Front & Center: Hospital emergency department brings challenges, rewards for Deaconness executive

Judging by the number of “ER”-type TV shows in syndication, trauma is a popular topic.

But much has changed since George Clooney donned scrubs as Dr. Doug Ross a quarter-century ago.

In fact, ERs officially aren’t even called that anymore.

Emergency department, or ED, is the generally accepted nomenclature throughout the health care industry, explained Louella Freeman, director of emergency services at MultiCare Deaconess Hospital and Deaconess North Emergency Center. “But I was just visiting with a patient, and when I said, ‘ED,’ he asked, ‘What is that?’

“In the old days, hospitals carved out space for emergencies – often literally one room divided by curtains to offer a bit of privacy,” Freeman said.

“Since the ’70s, as more services were added, they became known as emergency departments. But the term ER is still more common.”

During a recent interview, Freeman discussed career opportunities, opioid addiction and scooters.

S-R: Where did you grow up?

Freeman: In Dunlap, Tennessee, a one-stoplight town near Chattanooga.

S-R: Was there a high school in Dunlap?

Freeman: Yes, but I chose to go to a coed Christian boarding school in Georgia.

S-R: What was your first job?

Freeman: When I was 16, I was a nurse’s aide in our little country hospital.

S-R: Were there qualifications?

Freeman: I went through a training class taught by my mother, who was director of nursing.

S-R: What did that summer job teach you?

Freeman: To highly respect nurses’ aides and the important physical work they do – bathing patients, moving them.

S-R: What was your dad’s profession?

Freeman: He was an old-time country doctor, making house calls, delivering babies, setting bones and covering the ER.

S-R: When did you set your sights on a medical career?

Freeman: By the time I was 9 or 10, I knew that’s what I wanted.

S-R: Where did you attend college?

Freeman: I earned my bachelor’s degree in nursing at Loma Linda University in Southern California, and stayed for my master’s.

S-R: What career path brought you to Deaconess?

Freeman: I took the staff nurse route, starting in high-risk perinatal services at Loma Linda University. At 24, I became a charge nurse. Then I was encouraged to apply for an opening as head nurse and got it. After six months, I was put in charge of three departments, and did that for five years before moving up to a director position. I was a director at several hospitals for 12 years and have held executive-level positions for 18.

S-R: Did anything in your academic training prepare you for leadership roles?

Freeman: My bachelor’s program included nursing leadership and responsibilities. But in those days, you mostly learned on the job. Nowadays, we have leadership development courses and mentoring.

S-R: What is your leadership philosophy?

Freeman: Do what is right, not what is easy. And take care of your caregivers so they can take care of patients.

S-R: What brought you to Spokane?

Freeman: Our oldest son is a nurse practitioner in the Valley with two adorable boys. So when MultiCare Health System bought Deaconess and Valley hospitals (two years ago), I looked for something that would be a good fit. When the emergency services directorship opened, I applied and got it.

S-R: Did you have emergency department experience?

Freeman: ERs reported to me as an executive nurse for the past 18 years.

S-R: How have emergency departments evolved?

Freeman: Their sophistication and range of services have gone way up – for instance, MRIs and CTs instead of only X-ray. That helps rapidly diagnose what’s going on with patients and get them the care they need.

S-R: How have patient demographics changed?

Freeman: Nationwide, the number in behavioral-health patients has risen tremendously, along with the homeless. They use ERs for primary care and don’t have follow-up with physicians to manage their chronic conditions. That’s a huge challenge for emergency departments, because we have people who repeatedly come to us in some sort of crisis.

S-R: Opioid addiction is getting more attention nationwide. What’s the local perspective?

Freeman: We’re definitely seeing more patients struggling with opioid addiction. We recently added a grant-funded nurse and data-collection specialist focusing on opioid-use disorder, and can offer patients a medication-assisted treatment plan.

S-R: How long do your ER patients typically wait to be seen?

Freeman: Anywhere from no wait to two hours, depending on the time of day and who else is arriving through the ambulance entrance. Mondays are busiest – particularly later in the afternoon and into the evening. Seasonally, wintertime is busiest, when flu and colds spread.

S-R: How long are nursing shifts?

Freeman: We do 12-hour shifts. RNs prefer that, because they can work three days and then have four days off with their families.

S-R: What’s the salary range for your RNs?

Freeman: Salaries vary depending on training and experience, but the average hourly wage for nurse’s at Deaconess is $40.37.

S-R: What do you like most about your job?

Freeman: The people – both staff and patients. Also feeling like I’m making a difference, and the fact that it’s never boring.

S-R: What are you most proud of?

Freeman: How engaged our staff is. When we surveyed nurses last fall, ED staff satisfaction had gone up tremendously in the short time since MultiCare took over.

S-R: What distinguishes Deaconess from Providence Sacred Heart, your primary competitor?

Freeman: We have a wonderful, friendly, family spirit – welcoming, with good teamwork between different disciplines. I think we’ve rebuilt our reputation as the place to come.

S-R: What should patients consider when deciding whether to go to a hospital emergency department, a minor-emergency clinic or the nearest pharmacy?

Freeman: Ear infections, sore throats, sprains or minor cuts may be more appropriately handled at an urgent care clinic or over the counter. But if you’re having chest pain, stroke symptoms or the worst headache you’ve ever experienced, or vomiting and unable to keep anything down, you need to come to an emergency department.

S-R: Are there common misperceptions about ERs?

Freeman: Some patients assume if they call an ambulance to bring them here, that puts them ahead of someone who walked through the door. But each patient is triaged upon arrival, and if their acuity level is lower than a walk-in patient’s, the walk-in will go ahead of them. Patients with the highest risk get top priority, regardless of how they arrive.

S-R: Is insurance coverage a consideration?

Freeman: People’s ability to pay has nothing to do with the care we give.

S-R: Many people’s impressions of ERs are informed by television shows – “Code Black” and “Trauma: Life in the ER” – which emphasize pandemonium. Are those portrayals accurate?

Freeman: Usually not. We get our share of patients with strokes, chest pain, stab wounds, aneurysms, overdoses and suicidal patients. But we also have additional hospital resources to support us.

S-R: What should people bring with them to the ER?

Freeman: Their insurance card, ID and a current medications list. They should not bring the medications themselves, nor any valuables.

S-R: What’s the outlook for nursing careers?

Freeman: The shortage will continue to grow, offering people greater flexibility in job choices and schedules. A bachelor’s degree is going to increasingly be an expectation for employment.

S-R: Is the gender ratio changing?

Freeman: There’s been a large increase in the percentage of men entering the profession. I think that’s the result of rising salaries and changing attitudes, like the recruiting ad that asked, “Are you man enough to be a nurse?”

S-R: What challenges lie ahead?

Freeman: Increasing services for the underserved and helping patients manage pain with alternatives to opioids.

S-R: Any changes ahead for your department?

Freeman: We’re in the process of getting recertified to treat level-2 trauma patients – more serious injuries. (Deaconess’ previous owner, the Tennessee-based for-profit corporation Community Health Systems, allowed level-2 trauma certification to lapse.)

S-R: Is working in an ER inherently stressful – not knowing what crisis will come through the door next?

Freeman: Emergency staff thrive on helping patients in crisis. If someone is bleeding profusely and you stop the bleeding and send them on their way, that’s exciting.

S-R: What goes through your mind when you see kids zip past on electric scooters, or pedestrians cross the street looking at their phones instead of oncoming traffic?

Freeman: It’s scary. Not paying attention is a good way to end up in ER.

Writer Michael Guilfoil can be contacted at mguilfoil@comcast.net.