Working in the ER During the Height of COVID-19

Working in the ER During the Height of COVID-19

While the worst of the COVID-19 pandemic seems to be behind us, the spread of the Delta variant indicates that it’s not completely over yet. During the height of the pandemic, nurses worked on the frontlines all over the country, and some are just now sharing their experiences working in the ER during the height of COVID-19.

Rastisha Smikle, RN, works in an ER at a hospital in central Florida. Having worked as a nurse for more than 10 years, she answered our questions about what it was like in the ER during COVID-19.

As a nurse in the ER in Florida, what has it been like working there during COVID-19? How has it changed over the last year or so? 

It was very challenging to work during the pandemic. In the ER, we are a patient’s first point of contact, and because of that, our staff is considered at a higher risk of being exposed to the virus. Although safety and infection control elements have always taken priority in our roles, the unknown factors of the virus’ transmission, ever-changing symptomatology, and treatment contributed to our challenges because of all the unknowns.

Patients were more fearful than ever; they often came in anxiety-ridden wanting testing because of recent exposures, which added additional challenges because the critical emergencies also relied on our care.

In some ways, things have gotten better. As we have learned more about the virus and therapeutic treatments, patients are being cared for more efficiently so that they can recover at home. Unfortunately, hospitals nationwide are busier than ever right now. The volume that we are seeing is higher now than we saw during the pandemic. It’s tough to say what that is.

Did your duties change during COVID-19?

My duties didn’t change per se, but the way we cared for patients did.

Before the pandemic, PPE like N-95 masks were not permanently a part of my uniform. Now, I wear an N-95 and face shield with every patient encounter. Because of the wide range of symptoms, we have to be extra diligent in caring for patients just in case they have the virus and aren’t aware of it yet. In addition, minimizing my exposure time with known Covid-19 patients is also an element that I have had to implement in my care. For the safety of myself and the other patients, swift patient care must be implemented with these patients when appropriate.

Employing the use of hospital phones has been a way that I try to fill in the gap. Throughout this time, I have learned how fearful patients are after they get the diagnosis. With these talks, I can extend some reassurance, listen to their concerns, and figure out thoughtful and effective ways to help them with the emotional challenges that often accompany the diagnosis and isolation.

Was it scary to work there in the beginning of the pandemic? Why? 

There was a level of fear when it came to the unknowns. I had worries about getting the virus. But primarily because of my level of exposure in the ER, I was mainly concerned about others being around me. I isolated myself from family and friends, and my life was work and home.

There were times when we would care for patients with no known symptoms and later, we’d find out that they were positive for Covid-19. I would have mounting thoughts of whether I wore the correct PPE or if I was exposed in those moments.

We also had staff members contract the virus, which was scary. Thankfully, most of them recovered well, but seeing how careful other staff members were and finding out that they still contracted the virus was nerve-wracking. Every minor allergy symptom or cough would cause concern and anxiety about whether I was next. To combat those fears, I had to reshape my focus. Instead of being hyper-focused on getting sick, I began to fix my focus on doing my job well and providing the optimal patient care that I was used to. With this newfound focus, my anxieties slowly began to dissipate.

How do you keep yourself from bringing the stress of the job home? What do you do to relieve your stress?

Sometimes it can be challenging, especially after losing a patient. My go-to stress reliever is prayer. I have a solid spiritual foundation, and thankfully the organization I work for also provides spiritual support, if needed. As nurses, we are fortunate enough to work three shifts per week. I try not to take my days off for granted; I use that time to refuel. Therapy, exercise, and self-care activities have been essential to my mental well-being.

What are the biggest challenges of your job—especially during COVID-19?

One of the biggest challenges of my job is knowing that I have to be on my A-game at all times because the safety of myself and others depends on it. The unknowns that came along with COVID-19 made it challenging to do and be our best. For example, we didn’t always know the best course of action when treating some patients because everyone would respond so differently, which posed one of the biggest challenges. Thankfully, as time went on, we learned more about the virus, the treatment options that worked for others, and we eventually adapted very well.

What have been your greatest rewards during this time?

My greatest rewards have been seeing how the nursing and healthcare community banded together during the most challenging times. The support from our community members was also very inspiring. We often came into work with goodies from companies that wanted to encourage and thank us for our continued work.

Emergency Room or Urgent Care? How to Know Which to Visit

Emergency Room or Urgent Care? How to Know Which to Visit

With the rise of urgent care clinics as an alternative to going to the emergency room, many people are left unsure which to visit when they experience a medical issue. The choice is important, as while urgent care clinics are often much cheaper, they are unequipped to deal with certain emergencies and will refer you to an emergency room anyway. While the line between urgent and emergency medical issues is not always easily apparent, here are some ways you can tell whether you need to go to the emergency room or urgent care.


Pain is a troubling symptom, and either urgent care or the emergency room might be the right answer depending on its severity and location. Some pain, such as ear pain from a suspected ear infection, a sore throat, or other concerning but not alarming pain can be seen by urgent care. Severe pain, however, especially if stemming from the chest or abdominal area, should be looked at in an ER. This type of pain could be indicative of a cardiovascular event, appendicitis, tumor or cyst, or other serious condition. Even severe leg pain could be an emergency, especially if you are unable to easily walk because it could be a sign of deep vein thrombosis (DVT). DVT occurs when a blood clot forms in the deep veins of your body and if not treated promptly could result in required amputation.


In general, injuries that are not life-threatening can be taken to urgent care while anything life-threatening should be seen as an emergency. Simple or suspected broken bones can often be mended at an urgent care clinic, while complex fractures should go to the emergency room. Most animal bites, including insect stings and bites, can be handled by urgent care, although severe, life-threatening bites, such as to the head or neck, should be taken to the ER. For sprains or strains, you should go to urgent care, while anyone who is bleeding severely should be taken straight to an emergency room.


Most illnesses will not require a trip to the emergency room. Fevers, flu symptoms, coughs, vomiting, diarrhea, and most bacterial, viral, and fungal infections can be handled at an urgent care clinic. Even dehydration, which is often brought about by infections, can be treated at urgent care. If you have reason to believe the illness symptoms you, a family member or a friend are experiencing could be fatal, such as being unable to breathe, then an emergency room visit is warranted. If someone falls unconscious, you will also want to take them to the emergency room.

Slurred Speech or Confusion

Anyone who is suddenly experiencing slurred speech, confusion, vision loss, trouble speaking, or understanding others should be taken to an emergency room immediately. These are signs of a stroke, head trauma, or other brain damage that must be addressed immediately in order to have the best chance of restoring normal function. Other signs of a stroke include weakness in one arm or leg, drooping on one side of the face, and trouble walking or staying balanced. Strokes usually only affect one side of the body, with the left side being more common. Head trauma can have other symptoms such as pupil dilation, difficulty sleeping or awakening from sleep, light and sound sensitivity, and more.

Allergic Reactions

A minor allergic reaction can be sent to an urgent care clinic. Minor reactions can include rashes or minor respiratory problems caused by pollen, pet, or other environmental allergens. A major reaction will require a visit to an emergency room and typically involves not being able to breathe or experiencing severe swelling. The difference between the two usually can be discerned based on the severity of the reaction and whether the person has had contact with a known life-threatening allergy. If you are not sure what is causing the allergic reaction, you will likely be referred to an allergist after the reaction is brought under control to determine your health needs moving forward.

Generally speaking, the severity of your symptoms should help you determine whether to go to an urgent care clinic or an emergency room. When searching for a good clinic make sure you are trying to find the one nearest to you. For example, if you live in Illinois you might search for Urgent Care in Oak Brook. If you live in New York City you might search for a local CityMD, or Texans might search for the nearest Texas MedClinic. Certain symptoms or issues, however, are more likely to warrant going to one or the other. When in doubt, you can call your primary provider to see what they suggest.