I now only have two shifts on my elective placement in the Emergency Department (ED) before I go back home to finish off this placement block on a male surgical ward. These four weeks have flown by, just as I knew they would! Unlike my other placements in which I break down the day for you, I can’t do that for this placement as no two days were the same. I will however, give you a rough idea of the three areas I worked in whilst spending time in ED; Minors or Integrated Front Door, Majors and Resus.
Minors/Integrated Front Door
I loved minors! We were often the first people patients see when they enter the department, meaning we saw seriously ill or injured patients who needed to be moved to majors or resus immediately or used our clinical judgement to determine whether patients were safe to remain in the waiting room until being seen by a doctor. I say ‘often’ because a great system this hospital has in place is a ‘Streaming Nurse’ in reception. This nurse sees patients for a brief triage before they even sit down. I think this is a fantastic initiative as the receptionists feel more comfortable and confident with a trained healthcare professional next to them if a patient should deteriorate in the waiting room, the triage nurses feel under less pressure as they know all patients in the waiting room are safe and patients feel reassured that they have been seen in a timely manner.
Once a patient has been called in to triage we would ask about the presenting complaint, the history of the presenting complaint, any past medical history, allergies, and create a plan. The plan would depend on what the presenting complaint was so it could be anything from obs, an assessment of a limb, neuro obs, urine analysis, bloods, xray etc. We would then put each patient into a category to prioritise the order in which patients need to be seen. This scale goes from a patient needing immediate treatment for preservation of life, to patients whose conditions are not a true accident or emergency.
My days in triage were always busy and people would continue to come in non-stop! There were always two nurses working alongside each other and we would each see an average of 40 patients a day. I saw limb injuries, head injuries, breaks, burns, fractures, lacerations, dislocations, foreign objects, self-harm and abscesses to name a few!
Majors is even busier! One patient comes in and hasn’t left before the next one comes in. In majors I had the opportunity to manage my own patients, under supervision, and this was a hugely beneficial experience as it encouraged me to think for myself and make my own clinical decisions. When a patient first comes in we triage, like in minors, and begin our initial obs, checklist and other necessary tasks depending on the patient. I really enjoy majors because I was involved in the treatment as well as assessment.
I saw patients who were septic, experiencing chest pain, having a seizure, with a fractured skull, who had overdosed and injured paediatric patients etc.
Resus was probably my favourite area to work in because I was exposed to seriously ill and injured patients and I was working alongside a varied multidisciplinary team such as nurses, HCAs, doctors, consultants, critical care nurses, stroke nurses, anaesthetists and professionals from ITU. Due to the nature of this area, it was imperative that we worked efficiently, effectively and well as a team for our patients. Treatment for our patients would, again, depend upon what they were coming in with so I can’t give you a set list of what we would do in resus but I can tell you some of the scenarios we had. We had stabbings, dislocations, cardiac arrests, seizures, shortness of breath, palliative patients, exacerbation of asthma, major haemorrhages, sepsis and a DKA.
I was nervous for my first placement of my third and final year but I have finally realised just how much I know and how much I have progressed and it is a wonderful feeling. This exposure to a variety of illnesses and injuries has left me feeling more prepared for when I qualify and I also really enjoyed working with paediatrics for the first time.
I cannot thank the team enough for making me feel so welcome and comfortable whilst I have been away from home. Each member of the ED team are super stars, they truly are so hard-working, work tremendously well together and it is obvious that they all love their job. Everyone is always willing to help each other out and no question is a silly question. I will miss this team and I am so grateful for this opportunity.