No One Has Heard of This Job.

I’ve read a number of articles lately written by grateful doctors about nurses who work in the Emergency Department. While I was reading, I pictured the busy ER where I work, and I imagined my friends’ faces as they use their extensive skills, caring for patients and saving lives. Their collective knowledge and years of experience are vast and impressive, and I admire and respect each of them.

After reading these pieces, however, I started to wonder about something. The nurses are, quite rightly, heroes of any emergency department, and they deserve all the kudos they receive. But what about the unsung folks toiling behind the scenes? What about the Unit Clerks who keep it all happening?

A long search on Google, using every word and combination of words I could think of, revealed nothing. No blogs by nurses to say they could never deal with everything that goes on in the department without the help of little old us. No articles by doctors remarking that they have no idea how a shift in the ER would pan out if there wasn’t a clerk in sight and the nurses had to do all of our stuff. Not even a bit of writing by a clerk about Emergency Department clerks, so I decided to change that.

I’ve worked as a Unit Clerk in many different departments of our growing north-of-Toronto hospital for thirty years. All of those years were interesting, but I’ve never enjoyed anything as much as my job in the ER. When people find out where I work, they usually ask if I’m a nurse. Fair question.  When I say I’m a clerk, they kind of narrow their eyes, thinking, and then say, “So you’re the person out front that I register with?” No, that’s an entirely different job.

Here’s a snapshot of what I do.

**All patient stories have been changed, but are representative of actual situations.**

I answer phones. A million times a day, I answer those phones.

“Good morning. I’m the daughter of Mr. A. Can I have an update?” (Find nurse. Does s/he have time to come to the phone? No? Anything I can tell the family member? Return to phone and complete call, hopefully without family member asking multiple questions before saying, “Thanks, I’ll be there in half an hour.

Request from CT via the computerized portering system. A little note appears on my screen when they call for a patient, and I have to read it carefully because it contains important information. In this case, the patient is getting IV contrast with his scan, so I have to ensure he has an 18 gauge needle in his arm and that the patient is free and available to go. Don’know patient / check electronic chart for IV status or, if I’m lucky, the nurse is nearby and they will give the information I need. Then I click a button to approve the request and a porter magically appears to take the patient upstairs. Sometimes a patient is already at a different test so I have to make arrangements for them to go from ultrasound, say, over to CT when they’re finished.

The requests from different imaging departments are constant and the little message boxes popping up on my screen interrupt anything else I’m doing, and that can make you a bit crazy after awhile.

“Hi. I was in the Emergency Department yesterday, and I saw Dr. Medicine. I had terrible pain in my stomach, and my husband brought me in at about 3:15 in the afternoon…”

At this point, I cut to the chase because three other lines are ringing, and two nurses are standing beside me with charts in their hands. “And what is it you need to know today?” I always ask, seeking the basic information I need to address the reason for their call because I don’t need to hear every single detail about their visit.

“I was in Emergency yesterday and I’m supposed to have an ultrasound done today, but they don’t have any record from your department requesting the test, so they can’t do it.” (A bit time-consuming, but easy enough to deal with.)

“My mother was there last week. She lives in a retirement home and was brought in by ambulance because she was having trouble breathing. They took her to, I think, a room in the Blue Zone, Room 9, I think, or it might have been Room 10. I’m not sure which doctor saw her, but it was a tall man with brown hair.”

I’ve already cut in once to ask what her main question is, but I’m going to ask again because the specialists have come to write orders, and charts are starting to pile up on my desk. I’m not ready for the shouting that follows my gentle request to know what she specifically needs today.

“Don’t you dare push me around. If you’d just show me some common courtesy and listen to my story, you’ll find out what I want.”

Here’s a bit of information: If you yell at me, I’ll listen for a minute because nothing is gained by interrupting a rant. But I’ll hang up if you don’t stop yelling pretty soon.

This lady stops yelling, but she proceeds to give me every detail of her mother’s hospital visit, all leading up to the fact that she suspects an allergic reaction this morning to one of the medications her mother received in the ER several days before. She wants to know the name of the drug.

She talks for five minutes (I time her while I work at other, more pressing, things during her harangue) and it gives me great satisfaction to calmly state, “Your mother’s chart has been sent to the Medical Records department and they’ll have that information. I’ll transfer you there now.” My trigger finger has gotten real quick on the transfer button. Buh-bye.

And there are more:

“I’m calling from Shoppers Drug Mart. We have a prescription here from a doctor and I can’t read the doctor’s name/dose/name of medication.” (Sorry, you’ll have to fax it to us and someone will follow up on that.)

“Hey, there, it’s ultrasound calling. We need Mrs. R. here in an two hours. Do you know if she can drink?” (No idea.) Does she have a catheter? (No idea.) Well, we’ll need her to have a full bladder before we do the scan.” Okey dokey. Message to nurse to get patient drinking/turn up IV, and clamp catheter/tell patient not to pee.

“Hi, Phyllis, it’s Friendly Nurse calling from Red Zone. Do you know if Ms. W. has a breakfast order? Can you check the computer and see? If not, will you order her a tray?”

“Sure. What kind of a diet can she have?”

“Oh, just a regular one.

I check, and there’s no diet ordered for that patient. I enter the order in the computer and send an extra request for a late tray for breakfast. After breakfast arrives, the nurse comes to say that the patient is a total vegetarian, so she can eat very little of her meal. Alrighty, then. I’ll just redo my earlier work and order her a vegetarian diet this time. No problem.

I’ve heavy into processing orders by now — that is, deciphering mostly indecipherable handwriting — entering the requested labs and diagnostic tests correctly into our user-unfriendly computer system, or completing release forms so I can get information from another office or facility. Many of the tests and computer entries for patients recently arrived to the ER are so standard that I could do them while standing on my head with my eyes closed, but they still take time.

Doctor’s orders for admitted patients  in the ER, who are waiting for a bed on one of the hospital units, are another can of worms though, and they can be long and complicated. With constant interruptions by phones, staff, and visitors, it’s sometimes a challenge to make sure that each order is entered correctly in the computer system. Check, check, and re-check is especially important when it’s busy.

Sometimes, amidst the calling of specialists, the answering of questions for patients or families who come to my desk, the to-ing and fro-ing of patients for tests, or to their rooms on the floors if they’re admitted, there is a genuine emergency. In addition to STAT orders to enter, doctors may need to be put in touch with specialists at downtown hospitals via Criticall.

While the physician and nurses are busy stabilizing a patient or saving a life, the decision may be made to transfer the patient out. Then there is an ambulance or ORNGE helicopter or land transport to arrange, preparation of patient information and a chart to send along, and a CD of diagnostic tests to get. There may be phone calls to and from the ORNGE dispatcher. Finally, once the patient leaves by EMS, or the ORNGE team arrives, the department starts to feel calm again. Except when there are two emergencies at once.

We do have lovely times at work, though, and when you see us chatting or sharing a laugh while you’re waiting, please know that you are still being looked after. There are many reasons why it’s possible to share a few minutes of camaraderie, but it’s never at the expense of patient care.

Sometimes, the quietness is measured in minutes, sometimes hours, but always, there’s a feeling of looking over your shoulder, wondering what’s about to come in. And that’s the beauty of working in this department and being a small cog in this well-oiled machine. I don’t like that some people are critically ill, but I do love watching the professionals around me spring into action to care for them, and I love the small part I play in the whole thing.

So, there you have it. Now you know a tiny bit about what I do each time I go to work, and I hope you have a small understanding of what a great team I have the privilege of supporting.