Traffic Control, Problem Solving and More for ER’s Calm ‘Czarina’
If ever a job required unflappable composure in the face of chaos, it’s a charge nurse in the Emergency Department. And if ever anyone had the temperament to do the job, it’s Krista McDonald.
McDonald is a charge nurse at Einstein Medical Center Philadelphia, a job that brings to mind a few analogies: an air traffic controller, an orchestra conductor and the captain of a storm-tossed ship. A supervising physician calls her the “czarina” of the department.
Walk-ins arrive through one entrance, ambulances through another. Some patients are near death and others are less critical. There are more than 55 beds and several sections, called pods, and McDonald decides where they go.
She moves staff around when necessary, too, to assure patient needs are met and staff isn’t overburdened, to expedite patient admissions and transportation to diagnostic studies.
She continuously tracks patients’ progress: what bed they’re in; whether they’ve been seen by medical staff; whether they’re awaiting lab tests or admission to a floor upstairs. If there’s a hitch along the way, she works to solve it.
“I’m a point person for everybody to come to,” McDonald says. “The way I see it, my job is to get patients to a location to be seen as quickly and safely as possible.”
There are families who are terrified. There are cops, medics, doctors, nurses, technicians, residents, students, janitors – must be forgetting someone – who may have questions or need help. She’s a sounding board, a resource, a “problem solver.”
McDonald oversees all of it with a deliberate calm. If she gets upset, she doesn’t let it show. Her face, voice and manner are deliberately modulated to provide reassurance and instill confidence.
“I don’t anger quickly,” she says. “I try to stay calm to make rational decisions despite whatever challenges the department is facing. It’s an ever-changing environment and we always have to be ready for what’s next.”
McDonald certainly has found her calling – which makes sense, considering that both of her parents are nurses, too. But nursing is, oddly, a second career.
McDonald majored in business in college, in part because the prospect of finding a nursing job was slim at the time. There was a glut when she graduated from the College of New Jersey (formerly Trenton State), so she spent eight years in marketing jobs in the private sector. She worked seven days a week, bartending and waitressing to supplement the income from her day job.
Work was demanding but not fulfilling. “One day I had an epiphany,” she says. The market for nurses had changed and she decided to go back to get her nursing degree. “It was time for a life change. At 28, I went for it.” She graduated from Drexel University in 2006 and came to Einstein’s emergency department, where she’s been ever since.
McDonald is an admitted workaholic who works overtime almost every week – sometimes racking up 55-hour weeks. “I’ve always been driven. I must like it,” she says with a laugh. “I like the people. There’s a level of excitement and I must like the chaos.
“It’s hard on mind and body; if we didn’t like the job we wouldn’t be here.”
In the ED, there’s no agenda for the day that can be planned for. When the doors open, the woes of the world spill in, from car accidents to sick children. If you don’t have the right temperament, it can be very crazy-making.
Fortunately for all, Krista McDonald isn’t susceptible to crazy.
“I have a motto: I try to do the best job I can with the time I’ve been given,” she says.