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Nurses play important role on emergency medical team

Community Memorial Hospital emergency nurses Cheryl Schilla (left) and Valerie Zack pose with Emergency Nurses Association President JoAnn Lazarus during the 2013 Emergency Nurses Annual Conference in Nashville. The two nurses said they learned a lot and came back with renewed energy for their jobs. Contributed Photo

Nurse Valerie Zack doesn't usually watch medical shows on television because it's too frustrating.

"They're not that accurate and they glamorize," Zack said. "And sometimes they show doctors doing procedures they would never do."

"They're soap operas with doctors," added fellow emergency nurse Cheryl Schilla.

Besides, Zack and Schilla don't need to look to television for exciting medical care -- as emergency room nurses at Community Memorial Hospital (CMH) in Cloquet, all they have to do is go to work.

And, while the job can be demanding and exhausting, it's obviously something both nurses are passionate about.

"It's more than a paycheck," Zack said, shortly after the pair returned from the National Emergency Room Conference in Nashville, Tenn., an experience the friends and coworkers say was educational and refreshing. "It's a calling."

Both women are long-time nurses at CMH: Zack with a total of 26 years at the Cloquet hospital and Schilla with 16 years here. Both also went back to school to be certified as emergency nurses, after starting their careers as licensed practical nurses (LPNs), then going back to school to be registered nurses (RNs).

But it takes more than medical credentials to be a good emergency nurse, emergency room doctor Cliff Chapin said. It takes "a special person with a special intellect."

"ER nurses have to be able to think critically and very quickly on their feet," he said. "There has to be a certain comfort with crisis, a cool head and, most importantly, the ability to be a team member in high intensity situations. ... Excellent care is provided when there is collaboration between everyone on the [emergency room] team."

Zack and Schilla said things in the emergency department have changed a lot over the years.

In the "old days" at CMH, nurses would call a doctor if he or she was required. Now there is a doctor in the ER 24 hours a day, seven days a week. Generally, there are four nurses on at any given time, with three managing three beds each and one acting as a triage nurse, interviewing patients when they arrive to determine the next step.

"The triage nurse decides whether they can go straight back or back to the waiting room," Zack said. "If someone comes in with chest pains or trauma, it's our job to get them back and in a bed."

While everyone in the emergency department works as a team, Schilla described the nurses as kind of "the eyes and ears of the doctor when they're not in the room."

Nurses do far more than simply act as an assistant to the doctors, contrary to the old stereotype of the nurse handing over requested tools with a meek "Yes, doctor."

A look at some of the classes Zack and Schilla attended during the conference in Tennessee is proof of that. Included in the list were Pediatric Head Traumas, Procedural Sedation and Acid Base Abnormalities Made Simple.

Zack translated the last one.

"Understanding lab values," she said. "They tell us to interpret. We're the patient advocate. We're there to catch abnormalities and tell the doctor about it."

The ER nurses also work very closely with paramedics and other emergency medical responders.

Zack explained how the CMH emergency department has been working with the EMS responders on something called a STEMI, when a patient comes in with a possible heart attack.

"We do an EKG, and if we see signs of a heart attack, the physician and nurses collaborate with the EMS and the transferring hospital and we get them down there," she said, proudly noting that one patient made it from CMH to one of the Duluth hospitals in 26 minutes. "Time saves muscle."

She opined that some larger hospitals might struggle to get a patient who walked in their own ER department identified and transferred that quickly.

"When you're [a smaller facility], sometimes you can do things more quickly," she said. "Like how fast we get those STEMIs down the road."

The work is gratifying, demanding and sometimes heart breaking. It also doesn't stop for national holidays or Christmas.

"I like the adrenaline rush, I guess," Zack said. "I have a lot of gratitude too, because you realize your own life could be worse. We're often the ones who are there to hold someone's hand when they've gotten some bad news. Sometimes we have to translate what the doctor said into regular language."

Both women are excited about the hospital's ongoing transition from an ER staffed by visiting doctors to one with its own slate of full-time and part-time local doctors.

Chapin is a recent arrival to Cloquet, and working part-time at the hospital ER for now. He has worked at between 10 and 12 other hospital ER departments, but he said the department at Community Memorial Hospital functions remarkably well.

"I've been very impressed with the cohesiveness of the staff," he said. "The level of cooperation is wonderful."

Zack echoes the praise, albeit more directly.

"It's a great hospital and a great emergency room," Zack said. "We do good work there; we save lives."