“You need to be taking care of patients who are awake.”
Those words from a hospital recruiter in 2012 steered Alison Harmon MSN, RN, CEN, into her emergency nursing career. Harmon had just completed a BSN/RN program and landed an interview for an OR job.
“I loved the OR and the ICU, I loved the drips and the calculations,” Harmon said. But when the recruiter asked Harmon to consider an ED job instead and she shadowed both open positions, Harmon’s decision was easy. About two years later, she moved to University of Iowa Health Care, where she is now director of nursing, department of emergency medicine and transport services and director of nursing crisis stabilization unit.
Harmon, who has been an ENPC and TNCC instructor for about 10 years, joined ENA during her first job.
“(The education) is what hooked me,” she said, and now that she is a nurse leader, “it is so nice to hop on (an ENA CONNECT) message board and see what other people are doing.”
Harmon briefly left work in 2020 after the birth of her twins, her third and fourth children. Colleagues enticed her to apply for a new position while changes were underway at UIHC, both in leadership staff and in the triage space expansion.
“In my mind, I was coming back for a short period of time, just to help get over the hump. It was 2020, COVID and all of that,” she said. “But when you are working with your second family, it’s hard to just walk away.”
One early change was adopting a “vertical-horizontal” model of assigning beds only to patients who need to lie down and moving others to internal waiting rooms. That and other steps led to a dramatic left-without-being-seen rate drop to below two percent.
Nurse recruitment and retention have also improved, she said, helped by a culture that considers everyone—nurses, doctors, technicians, social workers— to be one ED team. Not only does she strive for transparency and staff input, but she also encourages the department to gather for fun, such as bike rides and tailgating at Iowa football games.
Harmon tells new nurses it’s OK to feel overwhelmed, and to ask for help.
“I felt like I was thrown to the wolves, and I don’t want that for anyone,” she said of her own first shift in an ED. “By no one’s fault of their own, they didn’t have time to stop and tell me everything.”
She wants all her nurses to be confident self-advocates, to be sure they know where to find their resources. She also pairs new nurses with experienced ones to build a “safety net” for them.
Building trust, sharing resources and helping people advocate for themselves are all skills Harmon uses outside the ED, too.
Five years ago, she and two friends – a doctor and a social worker – founded the Johnson County Human Trafficking Coalition to teach people how to identify potential trafficking victims and talk with them in a way that is helpful.
She recalled one patient who had been in the ED multiple times and a provider suspected there was a trafficking situation. The provider talked with the patient, and their suspicion was confirmed, but the patient wasn’t ready to leave the situation. It was hard to watch, Harmon said, but that person has since returned to the ED, and Harmon sees that as a positive.
“It’s a good example of why you have to have a conversation in the right way, so you can build trust,” Harmon said. “The patient has come back, and that’s because they know they’re safe.”