Butler ER Nurse Still Loves Her Job After 30 Years
As a registered nurse at the Butler Health System's emergency department, Joyce Brehm's day-to-day varies greatly and can change rapidly.
She can expect to work in the charge status, as a triage nurse, as a floating nurse, or she may have an assignment.
“I've been in nursing for 30 years and employed at Butler (Memorial Hospital) for all 30,” Brehm said. “I've been in the emergency department for about the past 10 years.”
Brehm ultimately got into nursing because of her late mother, Marilyn J. Boben, and a desire to see what nursing could be for her. She watched her mom work midnight shifts while raising Brehm and her siblings. She would go on to have a nursing career that spanned more than 40 years.
“She truly was my mentor,” said Brehm. “I don't think I can follow in her footsteps 100%, but she's someone I look up to and will admire forever.”
Brehm started out at BMH as a nursing assistant in a full-time position. Nursing assistants are vital to the care of patients. They help with daily living activities like eating and bathing.Nursing assistants may provide basic assistance while also offering some support when needed most by their charge or patient. They are sometimes called nursing aides.At the same time, she went to nursing school at Butler County Community College. Brehm was able to earn the credentials she needed to further her career and stay on track at the Butler hospital. When Brehm graduated, she took a job on the med-surgical unit at the hospital.Nurses in this unit care for a variety of patients, using different skill sets from their clinical practice. These nurses focus on patient safety, optimal treatment planning and medication routines among other things.“You're dealing with the whole medical picture,” Brehm said. “Med-surge units can fine-tune care by looking at the whole person and not just the problem they came into the hospital with.”Floor nurses in med-surge floors are responsible for taking care of patients by giving medication and shots and setting up IVs.They may also inform patients about their condition or diagnosis and are responsible for maintaining medical records. They also engage in conversation with patients offering emotional support while being informative, but not judgmental or opinionated, Brehm said.Jobs in med-surge floors can be steppingstones to securing jobs in critical care units.“From there, I went to telemetry and worked in the float pool,” Brehm said.Nurses who specialize in the monitoring of cardiac patients are called telemetry nurses. They use advanced technology like electrocardiograms (EKG/ECG), and they're experts at identifying potentially dangerous heart rhythms that could lead to more serious complications for their patient's condition.Float pools provide direct nursing care to a wide variety of patients in need. Floating is a form of resource sharing often used by health care institutions to remedy staffing shortages. It can be a great way for new nurses to get an idea of what type of nursing they want to specialize in.“Ten years ago, I accepted a position in the emergency room,” Brehm, said, “which is my love.”
Working in the emergency room is a fast-paced job in which each day is different. Brehm doesn't know what will happen on any given day and shared that she enjoys that part of it.In addition to the emergency department inside Butler Health System, there is also an urgent care side. Brehm also works in this fast-track part of the ER. It has fewer acuity type patients than the ER.“Every day is another learning experience,” Brehm said.Staff in the ER care for patients who show up without a prior appointment; either by their own means or that of an ambulance.“(We see) everything from a common cold, to nausea and vomiting, to a traumatic car accident, to an active heart attack that needs to go straight to the cath lab, to an acute stroke that needs immediate medication to reverse it,” Brehm said.“I love going to work every day and not knowing what's going to be on my plate.”Brehm said working in the ER is a team effort: everyone depends on one another whether they are a physician, aide, secretary or other co-workers.“No one could make it on their own in the emergency room without working as a team,” she said. “We all lean on each other and depend on each other, and together we get through each day.”Part of getting through each day is leaving personal issues at the door, she said.“The emergency room isn't right for everyone,” said Brehm. “You have to be open-minded and be able to work as a team with others. Taking criticism well, not taking things personally and not holding grudges is also required.“Going to the emergency room, in general, is a huge difference than your regular nursing. When I first went to the emergency room, there was a lot I was transitioning to, there were many more diagnoses and critical situations at hand.“You have to learn quickly on a daily basis during every shift. I would say in general, it takes a good six months to feel comfortable.”Communication with patients in the ER is different because most of the staff are in fast-track mode.“Changing the way I interact with my patients when it came to the emergency room was a huge adjustment from floor nursing,” Brehm said. “You can stretch out conversations and care in floor nursing. In the emergency room, you're not always able to do that. Information has to be delivered quickly and to the point.”Nurses transitioning to the ER have to find other ways of adapting clear communication with patients, while still maintaining quality of care.“You have to find the right way to deal with your patients and their family members while still letting them feel they are important, that you do care even though you're moving quickly, and their best interest is at heart,” Brehm said. “We don't always have the answers, but we care.”
“Initially, nursing to me it was just a job, but throughout my career I developed a true passion for it,” Brehm said. “Making a difference in people's lives became very rewarding to me. Interacting with patients, families can be very difficult at times. It's also very satisfying.”While following in her mother's footsteps was never the plan, after some time working in the airline industry, Brehm embraced nursing and found her passion.“I don't regret the trail I took,” she said. “I feel the most successful nurse is the one that truly has a passion for nursing (and is compassionate).”Brehm's story of how she started is a common one. People who are interested in nursing can start as nursing assistants and pursue higher education to obtain the licensing and certifications required.Butler Health System has many career tracks to choose from within the company and can be a way to break into nursing on a national or international level.“Coming out of nursing school, you're a brand new nurse,” Brehm said. “There's so much more to know in the nursing field than (what you learn in school). Starting out at the med-surge level was a great move for me because I learned the whole body system.“Going into telemetry, I was able to learn more about the cardiac system,” she said.The emergency room experience focused all that knowledge in a critical care situation and Brehm said she felt ready to be part of an effective team.“Once nurses come into the ER, they are usually here for life,” Brehm said. “I will be here until I am ready to retire.”
