True Grit

True Grit

Ariel Morris 10MN (left) and Dian Dowling Evans 90MN in the ED at Emory University Hospital


Bridge Effect

The Bridge Effect

Minding the Generation Gap

Culture of Inquiry

Hard Evidence

True Grit

Wounds of a Different Sort

Critical Conditions


NP program fills void in emergency care

It’s 3:30 on a Friday afternoon, and already the hallways are lined with gurneys and patients. Registered nurse Ali McCray 10MN 12MPH walks around the blue zone of Grady Memorial Hospital’s emergency department (ED), looking for her first patient, a young man with testicular pain. McCray takes the man’s vitals and a case history, recording the information on a little black notepad before heading off to review the case with her preceptor, a second-year physician resident. She will repeat this scenario many times over before the end of her shift. Seventy-three patients are waiting in the lobby, and more are sure to come as the weekend kicks into high gear.

McCray’s shift is part of the clinical rotation required by Emory’s emergency nurse practitioner (ENP) program. It is one of only seven in the nation designed to put nurse practitioners into U.S. trauma centers and EDs. And it is the only program that formally trains nurse practitioners with emergency medicine physician residents in a specially designed interdisciplinary clinical rotation.

“There is a serious national shortage of board-certified emergency medicine physicians to adequately staff existing EDs 24/7 across the country,” says Dian Dowling Evans 90MN, who directs the school’s ENP program and works in the ED at Emory University Hospital. “Nurse practitioners have become important players in helping address the ED provider shortage, which means that emergency physicians will probably work with an ENP at some point in their careers. Training NPs with emergency medicine residents is one way that Emory is helping prepare future ED providers to better understand how to work together to optimize emergency care.”

ENPs have been around since the 1970s but now are more common as hospitals seek less expensive ways to address the many patients who use EDs for primary health care. Between 1997 and 2007, the number of NPs working in EDs more than doubled, according to an article in the October 2009 Journal of Academic Emergency Medicine.


"The ability to communicate well and work as a team is critical."

Dian Dowling Evans, Emergency Nurse Practitioner Program


Like other types of nurse practitioners, ENPs are schooled in primary care. But they also learn advanced cardiac life support, central line insertion, advanced wound repair, and emergency births, and they complete 700 hours of clinical rotations. Not only do students work in the EDs at Emory University Hospital, Emory University Hospital Midtown, and Grady Hospital, but they also spend time in the orthopaedics, dermatology, ophthalmology, and surgery departments at Grady. These shifts expose students to some of the most common complaints of emergency patients—broken bones, sprained muscles, skin rashes, and eye infections.

Rotations also give nurses a taste of the pace and demands of working in an emergency department. “It’s not a 9-to-5 job,” Dowling Evans says. “It’s stressful. You need to be assertive. You must be willing to care for some of the sickest and most vulnerable patients. You have to be efficient and willing to make critical decisions fast. You also have to be gritty. You can’t get your feelings hurt. When people are in the ED, you have a short time to establish a relationship of compassion and understanding. The ability to communicate well and work as a team is critical."—Kay Torrance

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winter 2011