Nurses on the front line of health care

By Christine Barcia

For Lori Impastato, minutes, maybe even seconds, matter in her line of work.

An emergency room nurse at CentraState Medical Center, Freehold Township, she “hits the ground running” when she arrives at work for her 12-hour shift.

No time for idle chit chat over coffee with co-workers, Impastato’s day begins with a full update of the condition of patients in the emergency room from the nurse whose shift is ending.

Nurses first see patients in triage, in which they assess patient needs in order to see where they belong in the emergency room, she said.

“The rule of thumb is that in 15 minutes a patient is seen by a nurse and in 30 minutes a patient is seen by a doctor,” Impastato, who has been a nurse for over 30 years, said.

Patients are divided into four care areas based on their complaint: bumps and bruises; pediatrics; acute care (cardiac arrest, stroke, trauma); and intermediate care (abdominal pain, mental health, back pain), according to Impastato.

“The challenges are times of very high volume. Unlike a physician’s office, we have no control over the amount of patients arriving at any given time,” she said.

When volume surges, she said, it requires the emergency department team “to work faster and more efficiently.”

Impastato said she “sees everything every day.”

That includes losing a patient in the emergency department on a daily basis.

“It’s hardest when we lose children, teenagers in car accidents, babies with SIDS. I can tell you about each and every one,” Impastato said.

She said debriefing sessions, both formal and informal, with a minister, other nurses and physicians help staff members deal with such tragedies.

“We cry. We have feelings,” she said.

Impastato keeps families fully informed about the status of a patient.

“We rely on the family to help with the decision-making process and make sure the family understands that everything that could be done was done,” Impastato said.

One of the most memorable times in her career, she said, came in 2012 when superstorm Sandy made landfall off the New Jersey coastline.

“The volume was so high. So many people were struggling and stayed here for days. Seeing the elderly who lost homes, people on oxygen with no electricity, injuries, heart attacks, strokes, food running out, and we just pulled through,” Impastato said.

During the Sept. 11, 2001, terrorist attacks, Impastato remained at work despite worry over her husband who was working on Wall Street and her son who was at the Pentagon. She said many of her colleagues were experiencing the same concerns over loved ones.

“We stayed at work together and went through the situation,” she said.

In the summer of 2014, Impastato took care of the first patient suspected with Ebola, according to CentraState’s Director of Public Relations and Communications, Abbey Luterick.

“Lori (Impastato) went in and took care of her,” Luterick said.

Impastato said she was nervous, but “a great team outside the door watching every move to assure that safety wasn’t compromised” put her at ease.

“In nursing, we are required to step out of our comfort zone often, and we accept the challenge to provide care to the patients. You have to leave your personal life at the door,” Impastato said.

The patient was found to not have Ebola.

A Freehold resident who attended nursing school in Brooklyn and is now pursuing a master’s degree in nursing education at Monmouth University, Impastato said she has always been interested in helping people.

“When I first started out, nursing was very task oriented. The doctor gave orders, and you did it. Now, there is autonomy, education, research and participation in processes,” Impastato said.

Nurses, she said, are an “integral part of the team,” and as clinical leader in the emergency department, Impastato works with new nurses and integrates them into the work environment through nurturing and mentoring.

The emergency department, which Impastato has worked in for 20 years, in particular requires a team effort.

“We work closely with doctors, and there is respect and collaboration,” she said.

As a result, Impastato said, burnout is alleviated.

“There are more preventive tools in place now to curb burnout than there were in the past. There is a better nurse patient ratio, support from physicians and continued education,” Impastato said.

In addition, she said, there are now nurse-physician collaborative teams.

Through the years, Impastato has observed that “patients are coming in sicker and sicker and they are younger and younger.”

She said in the emergency department, the staff works closely with the local police department and picks up on problems in society.

For example, she said there has been an increase in heroine use in Monmouth and Ocean counties.

“When there is a surge in something like this, we see it first,” Impastato said.

Nurses also assume a central role in the community through outreach to all ages from children to seniors.

“All nurses (at CentraState) go two times per year into the community to talk about issues,” she said.

That includes going to high schools to talk about drinking and driving; offering helmet, bike and car seat safety classes; and participating in screening fairs.

“Educating the public helps them and us. We get patients in sooner when they know the signs and symptoms of medical problems,” Impastato said.

For example, she said, women often ignore the symptoms of heart attacks.

“We teach them the signs of a heart attack and not to ignore the symptoms. When they come in early, there are better outcomes,” she said.

Impastato said she is still learning after all of these years, in particular in an ethics class in which death and dying are discussed.

At the end of her shift, Impastato said she reports on the status of all patients in the emergency room to the next nurse reporting to work, and he or she “hits the ground running too.”

“Nurses are often the first to hold you when you come into the world and the last to hold you when you leave the world,” Impastato said.

Editor’s note: This is the first in an occasional series about the people who live and work in the community.