Double Duty
ER nurses take on additional medical challenges outside of their daily jobs

By Linda Childers
December 13, 2004

The 6-year-old girl was desperately ill with malaria. Sue Averill, RN, glanced at the girl with sadness as she and her colleagues prepared to transport her to the nearest medical facility hundreds of miles away.

Averill, an emergency department nurse at Northwest Hospital & Medical Center in Seattle, was in Monrovia, Liberia, serving on a medical mission. The disease had already ravaged the girl’s tiny body, and Averill fought back tears when she died in her arms en route to the hospital.

Averill is one of many emergency department nurses who take on additional challenges in the medical field. Some hold down second jobs as flight nurses or paramedics; others loan their expertise to medical missions or disaster teams.

For Averill, volunteering on medical missions has become an important part of her life. She works per diem at Northwest in order to remain flexible and travel on three or four medical missions a year.

After her first medical mission to Mexico in 1985, Averill was hooked.

“I realized I lived a pretty charmed life compared to many people in other parts of the world,” Averill says. “These people live in underdeveloped countries with no access to medical care.”

Averill just returned from Liberia on a mission with Northwest Medical Teams International, and plans to travel to Africa later this year with Doctors Without Borders.

In Monrovia, medical teams treated about 300 patients a day. Most lived in 6- by 8-foot mud huts and suffered from a variety of ailments.

Team members worked in primitive settings with basic medical supplies and were forced to rely on their assessment skills.

“We had a lot of pregnancy-related issues, but no diagnostic tools,” Averill says. “We quickly learned to improvise.”

Averill says medical missions offer wonderful opportunities for emergency department nurses.

“ER nurses think on their feet and work quickly without a lot of backup,” Averill says. “There are many wonderful medical organizations that desperately need nurse volunteers.”

Typically, organizations pay the airfare and living expenses of medical volunteers. Nurses can choose to go on missions lasting from one week to several months.

“The patients we treat are very grateful for the care we provide,” Averill says. “One man in Guatemala walked for five hours, then took a bus for 12 hours so we could operate on his son who was born with a cleft palate.”

Although the patients reap the rewards, so do the medical volunteers. “My work on missions has changed my whole outlook on life,” Averill says. “The experience renews your passion for nursing and makes you appreciate your own life.”

Putting out fires

Sometimes when Marty Vara, RN, is caring for patients in the emergency department at Christus Spohn Hospital Corpus Christi (Texas)-Memorial, they stare at him with confusion.

“Don’t I know you from somewhere else?” they ask. “Do you have a twin?”

Vara smiles and tells them about his other job, as a firefighter/paramedic for the City of Corpus Christi. Often his two worlds collide, and he finds himself caring for the same patients in the ED that he treated on emergency calls at their homes.

Vara always dreamed of becoming a nurse. His dad had diabetes, and watching his health decline fueled Vara’s desire to become a caregiver.

After high school, Vara applied to nursing school and was told that because he was a man, he was better off becoming a paramedic.

But he never gave up on becoming a nurse, and his wife encouraged him to pursue his lifelong dream.

“Being a paramedic made nursing school easier and being a nurse has made me a better paramedic,” Vara says. “As a nurse, I’m able to spend more time with patients and make more focused assessments.”

Vara works 10 days a month at the fire department, and a minimum of 24 hours a week at the hospital. His off hours are spent with his wife and three children, who range in age from 13 months to 13 years.

“Working in the emergency field has made me appreciate my family more,” Vara says. “When I leave the house, I hug them a little harder and kiss them a little longer, because I see how quickly your life can change.”

Critical care in the air

Randy Endsley, RN, CEN, fully admits to being an adrenaline junkie.

He divides his days between working as a chief medical crew supervisor for HALO-Flight air ambulance service and as an emergency department nurse at Christus Spohn Hospital Corpus Christi-Memorial.

Endsley’s schedule involves working full-time graveyard shifts at the hospital and then eight 24-hour monthly shifts as a flight nurse.

“I enjoy working in the emergency field and my two jobs allow me variety,” Endsley says. “As a flight nurse, you have a patient for approximately a half hour and you stabilize them, transport them to the nearest hospital, and then go on to the next call.”

Because HALO’s flight nurses work 24 hours on and 72 hours off, they all hold down second jobs, many as emergency department or critical care nurses.

“Working as a flight nurse utilizes your ER skills, but also takes you to the next level,” Endsley says.

“We make many decisions that would usually be made by an ER physician, such as whether to intubate a patient, or what drugs to administer.”

Endsley combats work stress by talking with his fellow flight nurses and paramedics, as well as his wife, about calls that have been particularly traumatic. “Knowing that you did everything you could possibly do on a call gives you some comfort,” he says.

Yet there are still some calls that hit home. “Calls involving children are the worst,” Endsley says. “I have two children, and I see my own children in the faces of the kids we treat.”

Preparing for disasters

For Cassie Richard, RN, CEN, an emergency department nurse at Oregon Health & Science University, life is a constant adventure.

In addition to her job at OHSU, Richard is a volunteer member of the Oregon Disaster Medical Team, a Level 1 federal Disaster Medical Assistance Team composed of more than 100 paramedics, physicians, nurses, and emergency medical technicians.

The team provides relief health care services when local, county, and mutual aid reserves are overwhelmed due to a mass casualty incident or disaster. Deployments have included traveling to areas hit by Tropical Storm Allison in Texas and to the Winter Olympic Games in Utah.

Even though both her jobs can be stressful, Richard realizes the importance of de-stressing.

“In both my job at the ER and with the [disaster team], there are structured debriefings for particularly difficult situations,” Richard says. “When I’m home, I try to spend quality time with my family or enjoy a ride on one of my horses.”

The most trying cases for Richard are those involving children. “I remember caring for a child who was injured in a freak accident,” she says. “There were several new nursing grads in the ER who had never seen a trauma code much less witness a child die.”

Knowing that the disaster team has been given Level 1 status and could be one of the first deployed in the event of a national disaster keeps Richard grounded.

“I find my job challenging and enjoyable,” she says. “Yet the nature of my work makes me appreciate all life has to offer and to never tempt the fates.”