Written by Elizabeth Cairns, Mobilize Recovery Special Projects, and reviewed by Code Recover Peer Advisors, August 2026

Peer recovery support specialist Spencer Costello talks about working with clinicians in a busy ER setting and how peers can prepare themselves.

Understanding the ED Ecosystem

The Emergency Department (ED) operates on a unique frequency. It is a high-speed, intense environment where the primary goals are triage, stabilization, and disposition (deciding where the patient goes next). As a peer, entering this space can feel overwhelming. Unlike community-based recovery centers where conversations may be lengthy and in-depth, the ED culture prizes brevity and clinical efficiency. To be effective, you must learn to work within this rhythm without losing the empathy that makes your role vital.

Working with the Clinical Team

Success in the ED depends on your ability to build alliances with the clinical team.

• Nurses: Nurses are the gatekeepers. If the nurses trust you, your job becomes infinitely easier. They manage the patient’s immediate comfort and safety.
• Providers (MDs, DOs, PAs, NPs, social workers and others): Providers make the clinical decisions regarding MOUD and discharge. They need concise, actionable information from you.
• Techs and Security: Techs and security officers often spend the most time in the hallways and can alert you when a patient seems ready to talk or is becoming agitated.

Quick, Structured Communication is Key

In a medical culture, communication is often structured. You don't need to speak in medical terminology, but you do need to be mindful of the clinicians’ time. When approaching a clinician, keep it focused. Instead of a detailed story, try: "I’ve spent 20 minutes with the patient in Room 4. They are open to starting Buprenorphine and have a ride to the clinic tomorrow. Is there anything you need from me before I start the paperwork?" This gives them what they need while respecting their time.

Similarly, while you are an important bridge between the patient and the clinical team, and an advocate for the patient, keep in mind that your role is different from the clinical team’s role. When it comes to patient stabilization and medical decisions, you should be facilitating understanding between the patient and the clinicians, not interfering with medical decisions.  

Professionalism and Presence

In the acute care setting, your presence is your most valuable asset. This means being visible but not in the way. During a medical emergency, give the clinical team space. By respecting the clinical boundaries of the medical team, you earn the professional respect needed to advocate for the patient’s behavioral and emotional needs.