My job

‘Emergency nurses do an amazing job in challenging circumstances’

Somerset Partnership NHS Foundation Trust consultant nurse in urgent and unscheduled care Mike Paynter explains why he is proud of his emergency nurse team

Somerset Partnership NHS Foundation Trust consultant nurse in urgent and unscheduled care Mike Paynter explains why he is proud of his emergency nurse team

Mike Paynter

What is your job?

I have been consultant nurse in urgent and unscheduled care at Somerset Partnership NHS Foundation Trust since 2011. My role encompasses advanced clinical practice, service development and education. My clinical team of about 40 emergency nurse practitioners (ENPs) is supported by staff nurses and healthcare assistants, and they are based in minor injury and urgent care units across seven community hospitals. Last year, the service managed in excess of 105,000 patients; of these, 97% were managed as ‘completed episodes’.   

Why did you become an emergency nurse?

The thought of working in accident and emergency appealed to me from a young age. I undertook various first aid training courses and worked as a volunteer in my local emergency department (ED) at the age of 15 – something that would be impossible now.

What might you have done otherwise?

Possibly a career in the military.

How and where have you developed your emergency care skills?

I have been specialising in emergency care since 1982. My first post as a junior emergency nurse was at St Bartholomew’s Hospital, London. While there, I was encouraged by the pioneering work being done by enthusiastic ED registrars. I was lucky enough to participate in various studies which subsequently led to the standardisation of advanced life support and advanced trauma life support.

At Bart’s ED, I undertook an early paramedic training programme in partnership with the hospitals anaesthetic department and the London Ambulance Service. The hospital ran a pioneering cardiac ambulance service long before the formal introduction of paramedics.

During the 1980s, central London appeared to lurch from one major incident to another due to a combination of IRA activity and other incidents, such as the Kings Cross fire. Recent events in our capital are not a new phenomenon – our emergency services have had continual practice over many decades.

How did you progress through your career?

As our speciality developed, I was always keen to do the next specialist course. There was also the opportunity to move around different inner city EDs. There was always something new to learn. In 1990, I moved to the Bristol Royal Infirmary for my first charge nurse post. From the late 1990s, I developed an interest in the role of the ENP and contributed to establishing a robust ENP service.

How did your interest in medicolegal issues develop?

The role of emergency nurses, and in particular ENPs, has developed massively. No single ED could manage its workload without the critical contribution of ENPs. Part of the responsibility of working in advanced roles is to acknowledge the uncertainty involved with decision making, appreciate the risks and manage them safely.

When things do go wrong, it is vital that clinicians and teams learn from errors. It is important emergency nurses are properly supported by their trusts and their colleagues.

I am privileged to be in a position where I can represent and provide expert ED defendant advice when reviewing cases on behalf of NHS Resolution. I also see the patient’s perspective when things go wrong and act as an advisor for Action against Medical Accidents. Unfortunately, with clinical errors there are recurring themes.

What achievement makes you most proud?

I am immensely proud of the minor injury and urgent care services provided by my colleagues in Somerset. Like many emergency nurses, my team do an amazing job with outstanding patient outcomes in challenging circumstances. A recent Care Quality Commission inspection acknowledged the commitment of the team, which makes me proud.  

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

The recruitment and retention of our best emergency nurses is under threat. Many of our senior and experienced workforce will be looking to retire over the next few years. The impact of Brexit is already being felt within the nursing family. The continuing 1% public service cap remains an obstacle. 

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