I am a registered nurse currently working part time in Emergency dept but have also specialized in acute surgery for 25 years prior to changing specialties. I also own a Cosmedical clinic.

There is no such thing as a typical day in nursing. While we attempt to have a sort of routine on the wards in emergency dept it is pure panic management, depending on what comes through the doors.

Ward nursing is very different across the specialties.

Pediatric nurses need to be on full alert 100% of the time because children’s health can deteriorate rapidly in a matter of a few minutes. This is the one place where time management is a major priority, even though parents are usually present all the time, it is the nurse who must be in a position to take sometimes massive action to save a child’s life. A lot of time is spent in this field liaising between parents and doctors, keeping the child’s spirits high, medications, and dressings where required.

Medical nursing is good for the nonchalant personality as not much happens here, just toileting and giving out medication. Patients stay for a long time and not much gets done for them, similar to nursing home nursing. Does not really need much intelligence as can be managed with a lot of nursing assistants, but needs a lot of humanity and patience. Also need to have a good understanding of pharmaceuticals as the patients tend to be on multiple meds for multiple conditions. Medical nurses spend their time toileting patients, giving medications dealing with patients who fall, or are dementia sufferers and causing problems, and doing paperwork.

Oncology or cancer nurses need to have an excellent etiquette around infection control and hygiene, also need to be hard enough to look after people who die in their care and who may have become like family over time. This type of nursing involves medications and personal care mostly, you need a huge heart with a titanium wall around it to do this work without being affected by such regular death.

Surgical nurses need to have the capacity to work at full pace for a full shift, it is not normally the place to go straight after qualifying, people can deteriorate very quickly post-surgery and the modern training is not sufficient to make nurses competent to work in this field safely. You need a good understanding of how pain medications work, their interactions with anaesthetics, and regular medications. You need to be aware and on the lookout for the plethora of complications that can occur post anaesthetic, you also need to understand immediate and long term post-op care and healing as patients look to nurses for advice on what to do when they go home, they don’t ask doctors because they think doctors are too busy (and nurses are not!). The days are usually filled with doing observations (every 5- 30 mins when the patient is just out of theatre). Collecting patients from theatre and getting them back to the ward comfortably, wrestling with drips, drains catheters, and dressings. Dealing with dumb visitors who get in the way and are no help anymore like they used to be. Giving pain medications as well as regular medications. Changing dressings and the dreaded paperwork, of which there is far too much, most is there only to keep the insurance companies and lawyers at bay, a big majority of nurses paperwork is more to do with compliance issues than patient care.

Emergency nurses need to have a good understanding of the most common medical and surgical conditions and how to effectively treat them in the acute setting. They also need to deal with mental health patients who take up around 40% of the space in the emergency department (in Australia anyway because it’s a free service). They need to have the ability to act quickly and calmly when things go downhill, they need to have the ability to problem solve, they need the confidence to make decisions immediately without waiting for the paperwork to catch up in life and death situations. They need to keep up to date with all emergency procedures such as bomb threats, fire, evacuation, etc. Need to be able to go 10 hours without a toilet break or eating some days. Most importantly they need to be able to work in a high stress environment and recognize when they are at their limit and step back and ask for time out or help.

A day in the life

I work night shift but in emergency, there is no definite variation as with surgical wards.

We get the same stuff coming through the door whatever time it is, illness’ cannot tell time ?

Start shift with handover of current patients in my area, reason for presentation, provisional diagnosis (if any) tests done, results we are waiting for, any medications or tests due.

Check patient identifications, allergy status, any concerns, what their understanding is of the current situation.

Ensure paperwork up to date.

Attend to dressings if required, medications, Accompany for some tests such as MRI, CT.

Take blood as needed.

Give antibiotics and other medications.

Chase the notes because Drs walk off with them and leave them in random places.

Chase up the Drs to bring them up to date on test results so they can make further treatment decisions. We have only up to 5 patients allocated at any one time, Drs might have 30 in various stages of investigation, treatment and processing.

Ensure patients’ have relevant discharge paperwork, remove IV cannulas and discharge from unit. OR

Ensure paperwork all completed for transfer to ward/ other facility. Book ambulance transport and inform relatives if patient not able themselves.

When patient deteriorates it is the nurse who must raise the alarms and get pt urgently reviewed or transferred into a higher acuity area.

We are trained to take emergency action before the Drs can get there, things such as commence oxygen, taking further blood, commence fluid treatments, giving life-saving medications.

We also have to deal with an increasing number of mental health patients and drug affected patients. These are the patients who kick, hit verbally abuse and spit on us. We often have to sedate them for everyone’s safety, and they are often frequent flyers (repeat customers) who are brought in by the police, sometimes under arrest, mostly not. These people are here because of their own immediate choices and waste so many resources that they cause actual sick people to have to wait for necessary services while teams deal with them. It takes a team of 7 or 8 to deal with and sedate most of the patients- 4 security guards, 2 doctors, 2 nurses, and sometimes additional staff depending on the circumstance.

The effect on the nursing staff is serious, with an increasing number taking additional stress leave as they burn out. Some hospitals are worse than others of course, those in the inner cities tend to be the worst for drug and alcohol issues.

There is a “morning rush” which starts around 0430 hrs until around 0700 hrs, of patients transferred from nursing homes, having fallen during the night. Regulations in Australia require them to be checked out by a doctor so it’s easier to send to ED as GP service for nursing homes is terrible. Also staffing at nursing homes is all unqualified assistants with only 1 nurse for up to 100 residents so it’s safer.

There is no ‘routine’ in emergency as a whole, just the routine treatment of individuals, which will differ depending on the reason for presentation.

Because of the urgent nature of many presentations its is not uncommon for nurses to work 8 hours (on their feet) without having any time for a drink, meal or toilet break. We are our own worst enemy when it comes to putting others first.

Pros

No 2 days are the same., there are days when it seems to be all cardiac, and days when it’s all abdo, then (too many) days when it’s mostly mental health.

You cannot get into a routine rut because of this, which is why you need to be able to think on your feet and have a very broad range of expertise.

You work with a very large team so difficult to have issues of clashing personality etc, also cliques cannot form and there is very little bullying in this environment.

You see people improve quickly and go home with answers and coping abilities they didn’t previously have, this is the feel-good part of the job we all signed up for.

You literally save lives, as a frontline worker this is what it’s all about.

You meet a lot of great people, a lot of them come to you with some sort of crisis and are apologetic for ‘wasting your time’. These are the genuinely sick people who we all want to help, they are grateful for your service and make you want to come back the next day.

Your skills are kept fully updated, being the first place new practices are implemented.

You can use your experience to teach people how to manage their injuries or conditions as the Drs mostly don’t have time to do this, and as the nurse we are able to spend more time with each patient. We often find out important information that was not revealed to the doctor and which has an impact on treatment.

Cons

You can get runs of really bad days, especially around the full moon when mental health issues naturally escalate, these are the days we wish we didn’t have to come back the next day.

You see the worst in people and the worst type of people, people are at their worst when they are in severe pain or have suffered a head injury. Some peoples personality types are not conducive to having to wait because they are the centre of their own world and think everyone should treat them first. Also people who ‘work the system’ are often present because they think they are entitled to certain services when they are not actually ill, and so they will make claims in order to get food and somewhere to lay down for a few hours, then when todays’ problem’ is deemed to be non existent, they become aggressive when told to leave.

You often cant get adequately fed and watered which effects your performance and health, on days when there are a lot of genuine patients who are acutely ill, or on days when there is a major incident, its common to suddenly realize its almost shift end and you haven’t had a coffee break or been to the loo. This has ongoing effects on your sleep, safety driving home, and effects your mood and personality at times, you become cranky with family and can take your stress out on them without realizing it.

It’s a physically dangerous place to work, massive risk of assault, which also affects your own mental health. Some hospitals are all over this and have adequate security in place with strict protocols. Others have a poorer attitude and care much less about their staff than their profits.

It’s becoming less enjoyable as society deteriorates. It is very apparent that people presenting to emergency department now are much less grateful for the service and much more demanding, rude, and entitled. Especially when dealing with certain sections of society. There is much more of a victim mentality from those under 40 years old. Unwilling to change their own habits and actions, they seem to have become incapable of taking responsibility for themselves and expect a pill to fix everything instantly.

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