Emergency nurses treating gun violence can’t ignore the pain

Melissa Bales, a nurse with UChicago Medicine, has worked in emergency medicine for years and has a wealth of experience in treating victims of gun violence.

She says it’s important for even experienced nurses to realize when the stress and weight of seeing so much pain and trauma may be more than they can handle alone.

Bales is one of a group of nurses who spoke with Chief Healthcare Executive® about the toll of gun violence. She recalled when a doctor recognized that she was struggling, as Bales told him about the nightmares she was experiencing.

“I would have this recurring nightmare for months,” Bales said. “And one of my trauma doctors looked at me one day when we were talking about it. And he's like, ‘I'm not saying this to be mean, but you need help. Because that's not normal.’”

• Read more: The toll of gun violence, through the eyes of nurses | Special Report

Bales saw that she did need help and sought counseling with a therapist. And she said she wants to encourage other nurses who regularly care for victims of gun violence to get help when they need it.

“You see so much bad, and it does take a toll and it takes a toll physically,” Bales said. “And I think being able to recognize that and know that it's okay to have to talk to somebody, like a professional somebody. It's always good to talk with your coworkers, and if you have family, but sometimes you need somebody that's on the outside that can give you the resources and tools to help you manage that.”

Bales said it’s important for emergency nurses to recognize those symptoms of burnout. And she said those symptoms can go beyond sadness and feeling a little depressed.

“A lot of times, I don't think you realize it because your symptoms can present like physical symptoms,” she said.

And she said nurses should be wary of persistent symptoms, such as daily headaches, stomach pains, loss of appetite, or recurring dreams.

She also said nurses should pay attention if they realize if they’re indifferent and don’t feel anything outside the emergency department.

“Recognize that that is something,” Bales said. “It is serious, and it is significant.”

Bales has studied compassion fatigue in the emergency department and presented at conferences. She’s also participated in education sessions with small groups

“Compassion fatigue affects staff, not just nurses, but everybody that works in the emergency department,” she says.

Bales cherishes the relationships she has with her co-workers in the emergency department.

“We have a great group of doctors and nurses,” Bales said. “And we take care of each other. There's certain cases that you have them come through your door, and for whatever reason, they just hit closer to home.”

When the chaos settles, Bales said staff will check on each other, and she may tell one of her fellow nurses to take 10 or 15 minutes to leave the department, perhaps to get some fresh air or just get a brief change of scenery.

“You need to go somewhere else away from here, and just take a few minutes to just collect yourself and kind of decompress for a second and then come back,” she said.

But then there are times when nurses in the emergency department need more than just a momentary respite after seeing the toll of so much violence.

Even with her experience and knowledge, Bales said she is still learning to recognize when it’s time for a break. She said she’s learning when it’s time to take a couple days off to decompress.

“I think you need to be able to take a really honest look at yourself,” Bales said. “And sometimes it's hard, it's hard for me to sit down and say, I need to slow down, or I need to stop.”

There are times when she knows that she’s feeling burnout, but doesn’t want to stop or thinks there’s too much to do. Sometimes it’s a matter of being stubborn, and sometimes it’s the feeling that she’ll let down co-workers, she said.

And those are times she’s learning she needs to step away for a few days and not think about work.

“I have to take care of myself,” Bales said. “And I think a lot of nurses and doctors and health care workers put themselves last and we're really bad about self-care. That is something that is important. And you need to make sure that you put yourself first sometimes. Because you have to be able to take care of your patients, and you have to be well enough to do it.”

When asked about particularly difficult times treating victims of gun violence, she recalls the fatal shooting of a Chicago police officer, Ella French, in 2021. French’s partner, Carlos Yanez, was shot several times and survived, but continues to deal with his injuries.

Yanez returned to the emergency department to thank the staff for treating him. French’s mother also visited the hospital to thank the nurses and doctors who worked to save her daughter.

“They came back to visit and to say thank you,” Bales said. “And so I think those two stick out for us in particular.”