Hello! It has been a while!
So this placement took place last year… (winter to be specific) so as you can imagine this was a very busy time to have a placement in A and E especially as a result of strikes and strains on the ambulance crew at the time.
I enjoyed what learning opportunities I had in this placement and felt I really developed my independence and nursing initiative during this placement at times having the opportunity to take patient case loads with staff near by to call on.
Structure to the day
There were several areas in A and E triage, rapid assessment, majors, minors and resus and overspill. All areas so diffrent in their own right. We had a team briefing in the morning where we were allocated an area and then you would start the day taking over from the previous staff.
Triage mainly involved observing the nurse as you need to have extra training to work in triage. Triage was where most patients came to first unless they came in with an immediate emergency. The nurse would allow the patient to explain their reason for attending A & E, asses their vitals and sometimes depending on the concern the patient presented with they would have an ECG or urine dip test. The nurse would then code their concern using the triage system. It is a clinical risk management tool used by clinicians worldwide to enable them to safely manage patient flow when clinical need far exceeds capacity.
There was 3 bays in this area each with one bed and it was quite a busy area! Patients would come here when they were waiting for a bed in Majors. They would either be directed here from triage or the ambulance. If the patient came in with the ambulance crew students had an opportunity to take hand over from them about the patient. It is as it says on the tin “a rapid assessment”of the patient. It was an area where entail paperwork could be done; vitals, ECG, neurological assessment, patient history and reason for visiting A and E. It was also a very good place to practice venipuncture and cannulation and allowed my venipuncture and cannulation booklets to be signed off (Photo example from google).
Majors was exactly like you would see on casualty if you watch that, minus the actors! A very busy setting. So patients in this area would either come from rapid, straight from triage, or resus if they were stable. In this area patients were waiting to be see by medical staff who assessed the individual and either referred them to another ward in the hospital or suggested a care plan and discharged them. In this area staff were assigned to a side where you would be allocated a number of bays to care for. This included doing regular observations, managing pain (this may mean asking the medical team to write a prescription of pain relief). I took it upon myself to make sure people were comfortable. I made sure people were fed and watered and checked with the medical team they did not need to be nil by mouth for a scan before offering patients anything and insured they were safe to swallow and didn’t have a suspected stroke. It meant putting up IV’s and administering medicines for some people (with supervison) and often supporting people with patient care. In this area I very often took people for CT scans or Xray assessments. It was like a convert belt; it was important to get people assessed and the care the needed as soon as possible to make a space for other people to be seen. Once the individuals had been see and were to be discharge to another ward they would go through to the overspill waiting area. Staff with stroke assessment training could
The Overspill area was very much run like a ward setting. In this area it was about making sure the patients were comfortable while they waited for a bed to be made available in another ward in the hospital or an ambulance transfer home. In this area students were involved in providing food and water, medication and personal care. It was important notes were kept up to date. Once the ward was ready we could assist the porter to transfer the patients to the ward.
This is where all the emergency patients came too. The day started with resus area checks which involved checking all the bays had the appropriate equipment, checking controlled drugs, and replenishing the stock both on the counters and in the cupboards. Just generally making sure everything was in order for the day ahead. When emergency came in i was involved with the observations and supporting the team in general within my scope of practice. There were a few occasions where I held the hands of some very frightened people to reasure them and i wont forget these moments. These moments are the reason I want to be a nurse and remember when the going gets tough! There were some survival stories and some really sad occasions where i was involved in last offices. (Photo from Casualty TV programme)
Minors area is for you guessed it minor complaints “not a risk to life”. This was a fab team of people! In this area you could expect breaks, sprains, burns and occasionally open wounds to name a few. This was an intresting area. I had the opportunity to practice suture removal in this area on a sponge which was cool!
Conditions and health concerns I came across
In A and E you can expect to see literally everything possible!
Stroke, heart attacks, infections, COVID, drug overdoses, alcohol overdose, people in mental health crisis, injuries, accidents, road traffic accidents. broken bones and open wounds. Bleeds, GI complaints and Seizures. There was so many to name them all! Falls were one the main concerns that I saw! There was some really sad situations my heart melted for many cases.
Skills I had the opportunity to practice in this area:
Moving and handling
Supporting medical team with casting broken bone
12 lead ECG
NIV nd 02 administration
Management and leadership
Medication calculations and administration
Recognizing and escalating deteriorating patients
Extra learning opportunities
Children’s A and E
Minor injuries unit
There was so much to see and learn in this area and it came with both highs and lows. I am pleased to have had an opportunity to work in this area. I have learnt a lot about many different things!