September 28, 2008, 3:06 pm

“We Manage Chaos”

(Well, I thought I was homeward bound. Turns out they overbooked my flight from Phoenix to Oakland, and needed volunteers to take a later flight. What’s in it for me? A bigger jet, dinner and a free round-trip ticket to anywhere US Airways flies in the US. Hello?

Heck yeah, I’ll volunteer! I’m exhausted but I’m thinking, “NASCAR, here I come!”. My husband has it tagged for something else. Not a chance, Bub – Coca Cola 600, 2009, I’m so there! So I’m blogging in a combo Wolfgang Puck/Pretzel Mania/TCBY/Pizza Hut cubicle. It’s the only place with a plug!)


Here I am with Mary Tyler Moore on the Nicollet Mall in Minneapolis.

Or at least her statue.

I didn’t have a hat to toss, darn it!

The mall is beautiful, with sidewalk cafes, plants and flowers – and every store you can imagine.

This photo is somewhat misleading.

The statue really doesn’t look like Mary.

And I’m not seven months pregnant.

In fact, I’m much thinner than this.

Trust me.


When I decided to attend the ENA conference, I expected to be inspired and informed

I didn’t expect Major William White.

He wasn’t on the agenda.

He was asked to reprise a statement he had made during the General Assembly for the Opening Keynote.

Major White is the Director of Trauma Education for the Defense Medical Readiness Training Institute. He served in Iraq as the nurse manager of the emergency department in the International Zone.

They cared for everyone: men, women, children, Iraqi, American. Insurgents.


Think your ER is busy? Imagine a two minute (maybe) heads up that you are getting fifteen major trauma patients from a bombing. Horrible injuries. Multiple amputations. As you gear up to care for those, more are being pulled from collapsed buildings and being brought in for care and your ER itself is under fire.

In the middle of all this, a reporter embedded with the unit puts a microphone up to you and asks how you handle all this? How are you able to deal with it?

Major White had an answer.

He said, “We are ER nurses, this is what we do. We manage chaos.”

That was perfect.


We manage chaos.

Most of us have never had to manage it in an ER in the center of a war zone, but that is exactly what we do as emergency department nurses. Every department. Every day. Every shift.

We manage chaos.

We manage it when the rooms are packed, the hallway becomes an ICU, the waiting area is full of people who should be roomed and two people call in sick for the next shift.

We manage it with a patient who is acting out because their ability to cope is gone.

We manage it when a family hears the news that their loved one is gone.

From the department level down to the individual patient, we make order out of chaos.


Major White’s comments during the Keynote Address were brief, vivid, poignant and inspiring.

I started to lose it when he told us that the staff of the ER had made a pact. A staff member would always be with a patient if they were terminally injured; no one in that ER in the middle of Iraq would ever die without someone at the bedside. No one would die alone.

And it didn’t matter who you were.


This post doesn’t even begin to convey how proud I felt to be an ER nurse that day.

I’ll never see one-millionth of what Major White has seen. I’ll never have that level of awesome responsibility.

But I’ll hold my head up a little higher when I realize I am in a profession that allows me to call someone like Major White a professional colleague.

He brought clarity to the role of the emergency nurse in one sentence.


No matter what nursing specialty you work in, stop to think about what you do.

Really stop and think about it.

Not just anyone can do what we do.

We’re nurses.

And we should be proud of our accomplishments.

Every department. Every day. Every shift.


  • Dan Weberg

    September 28, 2008 at 3:51 pm

    I love your post but think that “MANAGE CHAOS” is the wrong word. From the description you gave, the ED nurses are thriving in chaos. No one can manage chaos as that would be telling the chaos what to do. What ED nurses do is use the chaos to their advantage. They self-organize around problems, and innovation in problem solving thrives. This phenomena is called Complexity theory or Complex Adaptive Systems. We as ED nurses are thriving on the energy of chaos swirling around us. Take a step back and watch as the nurses swarm, like bees, from problem to problem solving it and quickly adapting and moving on. 2 sick calls, allows the bond to become stronger among the workers, creating energy that is used to save lives, deal with change, and overcome adversity. ED nurses don’t manage chaos, ED nurses do not survive without it. The power is unleashed in the worst of times.

    Dan Weberg
    I am a PhD student in Nursing and Healthcare Innovation at Arizona State University. I am also a Certified Emergency Nurse and Trauma Nurse.

  • runningwildly

    September 28, 2008 at 4:07 pm

    What an awesome post. I have goosebumps!
    I worked in emerg this past summer, fell in love only to go back in just a matter of months. I will be a critically care educated RN next year and I simply can’t wait. Your post put into words exactly what we feel as we run around on the ER floor. Brilliantly put.

  • NPs Save Lives

    September 28, 2008 at 6:36 pm

    You are so right. I also have to agree with what Dan Weberg said about not managing chaos because we just hang on for the ride and try to make the best of a bad situation. ER nurses are Pros at that.

  • Dr. Cason

    September 29, 2008 at 2:49 am

    You all are heroes!

    I felt nauseous after my ER shifts. I readily admit that I couldn’t handle the stress of not knowing what might come in.

    I’d hear the charts start coming in and I would groan. God bless you all for loving that job! Someone has to do it. 🙂

  • Strong One

    September 29, 2008 at 3:27 am

    HOORAH Kim.
    Thanks for that healthy dose of reality.
    I like to call it ‘controlled’ chaos. *wink*wink*

  • Healthcare Today

    September 29, 2008 at 4:31 am

    “We Manage Chaos” // Emergiblog…

    Kim’s big adventure continues at the ENA conference. Mary Tyler Moore would be proud! Read her post!…

  • Candy

    September 29, 2008 at 8:11 am

    Well put (now I have to find different words!). I’m NOT an ER nurse, but I felt proud to be surrounded by them (and next to you) at the conference listening to Major White. You guys rock!

  • Anthony Phipps

    September 29, 2008 at 4:21 pm


    It was a joy having you at the conference and reading your posts. Keep up the great work, you are a wonderfully vibrant voice for ED nurses, a voice that needs to be heard as often as possible.


  • Up To No Good

    October 4, 2008 at 5:04 am

    This totally gave me chills.

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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