Editor’s Note: This series was created by Gerhard Dashi and this week’s post was co-authored by Anali Maneshi. The series highlights the important work that our interprofessional colleagues do. Keep your eye open for more “Phone a Friend” articles and if you would like to be featured or know a colleague that should be highlighted follow this link to complete the questions on a google form.
Background on the “Phone a Friend” series
This is the third interview in the Phone a Friend series. This series gives our interprofessional colleagues a chance to remind their Emergency Medicine peers what they do and how we can effectively work together.
If you or someone you know is an allied healthcare worker in the Emergency Department, we would love to hear from you. Please send us the questions you would like answered or your own answers to the following questions.
The Noteworthy Nurses
We are privileged to have two nurses sharing their perspectives with us for this piece. Daniel-Martin (DM) Leduc works a registered nurse at Montreal General Hospital, and she has special training in trauma. Ana Krause is a registered nurse at Kingston General Hospital and Hotel Dieu Hospital.
Profession/ Current job title: Registered Nurses
Years of practice: 6 for Daniel-Martin and 5 for Ana Krause
Country of practice: Canada
Practice setting: Daniel-Martin works in an emergency trauma center while Ana works in a tertiary care facility with trauma and stroke care.
What do you do on a regular basis that has the biggest impact on patient care?
DM: Embracing the patient advocacy role! In other words, being their voice when they are at their most vulnerable state in the ED.
Ana: Collaborating with team members to ensure that patients get the care they need, for example by communicating concerns regarding patient safety for discharge.
What is the most common misconception about your role in the treatment of the acutely ill?
DM: Since the ED is a fast-paced environment, there is a misconception that we cannot appropriately care for the patient. Even though we need to work quickly and in a timely manner, the patient is always at the center of our attention.
Ana: I suppose [the most common misconception] is the idea that nurses are just there to give patients their meds and put them on bedpans. Although that is a part of our job, it is certainly not the defining feature. I don’t think most people realize how much we work together as a team, that we have a much greater knowledge base than [bedpans and meds], or really how much autonomy we have as ED nurses. Unfortunately, popular depictions of nurses, such as in TV dramas, perpetuate these stereotypes. Nurses are either not featured or physician actors fulfill roles that would normally be carried out by a nurse.
What is your favourite thing about working in an interprofessional environment?
DM: It is quite amazing to have the privilege to work with a myriad of professionals with their own areas of expertise. As a result, the ED is a true milieu of exchange and evidence-based practice, and it stimulates new avenues that we need to consider in order to provide the best care for the patient.
Ana: I am also always impressed to see how much we accomplish in a short period of time when everyone is on the same page. I think this is especially apparent during critical care scenarios. Everyone is collaborating to ensure the best outcome for the patient and each other, for example [by initiating] necessary but difficult interventions, good closed-loop communication, debriefs, [and] case discussion.
What is the most difficult thing about working in an interprofessional environment?
DM: Sometimes it is quite challenging to not interfere with the area of expertise of others, especially when there is an emotional component.
Ana: There are some occasions where communication is not the best that it could be and care gets delayed or missed. I think this is likely because the department is busy and everyone is often dealing with multiple things at once.
What could be done to improve interprofessional practice in the ED?
DM: Periodic reviews of cases in multidisciplinary teams.
Ana: I would love for more interprofessional education to be offered to all professions. For example, simulation training for resident resuscitation rounds could have nurses, respiratory therapists, and others attend on a regular basis.
What is your biggest “pet peeve” when you are working in the ED?
Ana: Not having sufficient space to bring in new patients, and therefore having to constantly plan for which patients can be moved into halls or chairs. There are many reasons that our department is often overflowing with patients, including but not limited to lack of inpatient beds for admitted patients, patients awaiting long term care that are not safe for discharge, consultants using our department to complete pre-op assessments before discharging home, and so on. This is obviously a problem across the country and is not only a ‘pet peeve’ but also a significant source of added stress for everyone since the quality of care suffers and many great staff members burn out.
If you had to pick the one thing about your job or career that you are most proud of, what would it be?
DM: The feeling that, for a brief period of time, you are the person that can alleviate pain and suffering, and can treat the patient with the fundamental dignity that they deserve.
Ana: I think about how much I have learned over the past 5 years and the pride that comes with applying that knowledge to benefit patient care and gain the respect of co-workers.
Can you provide an example of an optimal patient interaction (e.g. one in which you used all of your training to positively impact the outcome for a patient)?
DM: We received an unstable patient in the trauma bay; he was hemodynamically unstable, [had a] low Glasgow Coma Score, and so forth. The patient was significantly ill and we had no idea what was going on. As a team, we had to take a step back after numerous failed attempts at increasing the blood pressure with boluses and vasopressors. After a team member’s suggestion, we considered cardiac tamponade as a cause for this patient’s condition. Once confirmed, we did a pericardiocentesis and the patient survived. He went home two days after! It was such a great moment of intense yet true interprofessional collaboration!
Ana: I triaged an older lady who presented to triage complaining of nausea and vomiting. Knowing that women can have atypical cardiac presentations, I asked some other ‘screening questions’ and determined that her symptoms were likely cardiac in nature (chest heaviness, SOB, left arm pain) and so brought her into the department to be quickly seen. She was a STEMI and promptly went up to the cath lab. This made me appreciate the value of my earlier training.