids.

SPEAKER_02 29:28

How do you cope with those feelings so that they don't eat you alive and burn you out?

SPEAKER_01 29:35

I I think that we have interesting coping skills. I think we lean on each other. So, like one of my best friends from work, we'll we'll talk about cases together just because she can understand and I can understand. I think we all kind of have pretty interesting sense of humor, and we're all pretty like externally tough and compartmentalize a lot. And you do, you have to like you have to compartmentalize because if you if you get in tune to everyone's emotions, you just can't survive. And then I do think you get burnout. I think now that I'm 20 plus years in, I I've you have to slow down and you have to take time off and you have to really be more vigilant about your your own like mental, physical health, and and preserve yourself because you it's true. If you still work tons of hours and are around it all the time, it is hard and it does burn you up for sure.

SPEAKER_02 30:33

Compassion fatigue, it's real.

SPEAKER_01 30:35

Yeah, compassion fatigue is real, for sure. For sure. I try to always take time for myself, like working out is like what I do to sort of unwind. So I try to every day have some like self-time for exercise, whether it's just walking or if it's you know, going to the gym or going for a run or and sunshine is really a big thing. Like I'll sit and just sit in the sun and like read and kind of zone out in a on a frivolous like novel. Um constantly reading like diagnostic tests and medical stuff and medical notes, and it's like this certain type of like high-intensity information that you're constantly also kind of like translating and deciphering, you know, the code, so to speak. And so then I find that once I'm home, I'm just want to read like frivolous nonsense. Where I'm not my brain isn't happened to working as hard as it is at work, which works. It actually does really work. I I find it super relaxing.

Closing Thanks And Listener CTA

SPEAKER_00 31:37

I mean, this has been an amazing episode with you. Thank you so much for being so vulnerable and sharing all those great stories with us. And for that, we say thank you for sharing your story with us. You've officially joined the ranks of the brave and the bold. And thank you so much for your time.

SPEAKER_02 31:55

That's it for this week's confession. We've laughed, cringed, and maybe questioned our own career choices.

SPEAKER_00 32:02

Big thanks to our anonymous guests for keeping it real and reminding us that behind every job title is a story worth telling. If you've got a workplace confession of your own, we're all ears. Hit us up at our email address. And don't forget to subscribe, rate, and share. Your support helps us keep the secrets flowing.

SPEAKER_02 32:19

Until next time, keep your badge clipped, your coffee strong, and your stories wild. This is Workplace Confessions Behind Closed Doors.