Hacks, Quirks and Observations of an ED Nurse

Author: Cristiana Theodoli
Date: 19/12/2018

The level of clinical skill required as a nurse working in Emergency Medicine is extremely high, yet after eight months as a staff nurse in our Emergency Department (ED) I can safely say that clinical skills are not the only things you pick up.

Here is a list of observations, hacks and quirks unique to ED.

Always carry money

With 100+ employees in our department there is always a collection sheet or five on the go, collecting cash for someone’s upcoming retirement, maternity leave, wedding or change in job. Keeping an extra £5 or two in your bag is a must - and comes in useful on those long stressful nights where the only thing that can help is a bucketload of chocolate. Which brings me onto my second point.

Diets are a practical and logistical nightmare

The nurse or clinical support worker, doctor or porter who manages to stick to a diet while working in a busy Emergency Department gets all my respect and admiration (sprinkled with a healthy dose of envy). Between the leaving dos for people retiring or going on maternity, the birthdays and wedding or engagement celebrations our department likes to put on a spread. Coming on shift with your healthy meal only to find a tableful of chocolate, pastry, crisps, cakes and all manners of other unhealthy carbs is both a relief and a curse.

Connect a bung to the syringe when preparing to flush a cannula

We have all been there, insert a cannula then faff around trying to connect a bung or the cannula’s cap to keep the cannula closed. One trick I was shown early on is to attach a bung to a syringe when preparing to flush a cannula, this way it is already connected to the syringe and can just be screwed onto the cannula as you flush it.

Alcohol swabs and their secret use

Often short on time and working under steady pressure, ED staff are well versed in thinking of creative solutions to simple problems. One such unusual solution is the use of alcohol wipes as an antiemetic. With long standing anecdotal evidence and the stuff of twitter lore, it is said smelling an alcohol wipe or swab can be an effective alternative to traditional antiemetics in reducing nausea. Two recent randomised controlled trials backed the anecdotal knowledge. Both trials found that inhaling isopropyl alcohol, the main component in alcohol swabs, is effective in reducing acute nausea when compared with a placebo¹ as well as when compared with oral ondansetron². Neither trial reported any side effects or adverse events though we would always suggest discussing it with a doctor before getting a patient to smell an alcohol swab!

Learn to close cubicle curtains fast

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This is one of the oddest of phenomena I have witnessed in nursing. You show a patient into a cubicle, ask them to get changed into a gown and before you know it they are stripping off while the cubicle curtains are still open and in front of the whole floor. This phenomenon is not just seen in intoxicated patients but affects people of all genders, ages and backgrounds. Are they in a rush? Is it due to a power dynamic issue where nurses are seen to be ‘in authority’? I am not sure, but I now make a point to say: “I’ll leave a gown here, if you could change once I’ve closed the curtain, the opening goes to the back! One of us will be back in a minute to take a trace of your heart/take some bloods/ check up on you”.

Keep a close eye on intoxicated smokers

I say this having previously been a smoker myself for 13 years, but intoxicated smokers are some of the most challenging patients to work with. Though I stopped 6 years ago I still remember the cravings and know how difficult it is to go without a nicotine hit, yet it is completely unacceptable to smoke inside an Emergency Department around other patients and near oxygen ports. So is shouting and causing havoc on the whole floor after being told they are not allowed to go out for a smoke. Yet the impulse control of many intoxicated smokers is close to zero so keep a close eye (and nose) on them in case they do try and smoke within the department.

Cut a male cardboard urine bottle to fit a woman

One of the most useful and ingenious hacks I’ve seen in an Emergency Department is the staff ability to repurpose male urine bottles to fit women. This is particularly useful for patients with neck of femur or unstable fractures as it allows them to pass urine in a container whilst lowering the risk of making a fracture or suspected fracture worse. Looking back to my time as a student nurse I am surprised this hack wasn’t used in my Orthopaedic trauma placement where pre-op female patients with fractured neck of femurs would be rolled onto a bedpan. Though staff always made sure to be as gentle as possible it was often a pretty painful experience for patients and this is a simple interim solution for pre-op patients.

You see some horrible things and lie about them

There is no way to get around it. In a busy, urban Emergency Department like ours you see some traumatic sights. You see patients with injuries so severe that you will carry them in your memory forever, from the result of drunken fighting or crime, to serious accidents or self-inflicted harm. You see young patients with terminal diseases and old lonely patients with no family or friends. Some patients will break your heart, and you will lie about them. One of the first things people often say when you reveal you work in ED is “Ooh you must see some sights… What’s the worst thing you’ve ever seen?” and you lie. Aggression towards staff in the department, alcohol abuse or parents who don’t give children pain relief for basic ailments are all common answers, but the truly harrowing things we see we keep to ourselves. We protect our friends and loved ones from some horrible sights yet rarely stop and think how these might be affecting us.

People find humour in the most challenging circumstances

However, though this might be unique to Glasgow, a city with plenty of humour to spare, in an ED you will meet people who find the funny in the most harrowing of situations. Walk through our department any day or night and you might hear a middle-aged man making jokes while his shoulder is getting pulled in resus, a wee 85-year-old lady howling at being asked to recite the months backwards as we assess for signs of cognitive impairment, or the staff in the tearoom laughing at the silliest things during an otherwise busy and stressful shift. While the black or gallows humour in the tearoom may not always be the most appropriate, as discussed in my last blog, it has been shown to help emergency workers bond and gain support at work by developing group cohesion³ and can have a buffering effect on the processing of traumatic events⁴. Which brings me to my last point.

Christmas decorations in the ED

There are a million ways to decorate an emergency department during Christmas. You can put up garlands in the shape of all sorts of cardiac rhythms or build a Christmas tree out of inflated gloves. Use cardboard urine bottles for a unique wreath or make a reindeer out of a vaginal speculum, feeding that unique ED humour and providing a little extra Christmas joy to the tearoom. While we would never condone intentionally wasting medical supplies - and warn to always be careful any decoration are not a fire or infection control hazard - over time it is easy to accumulate bits and pieces that you can’t use with patients, either after falling on the floor or been accidentally opened and therefore no longer sterile. With Christmas approaching it is time to start hoarding all those bits and pieces so they won’t go to waste!

Hannah BellComment