Wednesday 4 February 2015

Emergency Nurses: The Real Force of Quality Care in Transitional Academic Departments !

From the Desk of Sagar Galwankar, MD

I was working the 1 pm shift in my emergency department. The nurses generally work from 7 am to 7 pm and Emergency Physicians work 8 hour shifts at different times and slots. It was 8 pm and I glanced around as my 8 hour shift was ending in another one hour. I saw one of my nursing colleagues from the day shift who was in a somber mood and standing in one corner.

I looked to her and asked her whether all was ok. She came close to me and whispered in my ear “Is she going to make it?”

I saw the eyes of my nurse and the tone of the voice and also realized that it was one hour post her shift. I was touched and overwhelmed. She was referring to one of our patients who was not doing well.

This made me realize the emotional aspect of what we the Emergency Health Providers do day in and day out. It made me visit the corridor of the perspectives as regards my nurses and what they go through every day every shift.

It made me realize yet again that Emergency Nurses are valuable and the most important part of the Emergency Health Care System.

Patients flow through the emergency department. As physicians we go from one bed to another so at any time we could be caring for more than 10 patients. The nurses are the closest to the patient and are the real eyes of the physician.

In the United States and across the Developed world, tremendous emphasis is placed on training emergency nurses. This training is above and beyond general nursing training.

Competency on Running Resuscitations, Getting Intra-Venous Access, Administering Life Saving Medications in minutes, Starting emergency medicine infusions, assisting in life saving procedures are some of many additional skills which need continuous education.

In Transitional Academic Departments where Physician Talent is new, developing Emergency Nursing Talent needs additional fostering. I believe that more emphasis should be placed on Emergency Nursing.

In my experience of setting up Academic Emergency Departments where Emergency Medicine was new I have successfully nurtured growth based on Good Emergency Nursing Care. Once the nurses are confident and well trained they take care of many of the processes in Emergency Care namely starting of investigation protocols, getting IV lines , managing patient flow and triage etc. New physicians get support and learn a lot of working culture and practices from Nurses. This is an established fact. In Transitional Emergency Departments there will be a lot of attrition but the nurses are the more constant part of the environment across the world.

Patient comes to emergency department in a lot of stress, and pain. Nurses are the interphase where compassion meets concern and solidifies the competency to comfort the patient. This makes a huge difference in the way the patient gets comforted and feels like he/she is being treated.

As Physicians it is our job to make sure that our immediate colleagues the Emergency Nurses are in synchrony of what we think and what we are doing and what we expect of them.

There should be a Bond of Confidence between the nurses and the doctors and this bond should be tested and fortified with every patient encounter.

It is bonds like these which stand the test of difficult times which in Emergency Medicine is All the Time!

Nurses are inherently caring and very diligent. They are trained that way. They do things which we may not be aware off. They clean the patients, they get IV lines, and they are more prone to infectious exposures, blood splashes, needle sticks because of their line of duty.

Additionally they keeping watching the patient in the ED continuously. When the ED is busy they can go up to managing 4 serious patients at the same time.

We as physicians are very swift in examining the patient and putting our orders in. We see one patient at a time and on an average put 5-10 orders. When one nurse is overseeing 3 patients and has 10 orders per patient she has 30 orders to chart, perform and accomplish.

Every job has its flip side and diverse points but challenges are far more for Emergency Nurses. They work longer hours, they work continuously and they are always in a mode in which they have to deliver.

Over the years I have come to value their contributions more and more. There are times when you feel that a nurse has been rude to you, there are times when you feel that a particular nurse does not listen to your orders, and there are times when you become judgmental about the acumen of the nurse.

Well this is a self-learning point that never be rude to anyone, listen and discuss when there is lack of clarity and never be judgmental.  Life is much bigger than the Job and Job is not the whole life.

Our success as Emergency Physicians depends on our Emergency Nurses which in turn depends on the way they operate which in the end depends on how We Cooperate.

The magic word is cooperation, which is in our hands at least 50 percent of all the time. Our success includes winning the other Nursing 50 % repeatedly and consistently. When the above is 100% the patient naturally wins.

Compassion, Competency, Confidence and, Cooperation are Crucial to Care.

When Nurses become Emergency Nurses that Extra equals Quality Care !



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