by Sydney Caracciolo, BSN, RN
Caracciolo is an emergency department nurse at Vanderbilt Wilson County Hospital in Lebanon, Tennessee.
I walk through the hospital doors just before 6:45 a.m. to prepare for the day shift. The day starts with a quick team huddle, including a briefing from our night shift counterparts with updates on patient statuses before getting our assignments from the charge nurse.
The ER never really sleeps, and patients come in around the clock, so I get to work checking on my assigned patients and restocking equipment and medical supplies we may
need throughout the day.
Each of us is responsible for a handful of rooms, but we may be tasked with floating to cover lunches, supporting a teammate during a trauma, or even jumping in when someone needs help starting an IV or an EKG (a recording of the heart’s electrical activity). Triage, the process of assessing patients based on their emergent care needs, is always bustling, especially since the 16 ER beds fill quickly. Each room could have a patient with vastly different medical needs, such as respiratory distress on a ventilator, a cardiac admission,
geriatric trauma or pending transfer to a specialty service.
People often think the ER is a place of chaos — and it can be — but what they don’t always see is the heart behind it. Each of us became nurses because we care about and want to help our patients. Every decision we make comes from that place. We have to make informed decisions that prioritize patients’ immediate and critical needs when moving individuals through the ER — part of this process includes determining who needs
a room for close monitoring and actively assessing care to prioritize patient care due to the level of emergency that day. It’s never a reflection of how much we care but a matter of the severity of a patient’s illness upon arrival.
Each day we see a wide range of cases encompassing everything from chest pain to falls in older adults. One moment that still sits with me was when a patient arrived with an EMS report that didn’t raise major concerns.
Our team noticed subtle signs that could indicate something more serious was going on. Within minutes, we discovered internal bleeding and rushed the child to the operating room. It was one of those “everyone in motion” moments, including surgeons, nurses, techs, where we all moved together, almost wordlessly. That kind of coordination doesn’t happen by accident. It happens when you’ve built trust over time and know the
strengths and instincts of your teammates.
In the middle of the most intense situations, I’ve learned to pause and take a quick breath, scan the room and ask myself: What’s the top priority right now? Who’s doing what? Is there anyone in this room who doesn’t need to be? Those split-second decisions can change everything. In high-pressure moments, I find clarity comes from order. Each of us in the emergency department plays a role, and when we follow that structure, things go
smoother for everyone — both the team and the patient.
This job can be both physically and emotionally exhausting at times. But at the end of each shift, I know I’ve done something meaningful and potentially helped someone through the worst day of their life. I’ve been a part of a team that refuses to give up. That’s why I come back, day after day. And that’s what keeps me going, even when the ER never slows down.
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