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My Life as an Accident & Emergency (A&E) Nurse

Chaotic, Exciting, Challenging, Dynamic-- these are few of the words that describe a typical day in the Accident & Emergency unit. In this unit, no two days are the same. But do you know that there are nurses who thrive in this type of environment?

Meet Jan or Yan, an Accident & Emergency (A&E) Nurse in one of the trauma centres in London.

Know more about his role and why he loves working in the A&E.

I am Jan or Yan for most of my colleagues and friends. I am an Accident & Emergency Nurse working for one of the major trauma centres in London.

Back in the Philippines, I was working in one of the biggest hospitals in the country as an Emergency Department Nurse and a Nurse Educator. I have also worked as a flight nurse for an international medical assistance company.

2017 was a difficult & big year for me. My heart was emotionally broken that year and I felt the need for a change. I decided to look for opportunities abroad. I was lucky enough to land a job in the UK as an A&E Staff Nurse. It was not an easy journey for me. Our processes and protocols in the Philippines are mostly based from the American healthcare system. When I arrived to the UK, you can just imagine how surprised I was when I saw how different the practices were. I had to learn the new system of working. It was a struggle at first, but I had to pick myself up and work hard.

I was a Junior Charge Nurse already in a hospital outside London but early this year, I have decided to further develop my career and applied for a Major Trauma Centre in London as a staff nurse. At the moment, I am just finishing the A&E course so I can start my post as a Senior Staff Nurse.

Why I love working my role as an A&E Nurse

Even when I was in the Philippines, I have always liked working in the Accident & Emergency unit. I love how dynamic and exciting the environment is. No one can predict what will happen in the next hours. You can have a very calm morning but it can be followed by a frantic afternoon. It is important that all the staff, from doctors, nurses and HCAs, are resilient to these changes.

Another reason why I love working in the A&E is that it gives me exposure to different types of people and cases. It enhances nursing knowledge, skills and my ability to think under pressure too. As an A&E nurse, I can say that I have been part of so many people’s lives, from their birth to sometimes even up to their demise.

My Typical Day

Our usual hours of work are 12 hours/day. It can be from 0730-1930. Or 1930 to 0730 the following day. It’s handy that I reside just 15 mins walk away from the hospital. My day usually starts with a unit handover. Each of the staff nurses will be assigned to an area within the unit. It can be in the Resuscitation, Majors, Minors, Ambulatory or Ambulance Receiving area. I love working in the Resuscitation area. In this area, you can be exposed to complex cases, those that you would only encounter in textbooks or specialised centres like ours. As our hospital is a Major Trauma Centre, patients with specialised & complex care needs are brought to us.

Regardless of the area I am assigned to, the first thing I would do is to introduce myself and assess my patients. I start by assessing their level of consciousness then look at the other details of the case, including history and treatments plans required. The number of patients and level of acuity needed would also vary depending on the area I am assigned to. I would tend to have less patients when I am in the resuscitation area but as these cases are more complex, the level of work & attention needed for each patient is immensely higher than the other areas in the unit.

What it’s like to be an A&E Nurse

A&E is usually the 1st point of contact of the hospital staff to the patients. My role is not only focused in providing initial assessment and care to patients, I also play a key role in building the trust of patients to the health care staff.

Our role as nurses involves more than assessing and supporting in the treatment plan. We provide emotional support to our patients during these stressful times. Working in the Accident & Emergency Unit is not for the faint hearted. The environment is so dynamic and can be highly pressurised. We need to be brave and resilient.

When you encounter a trauma patient and he is bleeding, what should you do? If a patient suddenly had a seizure what should you do? If a patient suddenly becomes aggressive what should you do? These are situations that happen in A&E.

It is a must that you know the process of the hospital, the protocols, nature of the disease and treatment plans. You need to be aware and calm so that you can make the right decisions.

Being calm is important in my practice. Panic will not get us anywhere. It’s easy to get overwhelmed by the number of patients you need to see and assess, treatment plans you need to do, etc. Being organised is also important in my role as an A&E Nurse. Knowing which and who to prioritise is paramount.

We, nurses must also know how to empathise, and be tolerant and understanding to our patients. When patients go to the A&E, it is because they felt the need for an urgent care OR treatment. Patients and their families are feeling stressed and emotional. As a nurse, you need to know how to deal with things objectively and professionally.

Aside from the basic nursing skills (basic life support, intravenous cannulation, administration of medications), you also need and can learn about plastering, suturing of wounds, rapid sequence induction and advance life support to name a few.

Benefits of Becoming an A&E Nurse

Since A&E is one of the specialty areas in a hospital, nurses and other health care workers are always up to date with their trainings. As an A&E Nurse, you are given opportunities to develop yourself not only through the courses provided but also the exposure to various cases. Financially, you can also get enhancement or special rates when you do overtime or odd shifts. Working in A&E can also pave other developmental & growth opportunities for you. It can hone your ability to prioritise, manage difficult situations and develop your assertiveness, all of which are important as you progress to management or leadership roles.

Personally, I have also found lasting and true friendship in A&E. I think the challenges we have faced in the unit did not only toughen us but also has strengthened our bond as a team.

I am fortunate to have worked with like-minded people. I am part of a multi-disciplinary health team. In our unit, each of our ideas and suggestions are valued. It is important that you collaborate well with each of the staff members. We depend on each other’s specialisms. Because of the wide variety of cases that we encounter, we need to work together to identify the problem and create a treatment plan for our patients.

Any Advice to Nurses

They say A&E is fast paced, unexpected and always disorganised, but I say A&E is where the magic happens. You can develop your clinical knowledge and skills in this unit. The challenges it present and its dynamic environment can make you a better nurse & individual. It is in A&E that I have met colleagues who I now consider as good friends. The challenges we have all faced together honed us individually and as a team.

Working in the A&E can feel like being in a marathon. We can easily get 10,000 steps in one shift. We are never seen in just one area, we run around either to assess the patient, get the medication, speak with the doctors. The list seems to be endless and can be overwhelming. As an A&E nurse, you need to know how to manage the physical and mental stress. Don’t worry. Don’t panic. Focus.

Lastly, regardless of the unit you’ll be working at, take care of yourself and your relationship with your peers. You are equally as important as any member of the group. Having good relationship with your colleagues can help you in the toughest of times. You also need to know when & how to call for help. Asking for help is not a sign of weakness.

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