Now Ye're Talking - to an Emergency Department Nurse

Boards.ie: Niamh · 26-11-2015 01:09PM #1

Bed shortages and patients on trollies are frequently in the news and just two days ago the INMO voted in favour of strike action over chronic overcrowding and understaffing. So what is it like to work in this type of environment? One of our members who is a nurse in a busy hospital emergency department has agreed to answer some questions for us this week so you can find out what it's like to work on the front lines of the health service.

She says:

Day by day in work I get frustrated with people not understanding how the system works which by no means is their fault. I want people to be able to understand that the reason they are waiting 12 hours is not due to us ignoring them but may be due to having a trauma and 3 arrests behind the doors that they cannot see. I also think many people are interested in knowing what goes on but only have a programme like 24 hours in A&E as reference

Our AMA candidate will be online later today; in the meantime feel free to get the ball rolling with some questions. Thanks

Mousewar · 26-11-2015 01:15PM

In your opinion, what percentage of patients who show up to Emergency department actually need to be there as opposed to those who really could have just visited their GP or an outpatients clinic (or even just taking some paracetamol or whatever)?

job seeker · 26-11-2015 01:26PM

What's the worst accident you've seen in your career and how do you manage to stay calm?

seamus · 26-11-2015 01:27PM

Funnily enough, the frustration with "people not understanding how the system works" was going to be my question.

What can the hospital administration/HSE do to improve this? I think key to reducing tensions and annoyance about A & E is simply ensuring that people know what's going on. It's unreasonable to expect patients to understand the system and unreasonable to expect nursing staff to spend their valuable time responding to "when will I be seen" questions.

Case in point - attending a small public emergency room recently, you had a door with word "Emergency Room" written on it, and a printed sign that said, "Please knock once and take a seat". There's a waiting area with other patients sitting around. You knock, and you sit down. And nothing. 10 minutes go by, nobody appears at the door. More patients appear, knock, sit down, nothing. A nurse appears, brings in some of the patients who were there before you, and a doctor pops her head out the door calling out names.
Hang on, nobody even know we're here, let alone what our names are. More patients appears, knock, sit down, and the nurse and doctor seem to be attending to other patients you haven't yet seen. But not to you or anyone else who arrived after you.
Eventually an hour later the nurse reappears and asks, "Right, who's next?". Of course there's some confusion, but once you speak to her it becomes clear that she's the triage nurse who takes your details and then the doctor calls you in.
Funnily enough we were only there for an hour and a half, with the first hour spent in complete confusion waiting for someone to answer our random knock on a door.

I guess this is kind of what you're talking about when you talk about frustration. The nurse and doctor there know the system. And no doubt get annoyed if someone pounds on the door demanding to be seen. But the patients don't know the system and as far as they can tell they're attending an A&E but they're being ignored.

So, what do think is the best way to resolve this? In my example, if there was someone at a desk who did a "check-in"; it could even be the security guard, this could solve a whole lot of problems. You give him your name, you go onto the "triage list" for the A&E and the triage nurse(s) come out and call your name in turn. They then assess you and place you on the treatment list in order of priority. For bonus points you could give each patient a number and display a "waiting list" on screens in the A&E to show every patient where they are in the queue.

Of course, when you check-in initially you get a leaflet that explains this system and what to expect, including, "More severe cases will be placed on the list in front of you" and so forth.

celligraphy · 26-11-2015 01:28PM

Excuse my ignorance but why is there a bed shortage? I always thought maybe it's because some people go for the most stupid things e.g headache , cough , spraining ankle etc..

Sunny Dayz · 26-11-2015 02:11PM

I know a lot of people will post here giving out about the health system, looking for gory stories etc

But I was wondering about the positives: what are your favourite aspects of your job and what have been your best moments in your nursing career to date?

Timberrrrrrrr · 26-11-2015 02:13PM

I don't have a question, just wanted to say thanks for all the hard work you guys do, Underappreciated, underpaid and overworked yet you still go in every day.

Dozen Wicked Words · 26-11-2015 02:25PM

Do you think there is a case for strike action across the country? Do you think the INMO is any good as a union?

I'm an Emergency Dept nurse, AMA · 26-11-2015 02:26PM

Mousewar wrote: »

In your opinion, what percentage of patients who show up to Emergency department actually need to be there as opposed to those who really could have just visited their GP or an outpatients clinic (or even just taking some paracetamol or whatever)?

Hi Mousewar, great question to start off! It really does depend on the day but quite a lot of patients, perhaps 20% or more could go to a GP or as you say just take paracetamol to get rid of a pain but tend to run to their nearest ED with any sort of pain or strain. It is quite irritating when a patient comes in saying they have 10/10 pain but they haven't even tried taking pain killers at home before they came in and then an hour after they have had some paracetamol their pain is gone and they are all better. What is maddening though is the amount of patients referred in by their GP when they could easily be treated with oral tablets or have their GP send off bloods instead of them having to come in and wait hours to be seen.

job seeker wrote: »

What's the worst accident you've seen in your career and how do you manage to stay calm?

Hi Job seeker. Some of the worst things I have seen are probably crush injuries. These patients tend to have massive injuries and need a lot of different teams to intervene. Another thing was a patient who almost amputated their arm... they punched a glass window and the top of the window fell down like a guillotine and left their arm hanging on by a piece of skin. It sticks in my mind mainly because I actually thought it was quite cool

Traumas are nerve wracking but because there are usually so many people around it is easy to stay calm as you have enough support. Everyone usually knows their role and pulls together. In other situations it is not as easy to stay calm I guess but the rush of adrenaline always gets me through.

seamus wrote: »

Funnily enough, the frustration with "people not understanding how the system works" was going to be my question.

What can the hospital administration/HSE do to improve this? I think key to reducing tensions and annoyance about A & E is simply ensuring that people know what's going on. It's unreasonable to expect patients to understand the system and unreasonable to expect nursing staff to spend their valuable time responding to "when will I be seen" questions.

Case in point - attending a small public emergency room recently, you had a door with word "Emergency Room" written on it, and a printed sign that said, "Please knock once and take a seat". There's a waiting area with other patients sitting around. You knock, and you sit down. And nothing. 10 minutes go by, nobody appears at the door. More patients appear, knock, sit down, nothing. A nurse appears, brings in some of the patients who were there before you, and a doctor pops her head out the door calling out names.
Hang on, nobody even know we're here, let alone what our names are. More patients appears, knock, sit down, and the nurse and doctor seem to be attending to other patients you haven't yet seen. But not to you or anyone else who arrived after you.
Eventually an hour later the nurse reappears and asks, "Right, who's next?". Of course there's some confusion, but once you speak to her it becomes clear that she's the triage nurse who takes your details and then the doctor calls you in.
Funnily enough we were only there for an hour and a half, with the first hour spent in complete confusion waiting for someone to answer our random knock on a door.

I guess this is kind of what you're talking about when you talk about frustration. The nurse and doctor there know the system. And no doubt get annoyed if someone pounds on the door demanding to be seen. But the patients don't know the system and as far as they can tell they're attending an A&E but they're being ignored.

So, what do think is the best way to resolve this? In my example, if there was someone at a desk who did a "check-in"; it could even be the security guard, this could solve a whole lot of problems. You give him your name, you go onto the "triage list" for the A&E and the triage nurse(s) come out and call your name in turn. They then assess you and place you on the treatment list in order of priority. For bonus points you could give each patient a number and display a "waiting list" on screens in the A&E to show every patient where they are in the queue.

Of course, when you check-in initially you get a leaflet that explains this system and what to expect, including, "More severe cases will be placed on the list in front of you" and so forth.

Hi Seamus, This is another really good question and one which needs to be addressed on a nationwide scale I think. I am lucky enough to have only been in emergency departments that have a registration process.... In fact I didn't know there was any that wouldn't have this very basic step. In all departments I have been to a patient comes in and registers and then is called in turn by the triage nurse.

As for informing patients... I think posters on walls of waiting rooms are essential explaining how things work. Even a quick explanation of the triage system and the usually routine a patient will go through for example Registration-Triage-Doctor or nurse specialist-test results etc. I think this would be great for a patient who feels like they are just forgotten about in the waiting room when this is not actually the case.

I have worked in hospitals where there is a time to be seen board which is helpful in some situations but the fact is that this board will change all of the time which will end up angering patients who can't understand why.

I hope this sort of answers what you asked?

celligraphy wrote: »

Excuse my ignorance but why is there a bed shortage? I always thought maybe it's because some people go for the most stupid things e.g headache , cough , spraining ankle etc..

Hi Calligraphy. The bed shortage which I think you mean is actually inpatient beds within a hospital. When these are full it means no patients can be moved to a ward as there are no beds available. This leads to elective surgeries being cancelled and leads to patients being left on trolleys. You would hope that all inpatients actually require their beds so they cannot be blamed on the bed shortages. Some beds on wards cannot open due to staff shortages meaning the nurses are already over stretched and patient safety would be compromised if patients were sent to those beds.

seamus · 26-11-2015 02:34PM

I'm an Emergency Dept nurse, AMA wrote: »

I hope this sort of answers what you asked?

Yeah. I guess I was asking whether you feel there's anything glaringly missing in the process?

Perhaps all A&E departments should be standardised? I'm usng the Argos model here only to be illustrative and simplistic. So in Argos you know that you go and queue at the tills (triage), then you get a number, it pops up on the screen and when your number is called, you get your stuff (get seen).

And this is the same whether I go to Argos in Blanchardstown or Mahon Point. Or indeed it's the same on Oxford St in London.

But if I go to A&E in Tallaght, it will have one system. And if I attend Naas the next week it'll be something else entirely.

Do you think making the A&E process standardised across the country would help alleviate the confusion/frustration, or am I looking at it far too simplistically?

eeguy · 26-11-2015 02:41PM

Do you do manual handling courses?

I've heard many nurses suffer from bad backs due to lifting and moving patients, beds and equipment?
Have you noticed any of this yourself?

I'm an Emergency Dept nurse, AMA · 26-11-2015 02:43PM

Sunny Dayz wrote: »

I know a lot of people will post here giving out about the health system, looking for gory stories etc

But I was wondering about the positives: what are your favourite aspects of your job and what have been your best moments in your nursing career to date?

I have a lot of favorites :P I obviously love seeing patients get better.... it makes the job worthwhile. Getting somebody back from a cardiac arrest is an amazing feeling even if its only for a short amount of time in which their family get to spend time with them or to say goodbye properly. Seeing someone improve after you give life saving drugs is an incredible feeling.... I am often moved to tears when a stroke patient regains their speech or movement

One of my favorite things (very morbid) is when I have a dying patient and I can help to make them comfortable or help their family in one of their worst times of their lives by explaining things or giving them a hug.
The thing that keeps me going is so simple though and that is when someone says thank you.... Its pretty sad but it really doesn't happen too often.

Timberrrrrrrr wrote: »

I don't have a question, just wanted to say thanks for all the hard work you guys do, Underappreciated, underpaid and overworked yet you still go in every day.

Thank you Timberrrrrrrr

Dozen Wicked Words wrote: »

Its only Beaumont INMO that have had a vote on strike action.

Do you think there is a case for strike action across the country? Do you think the INMO is any good as a union?

I think there is a need for something to be done to ensure the HSE is able to retain nurses, to ensure that nurses are kept safe and most importantly that our patients are kept safe.

I don't know if I actually believe that an all out strike will achieve this but I do think that work to rule is beneficial in some way if only to highlight how poorly a department works with nurses only doing their actual nursing jobs without all the other jobs we are expected to do.

I think people would be happier with the INMO if there were changes made but that isn't really their fault. It all lies with the government at the end of the day. The INMO are trying to fight our corner from what I can see but at the end of the day I don't know how changes can be achieved no matter what they do. That may be a negative point of view but I think this is a pretty shared view amongst nurses at the moment.

Toto Wolfcastle · 26-11-2015 02:44PM

Do you think Leo Varadkar is doing a good job as Minister for Health? He recently responded to an email I sent him and it seems to me that he has some good ideas but they're impossible to implement due to budget constraints. I'd be interested to find out if someone working in the health service thinks he's doing enough.

iPhone. · 26-11-2015 02:46PM

Well done Nurse!! Good on you for giving your time to answer the questions boardsies might have.

I don't have a question myself, just wanted to say how fantastic you Nurses are and I hope things improve work conditions wise in the near future!

moleyv · 26-11-2015 02:47PM

Having to attend A+E regularly with a relative something I notice is a lot of gardai having to be in attendance with people in custody or from prison.

I have seen fights break out etc.

In light of this, have you ever feared for your safety? Including patients not under garda supervision.

Do these patients under supervision get pushed up the line to get them out quicker?

everlast75 · 26-11-2015 02:56PM

hi there,

As I have two parents who are quite elderly, I just wanted to say thank you to you and your colleagues. Under tremendous pressure, you still manage to do a fantastic job.

I have one question - do you think that there is too much managerial staff in the HSE; could that number be reduced and that money saved used to recruit more nurses?

Also, whilst not a question I'd like to say that what irks me beyond belief is that the government talk about keeping tax breaks and high levels of wages to "attract the best and brightest" into this country, and use the excuse that TDs should be well paid for the same reason, yet when it comes to determining a reasonable level of pay for nurses, they fight tooth and nail.

Yakkyda · 26-11-2015 03:26PM

First of all, thank you for taking the time to do this ama, it'll be very interesting.

Secondly, yis do an amazing job(was in jamses last year for four days , wisdom teeth, required surgery . Was on septic shock watch for two days!)the nurses were fcukin amazing, kind and caring even under pressure and dealing with some right dickheads. It takes a special kind of person to do what you do, it's a shame the hse can't get its act together . Undervalued and under appreciated imo. You guys are the backbone of the health service, the only thing that makes a hospital stay bearable.

No question, keep up the good work, you guys are fcukin amazing!

I'm an Emergency Dept nurse, AMA · 26-11-2015 03:30PM

seamus wrote: »

Yeah. I guess I was asking whether you feel there's anything glaringly missing in the process?

Perhaps all A&E departments should be standardised? I'm usng the Argos model here only to be illustrative and simplistic. So in Argos you know that you go and queue at the tills (triage), then you get a number, it pops up on the screen and when your number is called, you get your stuff (get seen).

And this is the same whether I go to Argos in Blanchardstown or Mahon Point. Or indeed it's the same on Oxford St in London.

But if I go to A&E in Tallaght, it will have one system. And if I attend Naas the next week it'll be something else entirely.

Do you think making the A&E process standardised across the country would help alleviate the confusion/frustration, or am I looking at it far too simplistically?

You know despite you thinking its far too simple this is exactly what I think needs to happen. All departments do work on a triage system but I do think that it should be a standardised process across all departments that a patient from Cork, Donegal or Dublin hospitals know what to expect when they have to attend an ED.

eeguy wrote: »

Do you do manual handling courses?

I've heard many nurses suffer from bad backs due to lifting and moving patients, beds and equipment?
Have you noticed any of this yourself?

Hi eeguy, Yes everyone does manual handling courses and everyone has to keep them updated. I myself suffer with a sore back and to be really honest despite having regular manual handling classes I do think that sometimes you just have to do what is necessary in that moment if it goes against manual handling techniques or not!

easygoing1982 · 26-11-2015 03:41PM

Another poster sort of pushed on it but how would grade the levels of violence in A&E towards staff.Would you ever have to deal with violent people or does security step in straight away.

How could you class your working relationship with the likes of security etc.

How would you describe the facilities for mental health patients.

I'm an Emergency Dept nurse, AMA · 26-11-2015 03:59PM

Toto Wolfcastle wrote: »

Do you think Leo Varadkar is doing a good job as Minister for Health? He recently responded to an email I sent him and it seems to me that he has some good ideas but they're impossible to implement due to budget constraints. I'd be interested to find out if someone working in the health service thinks he's doing enough.

Hi Toto Wolfcastle. I won't lie, I do think that from the time I have become a nurse he is the best health minister we have had so far although after reading that he said he is disappointed with nurses decision to go on strike he isn't in my good books. I don't think anyone including himself realise the stress hospital staff in general are under especially in emergency departments. He is not there to see our frustrated tears or to see how stressed we are. I understand there are budget constraints but that doesn't negate the fact that changes need to be made to keep patients safe. The closure of departments around the country put a massive amount of pressure on other emergency departments and hospitals. We may no longer have staff to open these departments but I think reopening departments is something that needs to be considered. I'd love to know what his ideas are :P I think it would do no harm for there to be a team looking at what works elsewhere in the world and trying to introduce those initiatives here. It has been done in Scotland and massive advances in patient care have been made there, I cannot understand why that cannot be done here too.

iPhone. wrote: »

Well done Nurse!! Good on you for giving your time to answer the questions boardsies might have.

I don't have a question myself, just wanted to say how fantastic you Nurses are and I hope things improve work conditions wise in the near future!

Hi iPhone, thank you!

moleyv wrote: »

Having to attend A+E regularly with a relative something I notice is a lot of gardai having to be in attendance with people in custody or from prison.

I have seen fights break out etc.

In light of this, have you ever feared for your safety? Including patients not under garda supervision.

Do these patients under supervision get pushed up the line to get them out quicker?

Hi moleyv. I have often fared for my safety and the safety of my colleagues and patients. If I do a full week of nights I can honestly say I may not receive some sort of verbal abuse on only one or two of those nights. I have been physically assaulted on more than one occasion as have many of my colleagues. This may only be a scratch or a punch but it always sticks with you and ultimately makes me more weary of people.

In my department all patients are triaged and seen in turn as per their category. A person under supervision from the gardai may be moved from the waiting room to a cubicle out of the way but they will still be seen in turn.

everlast75 wrote: »

hi there,

As I have two parents who are quite elderly, I just wanted to say thank you to you and your colleagues. Under tremendous pressure, you still manage to do a fantastic job.

I have one question - do you think that there is too much managerial staff in the HSE; could that number be reduced and that money saved used to recruit more nurses?

Also, whilst not a question I'd like to say that what irks me beyond belief is that the government talk about keeping tax breaks and high levels of wages to "attract the best and brightest" into this country, and use the excuse that TDs should be well paid for the same reason, yet when it comes to determining a reasonable level of pay for nurses, they fight tooth and nail.

Hi everlast75. Thankfully all the management I come into contact with are a necessity and do a fantastic job as far as I am concerned. I think any management assosicated with an Emergency Department have a very stressful job which is often overlooked. My hospital in general seem to have amazing and necessary management who all seem to do a fantastic job with what resources they have. I think in general there have always been complaints about too many managerial and administration staff in the HSE so I am sure this is true... I do however think this is slowly changing.

Yakkyda wrote: »

First of all, thank you for taking the time to do this ama, it'll be very interesting.

Secondly, yis do an amazing job(was in jamses last year for four days , wisdom teeth, required surgery . Was on septic shock watch for two days!)the nurses were fcukin amazing, kind and caring even under pressure and dealing with some right dickheads. It takes a special kind of person to do what you do, it's a shame the hse can't get its act together . Undervalued and under appreciated imo. You guys are the backbone of the health service, the only thing that makes a hospital stay bearable.

No question, keep up the good work, you guys are fcukin amazing!

Hi Yakkyda, I am glad to hear you had a positive experience despite being unwell, glad to hear the nurses were great

On a side note, I think it is incredible how the care of sepsis in patients has improved so much in the past few years and is ultimately saving lives.

I'm an Emergency Dept nurse, AMA · 26-11-2015 04:13PM

easygoing1982 wrote: »

Another poster sort of pushed on it but how would grade the levels of violence in A&E towards staff.Would you ever have to deal with violent people or does security step in straight away.

How could you class your working relationship with the likes of security etc.

How would you describe the facilities for mental health patients.

Hi easygoing1982. One thing I will say about security is if differs in every single hospital. Some hospitals have a zero tolerance approach, some have security who are like ornaments and cannot really intervene and some have no security at all. Someone earlier said about standardising emergency departments and I think security should be something that is standardised in every department.

I think there needs to be emergency mental health centers in Ireland instead of patients having presenting to an emergency department. It puts so much pressure on both the patient and the nurse caring for them. That nurse may have 8 other medically unwell patients who require a lot of care and then have a patient who has a mental health illness who requires a lot of reassurance and assistance with getting transferred to a specialist facility. I think a a patient with a mental health crises require more than any busy emergency department can give. I think we all try our best but I think the mental health services in Ireland need a serious overhaul as soon as possible.

fussyonion · 26-11-2015 04:37PM

What would happen if you could not control someone's heartbeat?
Say they had A-Fib and no amount of amiadrone/beta blockers etc could slow it, what's the last resort?

allandanyways · 26-11-2015 04:41PM

Firstly, well done on doing what you do - nurses are the unsung, underpaid heroes of this country.

My question is this:

What are your feelings on drug addicts who present minor injuries in A&E for the sole purpose of getting pain meds/extended methadone prescriptions?

I ask because I was in the Mater not too long ago and while I was waiting for an ultrasound, I saw no less than 4 nurses trying to restrain a whacked out of it junkie and his girlfriend. He had a sprained wrist or something, nothing serious or visible.

Anyway, the next thing, the girlfriend is wheeling him (now calm and arm in a sling) out of the A&E and meets the nurse along the way and says "Now, will ya ask the doctor to write him up for a week's worth of methadone so he doesn't have to go down and get it, and give him 2 weeks worth of the painkillers as well?". From her body language and tone of voice, it was clear that was an instruction, not a request.

I don't know what happened after that as they walked away together but I felt really uncomfortable in that moment, and it was said loud enough (I would imagine) so that if the nurse said no, then she would have made a scene. I felt really bad for the nurse, and thought "I wonder how many cases like that she sees every week?".

Obviously drug addiction and heroin use in particular is a huge problem in Dublin/Ireland - does it have much of an impact on your work?

I'm an Emergency Dept nurse, AMA · 26-11-2015 05:13PM

fussyonion wrote: »

What would happen if you could not control someone's heartbeat?
Say they had A-Fib and no amount of amiadrone/beta blockers etc could slow it, what's the last resort?

Hi fussyonion, Fast Atrial Fibrillation is a funny one as it can actually come on due to something like an infection, in that case its important to actually treat the infection rather than the rhythm which will in turn control the rhythm if that makes sense? In a patient who is symptomatic or unstable with a fast afib we will cardiovert (shock) the patient. This is a controlled situation different to a cardiac arrest defibrillation/shock. Many patients sit happily enough in afib and you have time to wait and see if they will revert to a normal rhythm and have time to thin their blood and take them back for a cardioversion at another time.

allandanyways wrote: »

Firstly, well done on doing what you do - nurses are the unsung, underpaid heroes of this country.

My question is this:

What are your feelings on drug addicts who present minor injuries in A&E for the sole purpose of getting pain meds/extended methadone prescriptions?

I ask because I was in the Mater not too long ago and while I was waiting for an ultrasound, I saw no less than 4 nurses trying to restrain a whacked out of it junkie and his girlfriend. He had a sprained wrist or something, nothing serious or visible.

Anyway, the next thing, the girlfriend is wheeling him (now calm and arm in a sling) out of the A&E and meets the nurse along the way and says "Now, will ya ask the doctor to write him up for a week's worth of methadone so he doesn't have to go down and get it, and give him 2 weeks worth of the painkillers as well?". From her body language and tone of voice, it was clear that was an instruction, not a request.

I don't know what happened after that as they walked away together but I felt really uncomfortable in that moment, and it was said loud enough (I would imagine) so that if the nurse said no, then she would have made a scene. I felt really bad for the nurse, and thought "I wonder how many cases like that she sees every week?".

Obviously drug addiction and heroin use in particular is a huge problem in Dublin/Ireland - does it have much of an impact on your work?

Hi allandanyways, I hope you got sorted with your ultrasound and that all was ok.

I won't lie about addicts.... many can be a pain in the arse but I generally have good time for them once they are not abusive or destructive. I am very straight up and I am never afraid to tell them how it is and usually they will listen to that. Id say I can safely guarantee that no patient in any department in Ireland ever gets a prescription for methadone from an emergency department, in fact, any departments I have worked in have a strict policy that the patients methadone clinic is called to check their prescription before any is prescribed. If it is out of hours then a minimal amount of methadone is prescribed to prevent detoxing until their usual dosage is clarified.

As for the pain killers, patients usually will get a prescription if required for 3-5 days and they are informed to visit their GP if they require anymore.

It puts pressure on us when a patient comes in overdosed or abusive. Many patients are revived by paramedics only to come around and be abusive because the drug given to reverse heroin has taken away their buzz. Then they get angry because their clothes have been cut off in an attempt to save them.... I feel like we look bad on front of people if we are annoyed at these people on front of other patients who don't know what has gone on before they see us arguing :P:rolleyes:

Clearlier · 26-11-2015 05:14PM

What do you think about the changes in education requirements for nurses over the past 15 - 20 years? Is there a danger of it becoming a bit too academically oriented to the detriment of recruiting hands on practical people?

I've also heard that there's something of a glass ceiling in place with respect to promotion where a masters is basically a requirement - is that ruling out nurses who may be extremely capable but not academically oriented?

I'm an Emergency Dept nurse, AMA · 26-11-2015 05:33PM

Clearlier wrote: »

What do you think about the changes in education requirements for nurses over the past 15 - 20 years? Is there a danger of it becoming a bit too academically oriented to the detriment of recruiting hands on practical people?

I've also heard that there's something of a glass ceiling in place with respect to promotion where a masters is basically a requirement - is that ruling out nurses who may be extremely capable but not academically oriented?

Hi Clearlier, This is a great question. Nursing is defiantly more academic based now and it almost feels like nurses are replacing medics in a lot of cases. Nurses are learning from medical science meaning that we are becoming more advanced with our practice. Taking emergency nursing as an example, we make decisions re patients care, we interpret bloods after we take them. We take and interpret ECGs. We are able to diagnose without being able to diagnose

Although I think all of this knowledge is great in one respect I can see such a massive change in nursing now compared to years ago.... Doctors rely on us so much more to have answers whereas that used to be their job. We are expected to do so much more and what worries me is that this is leading to a decline in actual nursing care. We no longer seem to have time to sit and talk to our patient and I am afraid that nursing care will be forgotten as nurses are too busy doing jobs that only the doctors used to do!

I think a nurse can advance to a manager in most cases whether they have a masters or not but I do think that a nurse should be doing whatever courses are available when they can to keep up to date.... These are the nurses who will advance to management and rightly so. I do not think it is enough to just look after your patients anymore without updating your skills and knowledge and expect to advance in your career.

Fluorescence · 26-11-2015 05:59PM

Excellent thread so far! Thank you for all your hard work, nurses are some of the best people in the world

My question is if there was any one thing that made you want to become a nurse in the first place? An event, a person, a childhood dream? And, if you weren't to be a nurse, what other career could you see yourself doing?

TG1 · 26-11-2015 06:16PM

I don't really have a question but wanted to chime in as someone who spent 24 hours in a&e recently with a fractured pelvis, the work a&e staff do is amazing, and the manner in which patients are dealt with in such a busy environment is phenominal. I was so well looked after by the nursing staff, both in a&e and later on the ward, they really made a horrible experience bearable! The experience has just put me in awe of the work you do and the positive attitude you maintain while doing it in incredibley stressful conditions, and I think this should be highlighted at every available opportunity!

whiskeyman · 26-11-2015 06:21PM

Firstly, thank you on doing what you do.
There's no way in hell I could do it, and I see it as a vocation, one that you need to be better praised and paid for!

With the Christmas season coming up, are you dreading the increase in already problematic incidences of alcohol abuse / violence to staff etc...?
As you're one of the many people on 'the front line' when it comes to our alcohol abuse problem, is it as bad as the media make it out / are you shocked by it yourself?

Eugene Norman · 26-11-2015 06:25PM

Who is ultimately responsible for patients on trolleys? Is it funding or mismanagement and if the latter is it hospital level mismanagement or a higher regional level, or the health executive or the minister.

irishgeo · 26-11-2015 06:28PM

What you like to see change in A and E depts to makes things easier/better for nurses and everyone else?

Now Ye're Talking - to an Emergency Department Nurse

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