A Day in the Life of an Emergency Nurse in Australia

G’day~ Good afternoon, I'm Alice. Lots of people say they want to know what a day looks like for all kinds of N (not that many people, actually), and someone asked me why I like working in the ED, so today I'm revealing Alice's day in Wonderland!

Let me introduce myself first. Um... this is my third year as an RN. I currently work in the ED of a public hospital in Brisbane. I hate morning shifts and I'm a bit grumpy at work (because I can't get up, I'm so sleepy). But this post still uses a morning shift as the setting. The shift breaks down into these steps~

1. Receiving the royal decree:

The morning shift runs 0700-1530. At 7 a.m., all the morning-shift nurses and the night shift's in charge gather in the tea room, where the morning's allocation is read out (your humble servant receives the decree). Because the ED is split into different areas, the boss from the previous shift assigns us to areas based on that day's skill mix. After the reading, they cover odds and ends about the unit, like an upcoming in service or masks being required again, and then everyone goes to squat in their own pit (?), heading to their assigned area to wait for handover~ Handover: In the ED the ratio is 1:3, and you'll also have 1-2 coworkers in the same area. We use team nursing, so you need to know a bit about other people's patients too. Depending on how busy the previous shift was, it takes anywhere from 10 to 20 minutes. Morning taking over from night is usually shorter; after all, who comes to the ED in the middle of the night instead of sleeping at home! Handover is usually a bedside handover, which, as the name says, means hearing the patient's story at their bedside. It roughly covers: the patient's name, age, sex, why they came to the ED, what tests were done (e.g. bloods, ECG, CT or XRAY), roughly what the results were, what medications were given, and what they're waiting for. “What they're waiting for” sounds odd, but in the ED the most important thing is knowing the patient's next step (after all, we want patients out of the ED as soon as possible so we can welcome the next VIP), including but not limited to blood results not back yet, still waiting for a CT, or waiting for a consult from some department. When we finish with a patient, we also ask whether they want to add anything to the story or have any questions. We want to bring the patient into the handover so they can confirm it's accurate, and it also helps them understand their next step better. This way of handing over greatly reduces patients' confusion about their treatment plan, and the information gaps in our handover too. Once handover is done, the wonder(land)ful day officially begins!

First, a disclaimer: everyone works differently, and it's not that A is the best and B is the worst. My way of working grew out of my own habits~ As long as you get the work done smoothly, it's a good way of working~ The shift planner I mentioned before doesn't work in the ED, because there's no such thing as a routine in the ED...

2. Meeting the patients:

After handover I officially go see my patients, say hi, introduce myself, and ask if they'd like something to eat. While we chat, I start taking their vital signs and checking the emergency equipment. In the ED it's one set of obs an hour, so I usually just keep the equipment hooked up to the patient and tell them to let me know if they want to walk around. After writing down all the numbers, I go through everything not yet done based on what I heard at handover, including but not limited to oral or IV meds. First I check whether the doctor has written the order: no order, find the doctor; order in, get the meds; once everything checks out, I help the patient take them. If several patients need oral or IV meds at the same time, I think about who's more urgent. This is where clinical judgement really matters: they may all look important at first glance, but some can wait and some can't. I do the IV meds first and grab the oral ones while they dissolve (time management master?). By the time I've wrapped up what the last shift left, it's around 8 or 9. If I have time, I start on odds and ends, like restocking supplies (because when you're really busy and need something that isn't there, it's so infuriating).

3. Break:

Around 0830 I go on tea break, which is about 15-20 minutes. I usually have breakfast and a coffee then (I really can't eat first thing in the morning, and it gives me diarrhea), so my brain properly wakes up. Busy: After the break, from about 0900-0930, patients start coming in one after another. If a coworker happens to be on break, we help each other take in patients. A bit of background here: ED triage in Australia runs from 1 to 5. Category 1 is the most serious and needs a doctor right this second. Those patients have their own resus area, which doesn't really involve a newbie like me~ Most of our patients are category 2 or 3, and 2 is more urgent than 3. When a category 2 patient is coming, the triage nurse makes an announcement so the doctors and nurses in that area can get ready. Category 2 patients are “mostly” chest pain with risk factors, suspected sepsis, major car accidents with cervical spine protection, or young children having trouble breathing (I won't go into the rest, since I'm not a triage nurse). Common cases (e.g. chest pain, trouble breathing, stomach pain) are handled about 80% the same way, and you pick them up quickly once you've seen enough. The other 20% vary with the doctor's decisions and the patient. We're not doctors, but if an order seems unreasonable to you, you should speak up and ask at the right moment~ Let me use a category 2 patient as an example of taking in a new patient. When I hear a category 2 is coming to my empty bed, I turn on the monitor and get the computer ready. When the patient arrives, I introduce myself and have them change into a hospital gown. By then the doctor shows up too, and I start on vital signs, an ECG and so on. While the doctor takes the history, I pick out the story and write it up as my own notes, then ask any follow-up questions once the doctor is done. If I can manage it, I'll take blood for the doctor while I'm at it, but if I'm swamped, the doctor has to fend for themselves or wait a bit~

4. Handover again + break:

After a busy stretch, it's suddenly 1400! Ah, how lovely~ It means the afternoon shift will be here soon to take over~ Before they arrive, I go over my patients to make sure I've written my notes, have their latest vital signs, and know their next steps. Once the afternoon shift arrives, it's another round of story time, and after that I can eat! The meal break is about 30 minutes, or maybe 40-45 if there's an in service. This is when my urge to go home peaks, but after eating I still have to dutifully go back so the afternoon shift can take their tea break. If anything I handed over to the afternoon shift isn't done yet, I try to finish it first unless something more important comes up, partly to lighten their load and partly because I don't like things getting delayed. Of course, you only have two hands; if you really can't get everything done, don't feel sorry, just do your best. Nursing is a 24-hour job; that's why there are three shifts. Once my afternoon-shift coworkers are back, I can happily slip away~ Of course, when you slip away, you take the coworkers on your shift with you; sneaking off alone is rude~~ I make sure my coworkers don't need help, or that the afternoon shift doesn't need me to cover anything, before I head off~ The scheduled finish is 1530, and I usually leave around 1520-1530~

As for why I like the ED? Maybe I've always liked challenging, exciting environments. Getting something done that I find hard gives me a real sense of achievement, and in the ED I see lots of things I've never seen and learn things I've never learned. Maybe I'm a bit adrenaline addictive hahahaha~ I want to take leave and quit every day, but I think I still really love this job♡

(My work skills may be lacking, but the gear has to be all set~ hehe🥰)

Alice's ramblings: This time I recorded my Wonderland day in a pretty blow-by-blow, diary-like way. Hope you like it. My first hospital job was in the ED, and my memories of the wards come only from student placements, so I didn't write about a day as a ward nurse~ If anyone wants to know about a day as a ward nurse or clinic nurse, leave a comment and I can ask a friend to write a guest post hahahaha😂