My nursing placement in Accident and Emergency

Placements are an important part of any nursing or healthcare degree. Child Nursing student Abbi reflects on her experiences on placement in the paediatric Accident and Emergency department.

Placements are a big part of my child nursing course. So far, I would say that my favourite placement has been the Paediatric Accident and Emergency (A&E) department.

What are A&E wards like?

The A&E department is where those with serious injuries or illnesses that require an immediate response go. Examples of this are: broken bones, unconsciousness, convulsions, breathing difficulties and cardiac arrests. The Paediatric A&E department is specifically for children and young people aged 0-16 years old. It is usually a very busy department and is open 24 hours a day/365 days a year.

Patients can come into A&E through a number of routes:

• Self-referrals when a person brings themselves into A&E
• GP referrals when a person comes into A&E following the advice of a GP at their local surgery
• Ambulance where it is not possible for a patient to bring themselves to the hospital or they need medical attention immediately.

Triage

If patients comes in on their own they would usually check in at the reception and waited to be triaged. This is where a nurse initially assesses a patient using the resuscitation council's A-E approach and asks the reasons for them coming into the department. The patient has their first observations done, including temperature, heart rate and respiratory rate.

This is also where nurses make clinical decisions about their patients and prioritise their needs depending on the severity of their condition. For example, a child who comes in and cannot breathe properly would usually be seen before a child with a broken finger. In some hospitals this is done using the Manchester triage system which involves five categories:

• red: immediate
• orange: very urgent
• yellow: urgent
• green: standard
• blue: non-urgent.

There are also lots of sub categories that help professionals to distinguish between each patient into each of these categories.

If a patient comes in an ambulance, they usually tend to go into Resus if they are severe enough. The Resus of A&E is a separate area in the department, usually used for those admitted by ambulance who are seriously ill or injured and need immediate medical care.

Working the night shift in A&E

During my placement in the A&E department, I was on a number of night shifts, which was a great experience.

The shift would start at 7.30pm; this is where we would handover and find out about the children and young people currently in A&E. The day staff would then leave and we would take over the care of the current patients. This would include asking doctors to assess/review patients, asking specialists to come and see patients, and performing nursing care such as putting casts on broken limbs, taking bloods and completing urine samples.

While we worked, new patients would be constantly coming into the department. When a patient books in to A&E, it would come up on our computer screens and we would have a short amount of time to respond to them. The new patients could potentially be in a worse condition than the current patients, therefore A&E nurses have to be very good at triaging their patients and prioritising their needs.

There was also a chance that we could receive a phone call at any time stating that a child was coming into Resus, meaning that a competent nurse would have to go and help look after a seriously ill child or young person.

Another pressure is that we would have a maximum of four hours to move a patient on in their care, whether this was to the ward or discharging them. This is for all patients regardless of their condition. This put a lot of pressure on the nurses and when it was busy this was incredibly difficult to do, which meant that they had to work both competently and quickly.

What I learnt from my placement

I learnt a lot from my placement in Accident and Emergency:

• how important it is to be able to prioritise aspects of patient care and how this could have a huge impact on the patient's condition if not successfully done
• how important teamwork is in the A&E environment, as without it patients may be missed and this could have serious impacts on them
• how important observations are within patient care as it could indicate whether a patient is deteriorating or not, which could potentially happen even after triage.

Overall I have really enjoyed my A&E placement and I cannot wait to come back for my sign-off placement.

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