11 Tips For New ED Nurses
Author: Cristiana Theodoli
1. Being impatient can be an asset
With a UK-wide 4hrs target to get patients seen and either discharged or admitted, impatience can be a huge asset in a busy emergency department. Whether it comes in the form of chasing up plans from the doctors while they are tied up assessing someone else or wheeling the patient to CT yourself because all porters are busy, lack of patience can make the difference in ensuring a quick resolution.
2. You have got to hustle
Following up from the benefits of having no patience, as a nurse working in emergency departments you must work hard. At any given time, you have a never-ending list of tasks that need to be done. Two patients to get ready for admission, ensuring all paperwork and observations are up to date, another two about to come in to take their place who will both need an ECG and bloods. Three of your other patients need fluids or medications and everyone needs the toilet at the same time because for some reason in an Emergency Department everyone’s bladders sync up. Meanwhile the other nurse on your side is on break, the clinical support worker is in triage trying to get ahead with bloods and ECGs and the healthcare assistants are helping with other patients. To cope you have to pick up the pace. A 12hrs shift in ED is both a marathon and a sprint.
3. Do not hurry patients
However, do not hurry patients, picking up the pace is your responsibility, not theirs. When you call them in do not expect them to match your walking pace and if takes them 15 minutes to stand up and transfer to a commode, provide your support but do not hurry them. If your patients feel hurried they might not disclose their full concerns, especially those elderly patients whose attendance is already reluctant and yet are often the most in need of comprehensive assessments. Learn to write your notes faster, clean the cubicles at lightspeed, master the art of untangling ECG cables, but give your patients the time they need.
4. Communication is key
When I was a student nurse I never saw as much teamwork until a placement in an Emergency Department. In EDs you can see multidisciplinary collaboration at its best. Everyone from doctors to porters, from nurses to the patients themselves work together to solve a puzzle, ensure the patient is stable and safe before arranging for them to either go home or get admitted. As there are so many people involved in one patient’s episode of care communication is key. If a patient’s bed is ready but you are still waiting for his CT results before he can leave, ensure the floor coordinator knows so they don’t request porters and waste porters’ time. If the doctors need fluids or medication up, ensure they have prescribed them and ensure it’s for the right patient as they often see multiple patients at the same time. Double checking and communicating clearly is a great way to reduce the risk of any possible mistakes.
5. Rely on your colleagues
In one of my first placements as a student nurse my mentor told me “Your colleagues are your best resource, rely on them”. This is especially true in emergency departments as every day brings something new and different. While you might see a hundred patients with alcohol withdrawals by the end of your first week in an urban ED, you might only see a traumatic amputation twice a year. Be accountable for your knowledge, work at your level, and if there is anything you don’t know or haven’t seen before, ask. As an extension of that, if you are drowning ask for help. If one of your patients requires multiple interventions and you still have another six to look after, ask for help. The great thing about emergency departments is that there are always plenty of senior nurses and senior doctors on shift and they are more than happy to pitch in and help out when the department gets extra busy, or with clinically demanding patients.
6. Don’t forget the Activities of Daily Living
We are probably all guilty in emergency departments of focusing in on the immediate clinical tasks such as ECGs, X-Rays, Bloods, CTs and of forgetting to care for our patients’ basic needs. Unfortunately, there is a limited number of staff so an ECG on a patient with chest pain will always have to take priority over an other’s trip to the toilet. Learning to prioritise is a key skill. I was taught a useful mnemonic to remember the 12 ADLs His Majesty Charles Stewart WETS BEDS: Hygiene; Mobilising; Communicating; Safety; Working and playing; Elimination; Temperature; Sleeping; Breathing; Eating and drinking; Dying; Sexuality. Not all will apply in an Emergency Department. Patients’ expressing sexuality for instance, which includes things such as wearing lipstick and building romantic relationships, is something that though important in long term wards, we could all do less of on a Saturday nightshift (See point 7). However, it doesn’t take long to check if your patients are feeling hot or cold (ask as you take their temperature) and offer a blanket – provided you can find one. While not always a priority, it is useful to keep the 12 ADLs in mind and try to address the relevant ones as you go along.
7. Work on your poker face
As much as we have all gone into nursing driven by a desire to make a difference for other people, there will be times when patients will frustrate you. From the 10th intoxicated man on a Saturday night asking for ‘a cuddle’, to the parents who bring their kids along because of an earache before trying any pain relief. From the patient who has had the same symptoms for three months to the one lighting a cigarette in his cubicle, the inappropriateness of certain patients can make the most understanding of nurse roll their eyes or swear under their breath. However, we can’t show that to patients. Truth is a lot of inappropriate presentations are due to lack of education or lack of understanding of the services in place. Often these are an opportunity to provide some health education, explain the role of GPs, pharmacies and Out of Hours services and hope that patient will present more appropriately in future. Of course though, the man lighting cigarettes near an oxygen port will get a stern talking to.
8. Get involved
Starting a new job is never easy. It takes a while to get a feel for the place, the atmosphere, the people and management. Joining a well-established department can be especially daunting, and the best way to feel like a part of the team is to get involved. Get to know your co-workers and join in to any workplace/social activities that interest you. Put yourself forward for training and join any link groups in your department you might have an interest in (such as the stroke, infection control or Gender Based Violence groups). In short, get stuck in, it will make you feel like part of the team in no time.
9. Take care of yourself
It is easy for nurses working 12hrs shifts to forget to look after themselves. We run around with a hundred things to do and often forget basic things like making sure we are hydrated and well rested. As I mentioned above a 12hrs shift in an emergency department is both a marathon and a sprint so make sure you do everything you can to be ready for it. Drink plenty of water and make sure to eat fairly healthy while at work, you don’t want to come back from lunch break feeling sluggish after a heavy meal. Get plenty of rest, long busy shifts are a nightmare when you’ve only managed a couple hours sleep.
10. Have a good support network
You will have days where you get home struggling to keep your eyes open, days all you see is tragedy after tragedy, and days when you’ll have run around so much your whole body is left aching. Make sure you have a good support network at home, whether it’s a flatmate who will make you a cup of tea when you are struggling to move or a partner who’ll have dinner (or breakfast!) ready for you. It might be parents who will leave you in peace when you need some quiet time, a friend you can call to vent to after a frustrating day or a pet who will snuggle in after an emotionally draining shift. Some weeks it will feel like you spend more time in the department than anywhere else so having good support outwith your work makes a huge difference.
11. Enjoy it!
This last one is a cliché, I am well aware of it. But do enjoy it. Our ED used to be affectionately known as The Gate as it physically sat at the gates of the hospital. Though it has long since moved into a new building, emergency departments are still a gate into the wards as most patients pass through our doors before being admitted. You’ll have shifts where you feel like you are in a zoo, shifts that will leave your body aching and shifts that will make you ask yourself why you chose nursing in the first place. As hard going as a job in emergency nursing is, it is also challenging in all the best ways and extremely satisfying. Here you will see things most nurses never see, work among highly knowledgeable and capable colleagues and learn skills you wouldn’t learn anywhere else, take advantage of it!