Today I read a quote that an EM consultant from the US posted on twitter that pretty much sums up how I feel about Emergency Medicine….
Maybe I should elaborate.
It’s been a rough couple of months. I recently made the transition from being an ENP, seeing and treating mostly minor injuries and illnesses, into a trainee Nurse Clinician role (mostly thought of as ANP).
Before I even went for this role I knew I was going to struggle, but it’s my dream job, and after chatting to our consultants and matrons and my fellow advanced nurses I went for it and was very lucky (even more lucky that they know what I’m capable of as I was a blithering idiot in the interview).
So here I am. And so far I seem to be doing ok. It’s extremely bloody hard work. I go home most days with a headache from having to think so hard.
And our department is the same as any other, full to busting, stressed, overstretched and underfunded.
But I’m lucky in that I have an incredible team around me.
The consultants, other ANPs and senior doctors are ridiculously supportive and happy to teach and discuss things. They take on the role of supporting parent when I have a panic that I can’t do this, remind me that I haven’t done five years of medical school and it’s ok to still be learning. They can be a protective mother, (in way that only Emergency Department gang members can) and I’ve had at least four of them so far get into stand up arguments with other departments on my behalf. And they can role their eyes and take the mickey like an older brother when I forget my words and say things like “this looks too wiggly”, or “It sounds a bit fluidy”.
Theres a sense of camaraderie with the junior doctors in that if we can stick together then we can get through this, and we constantly seek advice from each other, or reassurance that “don’t worry I didn’t know that either”. The ED nursing staff constantly save my arse and have my back, in a way that only ED nurses can, somehow finding the time during the ridiculous amount of stuff they have to do to remind me of things I’ve forgotten, tell me not to worry and “did you spot that early warning score double?”.
I also have a very supportive network of friends, family and an amazing other half around me to tell me I’m amazing when I don’t feel it.
So between all that, the stuff I’ve learnt at uni, the stuff I’ve picked up by osmosis over the last decade, and the reading I feel I’m constantly doing to keep up, I think I’m getting there.
There are certain things, however, that can’t be taught. That you just have to do. Things that aren’t a “nurses job” so they don’t cover it in uni. It’s the art of delivering bad news.
I say art, because it is. As an ED nurse I’ve been in a position many times seeing doctors give various forms of bad news. I’ve seen some do it incredibly well. But at times I’ve sat there thinking “shit that’s not how you tell someone that”. I try my best to draw on all this experience and do it in a way I hope ‘judgmental staff nurse me’ would approve of.
The first “big one” for me was telling a young woman, also a nurse, that it looked like she may be having a stroke. She came in alone to get her headache checked out. And I saw the fear in her eyes as I told her. I knew as a nurse she was thinking of all the worse possible outcomes and she started to cry. So I hugged her. I didn’t know what else to do. And it seemed to help. We sat there on the trolley like that for ten minutes whilst she cried and I hugged her. I tried to reassure her by saying we needed more tests yet, and joked that if it was anything to worry about she knew fine well how many people would be in there flapping about, and she felt much better so I think it went ok. So I sent her to the stroke ward and went on to the next patient.
Then I went home and cried my eyes out. And I think that’s ok too.
We recently had a small person die in our department, and in the debrief one of our incredible consultants cried. The fact that he could do that, I think, is testament to what a wonderful team we have. Him showing his emotions like that showed the rest of us that it’s OK to feel things, so we cried too. Its sad, it’s what you’re supposed to do. As it was a first time for both of us, the senior registrar and I spent the day working together as a tag-team, taking care of each other.
For a long time we’ve been taught that we should keep our emotions in, or “man-up”. ED staff have a reputation for being hard faced and unfeeling. But here it doesn’t feel like that. And I think that’s a very good thing.
When I have a bad day I use my 30 minute drive home to call Poppa Mids, and his words were “if you don’t get upset when something like this happens then you shouldn’t be doing that job” and I think he’s right.
Being able to care and empathise, but still remain professional, is an important aspect of our job. And I think coming from a nursing background into advanced practice makes me better prepared for that, having spent years holding people’s hands and making tea when they receive bad news.
So now I just need to learn all the big words!