Welcome to the emergency department! I hope you love it as much as I do!
As a first placement you are going in at the deep end. If this is a subsequent placement then you still have a lot of changes to embrace in this challenging new environment.
Our most recent intake of fifteen brand new doctors has prompted this blog. It has had a noticeable impact on the department. They are all lovely young men and women and I really feel for them as they deal with all the new experiences in the emergency department environment. So I wanted to share some tips and insights that might help make the transition easier for anyone in this position.
My advice comes from twenty (something) years of nursing experience, and seven years of emergency nursing, but I still remember what it was like to be new. Which is something no one should ever forget because one day you will be the senior person and being able to remember how it feels will make you a better mentor and leader in the future. I wanted to gain a broader perspective than my own for this blog, so I asked for some input from my colleagues, and while the incidents and stories they relayed to me varied, the themes remained the same. I think that most of the issues and clashes arise from dealing with personalities and human nature. Unfortunately from both sides, medical and nursing. And a huge focus of the feedback I got related to blood collection and cannula insertion.
So here it is,
First quick one before you start. Yes, in the Emergency Department you have to work weekend’s and night shift. Knowing this will save the person doing your rosters from thinking you are stupid.
Clean up your own mess. That includes in the tea room.
Please don’t be offended if someone ask’s you to clean up your own mess.
Dispose of your own sharps.
If a nurse helps you find equipment and sets up for a procedure, for example the plaster trolley, please clean it up and put it back yourself. At least saying “hey, where does this go?” Shows you are happy to do it, you will be directed where to put it or (because you asked and showed an intent to do it) the nurse may take it for you. Leaving it in the corridors outside the cubicle and walking away will get you one pissed off nurse and he/she will tell their friends.
A good life long piece of advice, no one person knows everything.
If a nurse is telling you something about a patient, it is for a reason, please listen, it is probably important.
There is only one gift from god, and they already work here.
Carry lube in your pocket.
Bring a little pocket/purse sized snack, that doesn’t need the fridge, you may not get a break. Sugar is happiness. Nurses like happy doctors.
Be friendly, introduce your self, be approachable.
Now to the cannula issues, in the department I work in most of the nurses are able to take bloods and insert cannulas (most will have done more than you’ve had hot breakfasts) but ultimately it is the responsibility of the doctor to obtain the blood and iv access.
If the nurse has inserted the cannula and taken blood then they had time to. If not they were too busy and you need to do it. Chances are you need the practice, more than the nurse does.
On some shifts there may be a relief staff member that may not be competent to do cannulation so a good approach is, if the cannula is in, try to say thank you to the nurse (This one thank you will probably ensure all your cannulas for the rest of the shift will be done before you even see the pt.) And if the cannula is not yet in, do it whilst getting the pt’s story. Best not to just leave the blood slip there, try to find the nurse and see if they have time to do it.
You are qualified to put in a cannula and therefore qualified to take one out. You actually have time to remove it and apply pressure for a minute whilst giving a discharge letter and instructions to the patient.
This is a great practice, for both the patient and the department. Because when the patient tells the nurse ten minutes later that they can leave and then the nurse spends ten minutes trying to find you to confirm the patient can actually leave (and that they have their letter and possible script), before removing the IV, the next patient could be in the cubicle being worked up.
So there you have it, all simple things to keep in mind while you become familiar with your new role.
Do you have any positive tip’s or advice of your own? I would love to hear your thoughts or suggestions. Feel free to leave a comment below.
Stay safe, be happy.