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  • 09 August 2022
  • 8 min read

The Progression of an Emergency Department Nurse

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    • Mat Martin
    • Cecilia Wanjiru
    • Richard Gill
  • 1
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Emergency Department Staff Nurse, Lauren.

Emergency Department Staff Nurse, Lauren, describes her career path into Nursing, factors she considered before embarking on her journey and how quickly you can progress if you are open to the opportunities.

The Progression Of An Emergency Department Nurse

There was always something about Emergency Nursing that drew me in.

Whether it was the promise of an adrenaline-filled night shift while the rest of the hospital slept soundly, the constant influx of critically unwell patients or the emphasis on cohesive teamwork, it was always the area of nursing in which I wanted to specialise.

There were others that tempted me during my training. I had some amazing mentors in long term stroke rehabilitation wards who showed me the true value that lay in what some call ‘basic’ nursing skills.

The dignity involved in a bed bath, the glow on a patient’s face when you brushed their hair or put on their makeup, and the level of integrated care from the entire multidisciplinary team needed to achieve discharge to a patient’s own home were all skills I admired and only began to scratch the surface of during my management placement.

If I had to say anything about the course my career has taken so far, it is that it was entirely dependent on choices: choices about which way to study, which post to take after qualifying, what opportunities to grasp when I finally put on that blue tunic and started to be referred to as “Staff Nurse” instead of “the student.”

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Choosing To Study Nursing

The choice to study nursing was one I made relatively late compared to some of my peers. For most of my childhood, my only true insight into the working world was watching my primary school teachers go about their day.

School provided a comforting routine and a welcome challenge as I progressed into grammar school education. It was a place I enjoyed going to, where I developed friendships that have spanned decades since, and it aligned well with the subjects I excelled in.

Suffice to say, teaching was not the path I found myself taking. All that was required was a week spent in a classroom with twenty children all vying for my attention, plus a conversation with one of my former teachers stating how many hours she spent after school working on lesson plans, and I was cast adrift with my career aspirations.

Back to the drawing board!

I did the same as anyone else in my year. I looked at my favourite subjects – biology, psychology, English – and tried to find a career that could combine both science and art, often coming up short. I took quizzes, I spoke to my family, I poured through career databases trying to find one that fit.

“Doctor” appeared. I wasn’t keen – and then right beside it, in bold letters, “nurse.”

I hadn’t thought about being a nurse since I was a little girl running around in their uniform pretending to heal the injuries of teddy bears.

When I went home to my mum that evening, she reminded me that my nursery teacher used to fondly refer to me as “Florence Nightingale.” I was “always first to the scene of a crisis,” my mum said with a smile.

Emergency nursing it was.

It’s sometimes as simple as that to say something out loud and feel that it’s right for you. Other times it’s more difficult.

Never once in my time at university did I regret my decision to study nursing. To help if you’re trying to make this decision, these are factors I considered:

• The commitment to training – nursing school is three intense years (sometimes four, depending on the university). We don’t get the same holidays as other students. We work full time for half of the year, which makes it difficult to keep up with a part time job, and our hours often aren’t set.

I was lucky enough to be able to stay at home during my degree, but this might be something worth considering.

There are, however, apprenticeships available,  as well as the nursing associate role and numerous student loans and grants that could be of benefit, so this isn’t a deal breaker by any means.

• The lifestyle – I love nursing because it allows me a certain degree of flexibility. I work three long days a week, allowing me four days off to fulfil family commitments and indulge in hobbies.

If I had children, it would allow me to bring them to school and pick them up on those days too. Of course, there are nine to five nursing roles out there. Just be aware there won’t be unsocial hours payments along with these, so you will only get a base salary.

• The work itself – I find myself a very practical person. I enjoy being hands on and learn best when I’m shown something and then try it myself. I find a lot of my colleagues to be the same.

If you enjoy learning on your feet, going with your gut and refining your intuition, nursing will be an extremely rewarding profession.  

Don’t let concerns over pay or working conditions push you from a path you feel worth taking.

In my experience, I’ve had enough money to buy my own house at age 22, to live alone and have some savings on the side. This will, of course, be dependent on location – I’m in Northern Ireland, which is more affordable than many parts of England.

Shift patterns and working conditions can often be adjusted by moving jobs or advancing with enough experience.

Look at the pay for yourself, write out a monthly budget, and see if it was something you could live with.

My First Role

My nursing career started earlier than anticipated with the beginning of the Covid-19 pandemic. I was supposed to qualify in December 2020, and instead joined the workforce in a Band 4 capacity in April 2020.

I still had to be “signed off” as a student nurse and receive my competencies, but I no longer  had supernumerary status.

I worked on a rehabilitation ward near my home for four months before I officially completed my course and applied for a job in my local emergency department.

It was everything I had ever hoped for. Serving my community, being surrounded by some of the most qualified and impressive people in their field, and having the best team around me – what else could you ask for?   

Of course, not everything was perfect.

Don’t believe anyone who says they breezed through their first year. No matter whether you are new to healthcare or you’ve been an HCA for decades before, your first six months as a staff nurse will be something of a culture shock.

There are, however, tips you can follow to make the transition easier:

• Learn the lay of the land. In your first weeks, get familiar with equipment locations in your department. Know what to grab in case of emergency – non-rebreather masks, the crash trolley, defibrillator pads, oxygen cylinders. Take pictures on your phone of contact directories and favourite them.

The last thing you want to do at 3am is wait for the hospital switchboard to connect you to the surgical reg on call! Insulin charts, NEWS, GCS and nursing admission booklets are only some of the documentation you’ll be expected to complete, and your adjustment will be much smoother if you know where they are even before you know exactly how to fill them out!

• Cluster care. This is something of a hot topic in the United States nursing community, and it’s something I feel beneficial to talk about here, too. When you’re going into your patients, do everything you can think to do with them at once.

Chat to them as you’re doing their morning observations. See if they feel sick, if they’re in pain, if they’re worried about anything. Then you know if you need to pick up analgesia or anti-emetics with their morning meds, or call the doctor to clarify some of their treatment plan.

Bring dressings if the nurse before hands over that one is due. Bring in the scales if they need daily weights, or a bottle to empty their urinary catheter bag.

You’ll find yourself running around a lot less, and pretty soon, you’ll have more time in your day to learn the things you don’t already know, rather than chasing the things you do!

• Get support. This is something that we as nurses fail at so often. I personally think it’s because we don’t have time to reflect during our shift, and when we get home, we want to be present with our families. We don’t want to be reliving the past few days, thinking about how they made us feel. It can build up, though.

It was only after witnessing six cardiac arrests in three weeks, followed by a traumatic paediatric emergency, that I realised what a toll simply “forging on” was taking. Talk to senior nurses.

Talk to the sister in charge. Talk to mental health support that’s provided through your Trust. That’s what they’re all there for.

Admitting that you’re struggling doesn’t make you less of a nurse. It makes you human – and that empathy and compassion for patients that sometimes pains us is the one thing that takes a good nurse and makes her a great one. 

What Do You Think?

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Growing In Your Role

There will come a time, as impossible as it may seem now, that you will be a senior in your role. I’m barely two years in and I find my own name on the top of the off duty, wondering how it happened.

On reflection, there are several things that I have prioritised in my time as a staff nurse that have helped me to grow and develop.

Grabbing opportunities when they arrive is one of the most important: opportunities for study, further training, to develop relationships with other healthcare professionals or even to make a difference when you see a problem.

Managers aren’t always on the floor. They rely on staff nurses noticing issues and bringing them to their attention, and particularly when they already have a solution in mind.

For example, one sister in my department found that newly qualified nurses were panicking over how to differentiate between oxygen and medical air cylinders in an emergency, as they look very similar.

She adjusted the labelling on these, and then took the extra step of placing them in two different areas of the department to avoid any mishaps.

In my career, I have participated in a quality improvement project aimed at reducing insulin administration errors in my department.

I printed posters for the waiting room informing patients to take their own insulin while they waited for a doctor (sometimes this could be up to twelve hours in my Trust) to avoid further complications.

I improved documentation for nurses so it was clear who required insulin and when. I involved pharmacy and the diabetes specialist nurses to provide information sessions to staff about what to do for missed insulin doses and how to correct these.

Healthcare is not static. It is a constantly growing, constantly evolving practice. That is one of the things that I find so exciting about it.

In only three years time I could be eligible to apply for seconded training as an emergency nurse practitioner, advanced care practitioner or apply for a Band 6 position as a clinical sister.

All of these avenues are open to us as nurses, and the opportunities to positively change healthcare and impact patients’ experiences are endless.

Although sometimes nursing is difficult, tiring and complex, and the pressures placed on us are growing day by day, we are an integral part of the healthcare team.

We are there when people are born, when they die, at their best moments and their worst. It is a privilege to be part of one of the most human professions out there and to have so many possibilities at our fingertips.  

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About the author

My name is Lauren Irwin and I’m an emergency department staff nurse. I started my career early during the Covid-19 pandemic and chose to take my first post in emergency care. I’ve since worked on several quality improvement projects focusing on medicine administration and diabetes care. I’m passionate about helping newly qualified nurses and students settle in and achieve their full potential.

    • Mat Martin
    • Cecilia Wanjiru
    • Richard Gill
  • 1
  • 2448

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    • Michelle Hutchby one year ago
      Michelle Hutchby
    • Michelle Hutchby
      one year ago

      This is a well written and valuable read, thanks Lauren.