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‘We See the Worst of the Worst.’ Nurses Hooked on the ER

On what is probably the worst day of someone’s life, if they are shot or stabbed, a victim of an assault or a major car crash, these emergency room nurses provide medical care, counseling and consolation.

Barbara Williams has worked at Memorial Healthcare System in Broward since 1969. She was assigned to the emergency department in the 1970s and was promoted to the department’s assistant head nurse in the 1980s, the first Black person in that position. She now chairs the department’s process improvement team at Memorial Miramar.
Alexia Fodere/TNS
(TNS) - One started in Memorial’s emergency department in the 1970s as its first Black nurse.

Another has been working in hospital emergency rooms for 36 years, the last 18 years at Baptist Health.

A third is a Level 1 trauma nurse at Broward Health Medical Center, handling the most devastating of injuries.

Three long-term ER nurses in South Florida.

On what is probably the worst day of someone’s life, if they are shot or stabbed, a victim of an assault or a major car crash, these emergency room nurses, and the teams they work with, provide not only medical care, but counseling and consolation.

It is a job that takes a physical and emotional toll. Yet many longtime nurses have fallen in love with emergency care, its challenges and fleeting rewards.

Here are their stories:

Fell in love with the ER

For 53 years, Barbara Williams has looked after patients in the Memorial Healthcare System. In 1969, she joined Memorial as a nursing assistant. Two years later, she became a licensed practical nurse and in 1982, a registered nurse.

For the past decade, Williams has worked in quality and process improvement for the emergency department at Memorial Miramar, following up with patients after they are discharged from the hospital to make sure their healthcare needs are met.

“We want our patients to get better, go home and move on with their lives,” she said.

When Williams was assigned to the emergency room as an LPN in the 1970s, she was reluctant because she was a new nurse.

But then she fell in love.

“I had a passion for that type of care — the fast movement, working with the patients and then getting them better,” Williams said.

It was the ’70s, and there were few faces that looked like hers in the emergency department. Williams recalls only one other African-American, an orderly.

“But I worked with a great bunch of people at Memorial. When I went into the ED, I found my second family there,” she said. “The people that I worked with made it so much better because I was treated with respect.”

In the 1980s, Williams was named an assistant head nurse in the emergency department. She was the first Black person in the role. But when the director first asked her to take charge, Williams told him she didn’t think she had the experience.

“He had faith in me,” she said. “And that was my start in management. And I’ve been in management ever since.”

Williams eventually was promoted to manager of the Level 1 trauma center at Memorial Regional, where the most difficult cases go, and then interim director for the department. She helped open Memorial Miramar in 2005 as clinical manager of the emergency department and has chaired the process improvement team since 2015.

A self-described no-nonsense person, Williams thrived on the high-stress environment of emergency care.

“You have to be flexible. You have to be ready to move at a moment’s notice,” she said. “We have a patient’s life in our hands. We cannot afford to make mistakes.”

Williams will retire at the end of this year. Looking back over her career, she said she will miss the interactions with patients, the physicians and staff and the mentoring and friends she has made along the way.

“The most rewarding part for me is making sure that the patients get excellent care and that they get better and go on, go home with their families and move on with a good quality of life.”

‘It doesn’t matter what comes my way’

A fixture in the emergency department at West Kendall Baptist Hospital, Marta Madrazo has been an emergency nurse for 36 years. She became a registered nurse in 1984 and joined Baptist in 2004.

Madrazo rotates between staff nurse, rotating charge nurse and flow triage. Depending on the day, she could be the decision maker in charge of the department, the nurse ensuring that patients are receiving care in a timely manner or the person assessing injuries as patients arrive.

“It’s high stress, but it’s how you look at it,” she said. “I have very critical assessment skills so I feel very confident; it doesn’t matter what comes my way.”

As a member of the hospital’s Patient Safety Committee, Madrazo devised a simple system to alert medical personnel about a patient’s risk of falling, since falls are a major cause of serious injuries.

A red magnet on the door frame of a patient’s room indicates that a patient has fallen in the past three months. A blue magnet indicates a patient with a risk of falling.

“So anybody that’s coming into that room then knows that this patient has a falls risk without even looking at the chart,” Madrazo said. “It’s another way to serve our community.”

As a baby boomer, Madrazo said she has seen a lot of changes in healthcare, most notably in technology.

“When I started nursing back in 1984, everything was paper charting. There was no computer. There was no cellphone,” she said. “Technology has increased immensely and it has helped us, but it was challenging.”

The COVID-19 pandemic brought many challenges, including the loss of personal friends and family members. Yet Madrazo said throughout the pandemic all of the nurses have pitched in to work extra shifts, despite being physically and mentally exhausted.

“I have strong faith and I’m not going to lie to you, I cried many days, coming from work, leaving work. But every time after crying, I was like, ‘You know what? These people need me, so I better shape up and the show must go on,’ ” she said. “That’s what I signed up for when I became a nurse.”

When she looks back over her years, Madrazo said she has received a lifetime of personal satisfaction from her work.

“I see nursing as a public service profession. It’s attending to the needs of others and my role is that I always want to make a difference in somebody’s life,” she said. “It doesn’t matter if I meet them for five minutes and I never see them again.”

Empathy gets her through the day

In the chaotic environment of Broward Health Medical Center’s emergency department trauma center, Maritza Castano works hard to provide not only medical care, but empathy.

Castano is a Level 1 trauma nurse, one of seven specially trained trauma nurses at Broward Health, which handles two-thirds of the county’s trauma cases. She has been a nurse since 2014.

“I’m seeing patients with devastating injuries, life-threatening injuries,” she said. “We get patients anywhere from minor falls to major car accidents, fires. We see the worst of the worst.”

The trauma team members are the first medical professionals to treat serious injuries, so Castano works quickly to get patients stabilized and calm before they are moved to other floors.

Usually patients are in shock, severe pain or highly anxious.

“It’s embarrassing because we cut off all your clothes and there’s three different people talking to you, touching you, poking you, moving things,” she said. “It’s a scary experience and you just try to make that less scary for the patient in general.”

A big part of her job is contacting families. Sometimes a patient comes in as a John Doe, with no identification and only a cellphone. Castano tracks down family members to deliver the news.

“I try to soften the blow,” she said.

Known for her compassion, Castano, a mom herself, said pediatric trauma cases are especially difficult.

“If something goes really wrong or if they succumb to their injuries, it’s devastating information we give [to families],” she said. “If they’re critical, I have to prepare myself first. I’ll tell them ‘I’m working on your baby. This is what’s happening. I want to prepare you before you go back there.’ ... You have to have that therapeutic touch with your patients and with their families.”

Castano said she loves the nurses she works with, each complementing the others.

“What I bring to the table is I empathize with the patient,” she said. “That really gets me through my days, knowing that this could happen to anybody, that these are just normal people going about their lives and you’ve just got to help them get through it.”

Trauma bay is often chaotic, with multiple serious injuries streaming in or flown in by helicopter from other hospitals.

“It’s a high-pace, high-stress environment. I mean, we really are seeing people on the worst day of their lives,” Castano said.

That takes a mental toll on the trauma care team, especially night shift. Castano is trying to start a support group for trauma nurses.

“How do I deal with it? A lot of self-care, a lot of self-awareness, knowing your limitations, knowing your boundaries, because nursing is a labor of love,” she said.

“Some people do it for the money, but there’s not enough money in the world to do the stuff that we do. ... This is my community. This is my neighborhood. I grew up here. I take pride in what I do.”

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