A couple of weeks ago my friend became very ill and I had to rush her to the ER in a different hospital from the one I work at, simply for geographical reasons. Because she was vomitting almost constantly, we were rushed right to the triage nurse and then into the back, where they inserted an IV-line, took some vital signs, and told us to wait. We were parked in chairs in the hallway and then ignored for the next 4 hours or so without hanging any fluids or providing privacy for her given that she was also basically incontinent of stool by this point and had the worst diarrhea ever.

I don't want to recount the whole story minute by minute, because I am more interested in highlighting the things that stood out for me from the perspective of being "behind the curtain." As a new nurse, both to the profession, and to the ER, I feel like these are defining moments for me in my career, as I shape out what kind of nurse I am going to be, and figure out what kind of nurse I ought to be. And there is no better perspective than the one from behind the curtain.

So here are some of the insights that I gained that day as I sat behind the curtain (after they eventually gave her a room) and held my friend's hand.

1. You can be heard from the nurse's station: Patients and visitors are everywhere. They can hear you, they can pick up your conversations. Be respectful. I have struggled with this to some extent in my own capacity as an ER nurse because it's a stressful job, and you need that comic relief to make it bearable, and you do need to vent. It's understandable, and human. Here's what I figured works best:
- do not indulge in any jokes or humor within patient earshot that you wouldn't be able to include the patients in
- do not complain about your job or another staff member or patient or family member at the nurse's station or anywhere near the patient areas. Go to the staff lounge, get it off your chest, and then come back.
- do not depersonalize your patients. There's nothing worse than hearing yourself referred to as "the diarrhea in room 5".

2. Don't ignore your patients - pop into the room at least every half hour or so, even if the patient is just waiting for results or waiting for a room. It doesn't hurt, doesn't take too much time, and will keep your patients calmer. There's nothing worse than just sitting and waiting, with no news, no feedback, no human contact. It's reassuring to have someone come in every half hour or so and say "hey, we're still waiting on your results, is there anything I can do for you while you wait? Do you want something to drink, a blanket, etc? Like I said, it really doesn't take any time, and the odds are they won't ask you for much.

3. Be honest with your patients: If you know that test results ordinarily take a long time to come back, let your patient know that. They may complain briefly, but they will be grateful you were honest with them. Get that out of the way at the beginning, so that the patients know what to anticipate, and if it takes a shorter time then that will be a pleasant surprise for them. That's better than telling them "it will only be a few minutes" and then an hour later having them be completely annoyed with you. You want to maintain the patient's trust and confidence in you.

Finally, remember that your patients are in a vulnerable place. They don't want to be in the ER. They don't want to be sick. It's scary, and fear can manifest itself as anger, helplessness, or in extremes of emotional expression. Be patient, be professional, be compassionate. People will not necessarily remember how long it took them to get to that CAT Scan, but they will remember how they felt, whether they felt respected or ignored.

One of the most powerful phrases I have heard recently is: "Institutions do not depersonalize and dehumanize people, people do."

If our patients leave our ERs feeling depersonalized and dehumanized, we need to reevaluate our practice.