Author: Claire Fraser / Editor: Nikki Abela / Codes: CC15 / Published: 06/02/2018
Editors note: Claire is one of the best ED sisters I’ve worked with – she doesn’t mince her words but she has a heart of gold. Her rough manner will throw you in at the deep end – but she will also jump in beside you to keep you swimming. Working in the ED is not easy, but it is incredibly rewarding and you will learn so much, especially because you will be surrounded by exceptional people like Claire.
So I was asked to write this as if I was talking to you pre-ED rotation and I was also asked would it need to be censored prepublication . [Editor: You will find our sisters are very loving but fiesty folks, so there is definitely some censored content here].
One of the biggest issues coming in to any new ED is the general day-to-day workings of the unit and although there are some minute variances you will find that we all sing from the same hymn sheet.
- The nurse in navy blue tends to be the person that knows what’s going on, we can be your solution to most things. Just remember we didn’t get the job for being nice people, we got the job because on the whole we are vastly experienced clinical nurses with a lot of ED experience, so if you don’t know, ask us and if we dont know we will know somebody that will know. [Editor: This is also a skill you will pick up during your days in the ED]
- The nurse coordinator tends to be based in a specific area, don’t sit in that space, don’t use that computer and don’t answer or use that phone. This is not because we are historically grumpy and control freaks, it’s because trying to run an ED is like trying to herd cats. We have multiple different tasks all happening at the same time and using the chair is the easiest way to get yourself red carded or forcibly removed by security.
- Introduce yourself to the nursing team, they won’t forget you.
- If the phone is ringing at your station and you are sitting there – answer it, take a message, apologise, put it on hold-
not answering it is a red rag to a bull for all humanity, even if it’s the coordinator’s phone. Unless they’re standing next to the phone and able to answer it – in which case…don’t answer it.
- Don’t be too hard on yourself, it’s a difficult environment and everybody will want something from you. It’s perfectly reasonable to go into the sluice and drop the *f* bomb. It’s not acceptable to sit at the station dropping the *f* bomb – walls have ears when people are stressed and angry, and it will fall back at your door.
- Be nice to your junior nurses, they are the people that will help you the most. ED nurses are feisty ballsy creatures and they will have your back if they can. If you are in the room talking to a patient for 40 minutes and then come out and ask the nurse to do your bloods or cannulas it’s likely you will get that reputation and also the compliance and teamwork will drop. You may learn to multitask quite quickly in the first days you are with us. One of my most beloved professional relationships is with a current ED consultant who as a junior was often seen bringing cups of tea to her patients and also fetching commodes and pillows when she knew that we were busy. She is an amazing, grounded, well respected and well liked clinician who to this day still does the above and the nurses would jump through hoops for her. Try to be like her, for your sake and ours.
- Take your breaks and make sure you are well fed and watered because it will affect you. Have snacks in your pocket. If the senior nurse asks you if you have had a break it’s likely she thinks you need one because some aspect of your behaviour / appearance / performance indicates this.
- We generally can’t organise and pay for a taxi for patients.[Editor – and organising ambulances home is a privilege available for few. Don’t offer it!]
- Not all drugs have to be given IV or IM some can be prescribed orally.
- The pain ladder is really useful, however if you are asked to prescribe analgesia be mindful paracetamol doesn’t always hit the spot for fractures.
- If you think you patient is a regular attender, speak to a senior nurse or senior doctor. We will know if they are and they will have a plan. This will make everything smoother for you and the patient.
- Most departments have a code for fresh brew and/or food available when they declare it over the tannoy system – it’s the infamous Mr and Mrs Brown where I work. Remember somebody has to buy this and popularity stakes go through the roof, even for a token packet of Jaffa cakes or crisps, home baking will get you a statue, pizza a shrine… get my point?
- I will be your nonjudgemental friend, I get you, I understand you and I want to help you succeed. Let me know if you are struggling, I’ve seen it before and Ill see it again. I will be your biggest ally but I will also be your worst nightmare. You getting it right makes my job easier and we all want to be on that shift.
- The four hour rule is not mine, it’s ours and I’m not personally trying to force on you to make rash decisions. I have to manage flow, I have to manage the department. And for the patients that are waiting on the ambulance corridors – they would also like you to make decisions. [Editor: And remember, the target is four hours from arrival to discharge, not arrival to referral!]
- Without being corny , it’s ok not to be ok. One mans rubbish is another mans treasure, so what may affect you may not affect somebody else. Don’t take it home with you. As senior nurses we are static body in the ED. We are a good shoulder to lean on. Emotions run high after specific incidents and a constant exposure to these along with the mental application required from emergency trainees can be catastrophic. Compassion is inherent to all of us – you just have to tap into it.
Good luck xxx