When you hear the words “Emergency Department”, “Accident & Emergency” or even “Anything & Everything”. What springs to mind? Manic, busy, rushed and overwhelming. Yes, it can be a little overwhelming at timesbut so can other departments too. Before I qualified many people tried to steer me away from the Emergency Department (ED) as a newly qualified, but I was adamant that ED was the place for me. I was told that ward experience before venturing into ED would be much better, and that ED was for “seasoned nurses”. Four months down the line and surprise, surprise I’m loving every minute of it. I’ll be sharing with you a few of my tips that I use to stay as organised as possible in my local ED.
When I walk in for handover, I search for the nurse that I am taking over from. This usually consists of me walking around aimlessly going “cubicle 9-12?”, “are you cubicle 9-12?” or “who is the nurse for 9-12”? Yes, super annoying but until I can find a more efficient way… this is it.
I make myself a checklist to ensure nothing is missed and to keep me on track. I gain the information both during handover and looking over the notes after the previous nurse has left, because we all know that not every handover received is a good one. When taking handover, I like to know the following:
A) Presenting complaint
B) Have they had bloods and have IV access?
C) Have they had an ECG?
D) Has any medication been given, and is there anything left to be administered?
E) What’s the plan? Have they been referred to a speciality?
F) Any other concerns? High NEWS? Pressure areas? Low GCS?
“Hello my name is Chloe and I’ll be the nurse looking after you whilst you are in the department” is what I say to all my patients and relatives at the very start of my shift. Not only is it fantastic to say after a gruelling three years, but it allows my patients to feel grounded and know exactly who to ask questions regarding their care. Don’t forget, if it looks busy for us, it can do for them also. I have found that by telling them my name, patients and relatives are less likely to get angry and impatient if they know your name. Just please… take my word for it. In the cubicles in majors we also have a board that we can write our name on so that patients and relatives can look back at it if they forget. Not all nurses utilise this, but I for one love to and have made a habit of including it into my routine.
In my local ED our observations are supposed to be checked hourly, which is our gold standard. It sounds a little obsessive, but I prefer to recheck all the observations when I start my shift to ensure they are all due at the same time. This then leaves me a whole hour of not having to worry about them if all are stable. Another reason for rechecking the observations on arrival and gaining my own set is that I have observations that are at my standard. This includes a properly 1 minute checked respiratory rate and a temperature that isn’t guessed. Again, obsessive I know but I like to know exactly what’s going on with my patients.
Check to see what the patient has had already been administered and if there is anything else prescribed that needs to be administered and what time it is due.
If everything is up to date, I’ll just go through the notes and make sure everything is signed and up to date including the ED checklist in our nursing documentation. I’ll usually write a little something in the main documentation area such as: “Care taken over from day/night staff. Brief handover received. Patient alert, orientated and stable. No immediate concerns. Introduced myself to patient. Will continue to monitor”.
I always have this thought in my head that if anything was to go wrong and a case had to go to the coroners court. It would be clearly shown in the notes what time I took over care. I do this for every patient I admit in ED.
I hope these tips help you, for if you have a placement in ED approaching or are interested in a job but not sure if you’d be able to ‘keep up with ED life’. You Do You. I promise you’ll find a routine that suits you and that doesn’t just mean ED.
Written by Chloe – @EmergencyRGN