Make peace with stress in the ER

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Working in the emergency department or emergency room is not for health care practitioners who want to just chill. Although television’s portrayal of the ER on dramas like “ER” or “Chicago Med” is admittedly high on drama, life and work in the ER really are high pressure.

In 2016, the Emergency Medicine Journal completed a systematic review of literature on the topic of occupational stress in emergency departments and found that certain interventions could help ease things. The authors identified several ways to reduce demand and increase workers’ control over their job, improve managerial support, establish better working relationships and make workers feel more valued for their efforts.

We also spoke to several ER professionals who shared insights into how they manage the inevitable stress of emergency room responsibilities.

Go for the rush

“Doctors who go into ER work are adrenaline junkies,” says Shay Bintliff, MD, FACEP, FAAP, and spokesperson for the American College of Emergency Physicians (ACEP). “We love the high, but unfortunately, we don’t know ahead of time a lot of the stuff that goes along with it — like having to miss your partner’s birthday party because you have to work.”

Dr. Bintliff, 83, retired last year after a long and fulfilling career in emergency medicine. She’s worked at Highland Hospital in Oakland, California, the University of Washington Medical School in Seattle and with The Resort Docs on the Big Island — she lives in Hawaii now. She’s also a stand-up comic and appreciates that laughs are good stress reducers.

“I was prepared for this job and I actually enjoyed the constant challenge,” she says. “You never know what’s going to walk in that ER door. Then you ask yourself, ‘What is going on here, and how can I do the best for this patient?’”

Like many health care professionals, she found the actual practice of medicine a joy and approached it with the idea of making the world a better place every day. What she didn’t love — no surprise — was going through “a whole pile of charts and doing dictation.” That was added stress.

Stand your ground (nicely)

As she got older and more aware of her value and of the potential for burnout, Dr. Bintliff learned to take fewer shifts and to avoid temporary schedules — even if she had to engage in what she calls “a head-banging session.”

One day, when being coerced to take a part-time shift, the mother of two said, “I am not working this shift. Let me repeat: My oldest son is playing in a state soccer championship and I want to be there.”

Being straightforward, but polite, can go a long way toward strengthening your position when you’re asked to do things that may push you too far. “Employers may take advantage of you, so it’s important to guard against that,” she says. “Some are on your side, and some are on the other side.”

She encourages you to know your priorities. “Ask yourself, ‘Do my priorities reflect my values?’”

One of hers, intensely effective for reducing ER stress, is surfing — which she’s done for more than 35 years. She’s featured in the film, Surfing for Life. The story goes that when surf conditions were looking good, she’d tell her assistant in the medical office that she was off to a “board meeting.” And she was.

First things first

At Magnolia Regional Health Center in Corinth, Mississippi, Amanda Comer, DNP, FNP, ACNP, ENP, brings almost 20 years of emergency experience. She’s a member of the board of directors of the American Academy of Emergency Nurse Practitioners.

She agrees that “particular personalities” are drawn to emergency medicine — like hers. “It can be controlled chaos,” she says, “and you do a lot of prioritizing, with triage helping you deal with the most emergent things. You do all you can in the time frame you’re given, and it can be very overwhelming if there are so many patients on the tracker board and 20 more in the lobby.”

There’s light at the end, however. “You know your shift ends at 7 o’clock, and that relief is coming in to help. All the noises and sounds — you get accustomed to them, so much so you might not notice the telephone ringing. In ER work, you can ‘turn that switch off’ when you leave, unlike a family practitioner, for example.”

If she gets stressed and starts to be overwhelmed, she says that she tells herself: “I’ll get through this shift. Let’s start with the most important thing right now that’s in front of me.”

When she’s home and can de-stress, she likes to cook. She does spin classes and yoga, as well as lots of hiking and walking outside.

Working shifts on what others might consider odd days or hours can be a drawback, but also an advantage. “I can get my hair done, or do a doctor’s visit myself, or spend time with my child,” she says. “My family has adapted to this, even when we have to celebrate a holiday early.”

She knows that working in the ER isn’t a limited career choice and appreciates options for growth. “I have administrative and leadership roles and there are teaching opportunities.”

For Dr. Comer, the ER where she works is a particularly special source of inspiration. “My grandfather passed away in this same ER on Christmas night in 1988, when I was a child. I was grateful for the people who were there to take care of our family.”

Focus on fulfillment over burnout

The American Academy of PAs reported in May 2018 that emergency medicine PAs have the highest rates of burnout — but that they have the highest rates of professional fulfillment.

The lure of the unknown is part of the reason Fred Wu, PA-C, MHS, has been an ER physician assistant for more than 15 years. He’s president of the Society of Emergency Medicine Physician Assistants and works at the University of California, San Francisco (UCSF) in Fresno.

Previously, he was a paramedic and member of the ski patrol. “Now it’s nice to learn a little bit about everything,” he says, and that includes OB/GYN, pediatrics, trauma, cardiology, and gastroenterology.

He admits, however, that he doesn’t know it all. “Sometimes I tell a patient, ‘I can tell you what you don’t have — you don’t have a serious ‘X, Y, Z’ condition — but sometimes there’s no final diagnosis, and again, that’s part of the challenge. We are gatekeepers who decide who needs outpatient and who needs inpatient care and when to safely discharge a patient from the ED.”

One stress-less part of his job, he admits, is not having to be on call and having to carry a pager. “I do have a 45-minute drive to and from work, and that allows me to wind down from the day. Other providers might tell their spouses when they get home, ‘I need 15 minutes by myself to decompress after a long shift.’”

Wu also runs for exercise and understands the role his overall wellness contributes to the way he performs in his job. Like Dr. Comer, he enjoys being outdoors, especially hiking. He still skis, and says, “I love to travel. Everyone has to find their outlet, and those are mine.”

He and his peers understand that “all stress, all the time,” isn’t healthy for patients ­— or for those taking care of them.

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