By Chris Hinder MACN
In February this year, I was fortunate enough to land my dream graduate position in a large tertiary referral centre emergency department (ED) in my home town. After three hard years at university, I could finally call myself a registered nurse! Now, six months into the program, I would like to reflect on my experience of transitioning to professional practice.
I don’t think there is anything else that could halt a group of graduate nurses’ enthusiasm than corporate orientation! My first week was not nearly as exciting as I had envisioned in my mind. Endless presentations and self-directed online training almost consumed all of my enthusiasm. The process of being let loose on the floor was a bit more arduous than I first anticipated. My excitement was renewed during the second week which involved an orientation to the ED, the clinical assessment model used by nurses in the department (HIRAID), some simulations and then going out on the floor to practice some of the skills we learnt. The third week involved being out on the floor in addition to the numbers with my preceptor. This was my opportunity to get my head around some of the processes and focus on patient assessment in a not so rushed environment. The beginning of my last day supernumerary was framed with the notice “this is your last chance to practice because it’ll be all you next week.”
I remember one of the first (of many) unwell patients I took care of – it was an older gentleman transferred from another facility due to shortness of breath and triaged as a category three. I assessed him and he was mildly tachypnoeic, slightly low blood pressure and had multiple red flags including left and right ventricular failure, a pacemaker and heart valve replacements. The biggest flag, however, was that he just looked terrible. I was in a bit of a panic, thinking ‘’what do I do, what do I do…” but in a moment of clarity I remembered the orientation just a week ago, so I escalated the gentleman to the clinical manager and told her what I’d found. She took one look at him from the write-up bay and then re-triaged the patient and asked the in-charge doctor to review.
My advice to other early-career nurses starting out in ED would be:
- Make a habit of introducing yourself to everyone you meet and letting them know that you are a graduate. People are generally more supportive and likely to teach you along the way.
- Recognise when you don’t know something and don’t keep this information to yourself!
- If you ever become completely inundated and have no idea what is going on with your patients, just reset and regroup with your partner. Go around and systematically assess each patient, read through the notes and work out where they are at and what needs to happen so they can be discharged or transferred out of the department.
- Keep a list of tasks that need to be done so if you are offered help you know how they can help you. One of my downfalls is when people where there to help I’d be saying “I don’t know” – which is the wrong answer.
Despite the first six months in ED producing some of the most challenging experiences of my life, I do not have any regrets whatsoever. ED is an exciting, dynamic workplace where I am able to work with some of the most intelligent, dedicated and skilled people I have ever met.
I’m looking forward to completing my graduate program in February and hopefully to continue to work in this fast-paced environment.