My job

‘Be prepared to work outside your comfort zone’

Senior charge nurse Susan Macaulay describes what it takes to work in an emergency department on a remote Scottish island

Senior charge nurse Susan Macaulay describes what it takes to work in an emergency department on a remote Scottish island


What is your job?

I am the senior charge nurse for a nurse-led emergency department (ED) at the Western Isles Hospital, Stornoway, Western Isles – a rural general hospital in the Outer Hebrides, Scotland.

I have overall managerial responsibility for the ED, and for provision of emergency, minor injury care, policy and staff development.

Because the ED has a small team, I have direct patient contact as an emergency nurse practitioner when required. This is a part of the job that I value: it keeps me grounded and helps me, as a manager, relate to colleagues and patients, and I don’t lose touch with clinical demands.

What might you have done otherwise?

When I was at school, I wanted to be a nurse and never had any other thoughts of doing anything else. Before commencing my training, I was in the Youth Training Scheme working in a hospital in the late 1980s; this confirmed my aspirations to be a nurse.

Why did you become an emergency nurse?

I had been qualified for five years when I applied to work in an ED in 1998. I was attracted by the opportunity to learn new skills, the variety in work and the adrenaline rush of emergency situations.

How and where have you developed your emergency skills?

In the early years I was mentored by senior nursing colleagues, who had years of valuable experience.

In a rural department, you need to be prepared to deal with a variety of situations where specialist help is not on your doorstep. As there is no separation of minor or emergency skills, you need to be competent in both and a jack of all trades.

Even though I have worked in the same department for 20 years, and despite working on a rural island, I have had access to practical and academic courses, where the organisation I work for has invested in my development to meet changing patient and service needs.

How did you progress through your career?

In 2001, I was given the opportunity to do a BSc Specialist Nursing (A&E) and jumped at the chance.

It wasn’t easy juggling work, a young family and studying, but on completion, in 2004, I took up non-medical prescribing and was rewarded with an emergency nurse practitioner post.

In 2012, I began studying for a masters degree in health and wellbeing with the University of Highlands and Islands. The flexibility to do these courses as distance learning while working opened up a whole new world of academia.

What do you enjoy most about your job?

Working in a team where every day is different. This is why, 20 plus years later, I still enjoy my job.

What is your greatest challenge in your job?

As a manager there are many challenges, particularly with rural health provision. We are all guilty at times of seeing our own department priorities as the most important in a hospital, but I would encourage everyone to think about the challenges across all departments. Primarily, it’s about working together for the patient.

What advice would you give a nurse starting out in an emergency department?

Never say ‘I can’t do this’ when asked to do something new. Instead, ask yourself, ‘how can we or I do this?’ Be prepared to work outside your comfort zone.

What is likely to affect emergency nurses most over the next 12 months?

Recruitment for medical colleagues in rural areas is becoming increasingly difficult and nurse practitioners are constantly increasing their scope of practice to meet service needs.

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