In the years following the onset of the COVID-19 pandemic, health care as a whole has fundamentally changed — as have the lives, habits and health care needs of communities across the country.
Today, emergency departments (EDs) everywhere are seeing high volumes while staffing shortages persist. In rural areas with communities that are sicker than many others, these challenges are even more magnified.
“I’ve got patients who can’t see a doctor in the community mixed in with patients who have a pulmonary embolism,” said Dr. Leigh Patterson, chief of services for Emergency Medicine at ECU Health Medical Center and chair of Emergency Medicine at Brody School of Medicine at East Carolina University. “My team and I are trying to see the forest through the trees. Who’s the patient that needs the services? Everyone needs the services, but who’s the patient that medically needs the services next? And that’s hard.”
Meeting the challenge
At ECU Health Medical Center and throughout ECU Health system hospitals, leadership teams have needed to adapt quickly to meet the needs of the many patients seen through EDs.
Alex Baylis, ED nurse manager at ECU Health Medical Center, said she has been proud to see the department’s flexibility and persistence while helping patients through their time in the ED.
“We have flexed and bended, added and changed our spaces, we’ve changed our beds, we’ve changed our staffing patterns, we’ve changed our hours of when team members come in, when team members go home. We’re doing all that we know to do, and have the power to do, to get care to our patients faster and better,” Baylis said. “Right now, we’re facing really difficult barriers and obstacles within our space that are challenging, but we’re doing everything that we can and know to do to help our patients.”
Dr. Patterson echoed Baylis’ sentiment.
“We’ve tried, we are going to continue to try and it isn’t going to look the way it used to look,” Dr. Patterson said. “I think patients have been very understanding when we’ve had to do things in a different way. It is a really ugly reality right now, but we’re going to flex a lot. What I really want people to understand is what you see in the ED is actually all of the hospitals and all of health care right now.”
Matter of perspective
Dr. Patterson said she has seen a great deal of change in eastern North Carolina since she first came to the Brody School of Medicine and ECU Health Medical Center 17 years ago.
When she arrived at what is now ECU Health Medical Center, she became just the fifth female emergency medicine clinician. Today, she said, there are more females than that in the intern class alone.
“I am not the generation that was the first and only,” Dr. Patterson said. “I had other female residents who were with me. We were definitely the minority, but we’re not such a minority today.”
Dr. Patterson estimated there to be about a 50/50 male to female split among emergency medicine training program graduates across the country today and more women are holding education leadership positions.
However, that same shift has been slower to develop on the administrative leadership side.
“It takes some time to get all the way up the ranks so there are probably a dozen women chairs in academic medicine and emergency medicine and other positions like mine,” Dr. Patterson said. “But really, not a large number of us when you consider there are a couple hundred of our programs.”
From an outsider’s perspective, the number of female leaders in the ED may seem unique, but to those on the floor, it’s nothing to bat an eye at.
“We’re kind of past that – ‘Look, that’s so cool.’ Some days we’re still there,” Dr. Patterson said. “A lot of days it’s like, ‘Oh, yeah.’ I mean, I don’t think our nurses notice. We could go 24 hours in one area and it’s all women physicians and it’s just like that’s Tuesday. We don’t stop and notice that.”
Baylis noted that from the nursing perspective, more males in nursing tend to gravitate toward EDs and Intensive Care Units, but on the leadership side it is predominantly females.
Dr. Patterson reflected on the early part of her career and how conversations have shifted and become more normalized. Whether it’s the way patients address female providers or the interactions teams have with each other, she has seen positive change.
“I have men, physicians now who can have open discussions about, ‘Hey, how are you taking your FMLA leave when you have a baby? Are you splitting it, are you taking it at the end?’ The normalization of those conversations, that’s what comes from it,” Dr. Patterson said. “We’re not there all the way, we still have a long way to go. But it was not this normal in my first job.”
Providing compassionate care in trying times
As the care needs in EDs have changed, Baylis and Dr. Patterson noted how crucial it is to connect with patients on a human level and provide high-quality, compassionate care in stressful situations.
Baylis said the mindset of nurses in the ED has changed drastically in the past few years.
“In emergency nursing, you had to have tough skin and be almost hard,” Baylis said. “I think it’s changed with the population that we’re seeing in our patients, but also the care that we’re giving. We’ve learned to be more soft and more caring and taking that time to make a connection. We can be nice while still setting boundaries with our patients.”
Dr. Patterson said providing care in eastern North Carolina is a very unique situation. She shared that she trained at a county hospital in New Orleans and that in large, urban environments, it’s less common that she or her family members would be patients at the same hospital at which she practices.
Here, there is no line.
“So much of what I saw when I was in my own training, in my mind, I could pretend it wasn’t going to happen to me and you get this lovely distance that you don’t have here. And that’s good for you but, wow, some days it’s really hard,” Dr. Patterson said. “This is the same hospital you go to, right? I had my baby here. My husband has been a patient in our ED. My dad has been admitted here. I think this place is really challenging for that because it’s your community, you know, there’s no separation here.”
Baylis and Dr. Patterson said while that challenge exists, they are proud to serve in the same community they call home. What’s not lost on either of them: that solutions they are working to find in support of the communities they serve also directly impact their own family and friends — and light the path for ED teams to follow.