The toll of gun violence, through the eyes of nurses | Special Report

Inside the emergency department of a hospital, nurses witness the chilling toll of gun violence on a daily basis.

Every day in America, more than 130 lives are ended by gun violence. In 2022, more than 48,000 Americans died due to firearms violence, according to a Johns Hopkins University analysis of federal data.

More hospital leaders, doctors and nurses are talking about gun violence as a public health threat. Nurses who work in emergency departments shared their experiences with gun violence in interviews with Chief Healthcare Executive®.

They talked about treating victims, caring for families as they experience the worst possible moments, and how they try to cope with those horrifying experiences every day.

In the conversations, they make it clear that they are hardly numb by what they see. Yes, they process what they have seen and find ways to make sure they can care for other patients. But none of the nurses who talked with us described their experiences with any indifference or nonchalance. It absolutely gets to them.

(See nurses share their perspective in this video. The story continues below.)

Victims and families

Some nurses say they see a victim with gunshot wounds every day, with some who are fatally wounded and others who survive their injuries.

Melissa Bales, an emergency nurse with UChicago Medicine, said it isn’t unusual for her to see more than one victim of gun violence each day. She sees “a lot of gun violence more than I think more than any of us want to see.”

Bales said the number of patients with gunshot wounds is typically higher in the summer.

“We literally call it trauma season, which is kind of sad,” she said.

Victims of gun violence run the gamut, she said. Some were simply in the wrong place at the wrong time when they were struck by a bullet. Some are victims of domestic violence.

She’s also seen victims of gang violence, including those shot at services for a loved one who died due to gun violence. “We've had patients that have come in that were at funerals …, and they are shooting up funerals,” Bales said.

Angie West, an emergency nurse with UPMC in Pittsburgh, has been in emergency medicine for more than a decade and has seen victims of gun violence all too often. She said one victim, a 14-year-old boy who died of his wounds, sticks out in her experience, and she becomes emotional recalling taking the child’s mother to see him.

“It's the fact that you have to explain to a family member what just happened and the severity of injury that they have sustained,” West said.

“Bringing his mom back, and I can still see her face,” she explained. “This was like five years ago. I see her face all the time. I had to bring this mom back and show her her dead 14-year-old. That shit sucks. So it's just trying to explain to the family what happened and what we did to try to resuscitate them.”

For some, it’s the sound of wailing parents that are indelible. Hershaw Davis, who has worked as an emergency nurse at Johns Hopkins for years and teaches nurses at the University of Maryland Medical School, said the sounds of grieving parents stay with him.

“When you hear a mother or a father cry over their child's dead body, and I've heard it a lot, you will never forget that cry in your life,” Davis said.

Davis said seeing some of the victims of violence spurred him to pursue a role in training emergency nurses. He said he strives to help young nurses “realize a patient is not a body or a number, but a person with the story.”

“Sometimes when you read the story, or hear the story, it paints a different picture, you realize, if you really step back through some different choices,” he said.

Nathan White, an emergency nurse at Huntsville Hospital in Huntsville, Alabama, said gunshot wounds are a daily occurrence.

White described one victim who was shot near the hospital, and said the shooter followed the ambulance to the hospital and shot the victim again.

Emergency nurses build up an emotional armor to deal with what they see, mainly because they have to move onto another patient. But he said nurses are moved by what they see.

“I think we get into health care, because we want to take care of people,” White said. “We’re subject to human nature. We're sympathetic to it.”

While nurses see patients who are mortally wounded, White said it’s important to think about those injured by gun violence. Some of those who survived their wounds, but must grapple with injuries that are life-changing.

“I can think of many times where it leads to very long-term repercussions,” White said. “It's not just OK, well, this is going to be a couple months of recovery. It's sometimes years.”

In Chicago, Bales said she has cared for victims who she has recognized as coming to the hospital previously with gunshot wounds.

“I think it kind of hits you afterwards,” Bales said. “We're looking at one of my co-workers and, like, ‘Yeah, I just took care of him not even a year ago.’ And thankfully, he was lucky again this time.”

“We do have a recidivism with these patients as well, which is also heartbreaking and sad,” she said. “The nurses will have conversations with them … What are you doing? You can't keep coming back here like this. This is not okay.”

At the same time, nurses also said they don’t spend much time in a trauma situation weighing if the patient is an innocent bystander or a gang member.

As West said, “What I need to do is focus on the situation at hand right now.”

• Read more: Northwell Health gun violence forum aims to get hospital leaders more involved

Helping each other

At UChicago Medicine, nurses and doctors try to look out for each other if someone in the hospital staff is hurting or being worn down.

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

She said doctors will also share when a victim of gun violence is on the way to recovery, which often provides a much-needed boost.

“Those are the patients that keep us all doing what we're doing,” Bales said.

“Some days can be really defeating, and you feel like you've lost,” she continued. “But it just takes that one patient to know that we won because it may be one patient, but their brother, their son, their dad, their friend. So we save that person for themselves, but we save that person for the rest of their family too. So it impacts a lot of people. And that matters.”

Bales belongs to a family that includes other nurses and some police officers, so in some ways, she has more familiarity with the nature of gun violence. But she also said there are times she’ll lean on her husband, who isn’t in the medical field.”

“I’ll text him and I'll be like, I just need you to be there when I get home,” Bales said.

White stresses the importance of debriefing after dealing with gunshot victims. He said Huntsville Hospital has been building that into the process and looking at how nurses are coping emotionally after dealing with traumatic events, including assessing if people are “able to properly decompress.”

As White said, everyone processes the challenges of treating patients with gun violence differently.

“You’ve got to find that medium,” he said. “For some things, it may just be, you know, you've done everything you can.”

After dealing with patients wounded by gunfire, West said she often finds solace in silence.

“One of my big, big ways that I decompress … I do like to drive home in quiet,” she said. “I think we are just so overstimulated by noise all day long. I just like to go on a walk. I walk a lot to decompress.”

West lamented the fact that she routinely treats patients who have been wounded by gunshots.

“Gun violence is such an everyday thing,” West said.

“It's like you have a chest pain every day, or you know, you have an emergent case every day. It's just another part of the job. And it's so unfortunate that it's become this norm.”

Bales said it’s important for nurses to recognize when they need help, and to get assistance.

“I just want nurses and people who work in this setting to know that it's okay to not be okay,” Bales said. “And it's okay to recognize that you're not okay.”

(Look for more perspectives from nurses on gun violence in the coming days. Our thanks to the Emergency Nurses Association for their assistance with this project.)

• Read more: Surgeon general urges health leaders to tackle gun violence: ‘We need to step up’