APP Spotlight: Emily Elfreich, ARNP

By William Alexander

For Emily Elfreich, ARNP, taking care of some of Duke University Hospital’s most critical patients is all in a day’s (or a night’s) work. The nurse practitioner diagnoses, assesses, and treats patients in our Neuro Intensive Care Unit (Neuro ICU) in 12 and 24 hour shifts. In this week’s “Spotlight” interview, Elfreich talks to us about thriving in a busy, high-stress environment, her career path in nursing, and enjoying traveling, her rescue dogs, and reality television as stress relievers outside of work.

What are your responsibilities within the Neuro ICU? What does a typical day look like for you?
I am a critical care nurse practitioner in the Neuro ICU. I assess and diagnose patients in the ICU setting and manage the treatment of multiple critically ill patients. This includes ordering and interpreting lab and diagnostic tests, performing comprehensive history and physical exams, applying plans of care based on assessment findings as well as integrating pharmacological therapies. It can be high stress at times, but I thrive in that environment. A typical day is never typical! We attempt to start rounds after the previous shift signs out the patients; but as anyone who has worked in critical care knows, things can change in an instant. I think being able to handle any wrench in the daily plan is the secret to surviving ICU work.

How did you first become interested in nursing, and what do you enjoy most about neurocritical care?
I was born and raised in Raleigh and became a nurse in 2007. The path to becoming a nurse was laid out for me once I attended East Carolina University orientation. I signed up for the nursing program weeks before I started my first year. I was first introduced to the profession of nursing as a child. I was admitted to Duke for several weeks as a child. I met the most wonderful person who was my nurse who made me feel safe and cared for at that time. After experiencing that special bond between patient and nurse, I realized that is just what I want to do for other people. 

I focused my education on getting into a nursing program in the hopes of being just like the nurse from my childhood. Neurocritical care was an obvious choice for me as I worked in a level one trauma hospital all my career as a nurse, specifically in the Trauma/SICU/Neuro ICU. It was a natural progression to take the position of Nurse Practitioner in the Neuro ICU as my first job as I had worked in that Trauma/SICU/Neuro ICU for almost 10 years as a nurse and throughout my master’s program.

Where were you working before you came to Duke, and how does that work compare to your current position?
I first began my career as a RN at Wake Med in their Trauma ICU and after a little over a year moved to Florida to work in the Trauma/SICU/Neuro ICU at University of Florida. I spent 8 years building my nursing knowledge and experience when I knew I wanted to be a critical care nurse practitioner. I then worked full time while obtaining my Master of Science in Nursing. Shortly after graduation, a position became available for an NP in the Neuro ICU where I was currently working as an RN. And so, I began my career as a Neuro ICU NP in 2015. After 6 years with University of Florida hospital as an NP (14 years total including as an RN), I realized it was time to come back home to my family in NC. I applied to work with the Duke Neuro ICU and have been with them since!

Your schedule regularly includes night shifts at the Neuro ICU. How do those shifts compare to day shifts? What’s the biggest difference between night and day in the Neuro ICU?
My schedule is a mix of twelve-hour day and night shifts and twenty-four-hour shifts. There is not a work week that is the same as the next! Day shift is by far busier as rounds take up most of the morning. There is lots of learning and teaching on rounds which is always beneficial. Night shift however, has its own learning curve as one’s autonomy is much more applied. Many choices made during night shifts require one’s own knowledge and confidence in decision making. 

I have found all my co-workers have been extremely helpful at night as we still operate as a team. Anyone in medicine knows illness does not stop for nights and weekends; thus, my schedule regardless of time of day will encompass critically ill patients and I am at the ready! My last job as an NP in Neuro ICU was remarkably similar. It was a smaller unit, but the responsibilities and autonomy are quite comparable. 

What’s the one thing you’re looking forward to in 2022?
I am extremely excited about traveling out of the country in 2022. I think we all have had vacations or family functions ruined by the pandemic. I know we are still dealing with that now. I have two trips planned around a family wedding and I cannot wait. I have not traveled since the beginning of 2020 and am counting the days until the excursions! I love traveling and seeing unfamiliar places and this year will be even more special as traveling has been on hold for such a long time. 

What other passions or hobbies do you have outside of Duke?
I have two passions outside of medicine. I love dogs- specifically mine! My dogs bring me such joy, especially after a long shift. I love rescue dogs and have given to the Humane Society of Jacksonville (Florida) for many years as well as adopted my two dogs from there. Now that I have moved back to NC, I plan to find a dog rescue to give to and from which will adopt many more dogs! 

My other outlet for mental health during this pandemic and the stress placed on health care workers (in addition to working in critical care to begin with) is watching horrible reality television. Specifically, the Real Housewives on Bravo. I watch all of them. It is my time where I do not have to work, care, comfort or honestly, think. It is a complete dissociation from my life and stress as I dive into the character’s lives. It might sound ridiculous, but it is the best stress reliever I can recommend. I truly credit this unbelievable series to surviving the pandemic. I was an avid reader prior to the pandemic, but now I have replaced that with mindless reality television shows. 

Emily Elfriech's dogs
Elfreich's two adopted dogs provide support and stress relief when she's not at Duke.