Behind the Stethoscope: The Heart of ERx

Julie Hilton, MSN, ACNP/FNP-BC
Joined ERx: November, 2023
Joined NCCH staff: 1998
Current Position: Assistant Director NCCH, Willcox, AZ

What inspired you to pursue a career in medicine?
Initially, my intention was to pursue a career as a veterinarian. Growing up in rural Colorado, my life revolved around horses and livestock, and I aspired to specialize in equine veterinary medicine. However, circumstances led to a move to Arizona, where the absence of a veterinary school disrupted my plans. Consequently, I explored seven different academic majors before settling on nursing. Although my father believed I was capable of becoming a neurosurgeon, I took time to determine my desired path. Initially, my interests leaned towards liberal arts, but a pivotal moment occurred while I was in an emergency room in Flagstaff with my father, who was experiencing a deep vein thrombosis (DVT). Observing the nurses, I expressed to my mother that I believed I could perform that role and find it fulfilling. This realization marked the definitive decision. My mother questioned my choice due to the extensive mathematics and science involved, subjects in which I had not previously shown great interest. However, this challenge only fueled my competitive nature, solidifying my resolve.

Why did you choose to work in a rural ER?
I didn’t actually choose to work in the ER. When I first started here (NCCH), all my experience was in the NICU. I had never worked with adults. I only knew about three medications and it was very scary – I ended up being self-taught at first. I remember telling Nick I would never take care of adults, and now here I am in the ER and I love it because there’s so much variety.

Then I got a job as a flight nurse and I told them I had only worked in a rural ER, and not a big level one trauma center, and I didn’t understand why they wanted me. They said they look for rural ER nurses to fly because in a helicopter you have to be able to think on your feet and MacGyver, and rural nurses can do that better than anyone. I thought that was so cool, and it’s so true. We have to MacGyver all the time and that’s one of my favorite things about working in a rural setting.

If we don’t have all the diagnostics, we have to be resourceful. I learned in flight that if you’re worried about a patient’s circulation, you can feel their knees. If their knees are cold, they’re not circulating. It’s called a poor man’s Swan, and that’s what we use in rural settings. We have so many things like that; we have to use our instincts and good old-fashioned medicine, and that’s why I just love it.

I decided to become a nurse practitioner because in Arizona they work autonomously. I chose to become an acute care nurse practitioner and an FNP because at the time the hospital used NPs and PAs in their ER, and I wanted to work in the ER. By then, I had fallen in love with rural nursing and didn’t want to do anything else.

What are some of the unique challenges and rewards of working in a rural ER setting?

I always say I love taking care of my peeps and I also don’t like taking care of my peeps because it can break your heart. There’s something about them seeing a familiar face they know, and knowing that they will take care of you. The community values your care and work in the ER. You can’t get that in a bigger place. I really think that’s one of the biggest rewards of working in a rural place.