My job: consultant nurse Cliff Evans
Consultant nurse Cliff Evans on why you need 'true grit' to work in an emergency department.
Cliff Evans is a consultant nurse at Medway Foundation Trust emergency department. Dedicated to improving patient care, he was the first member of a new senior leadership/management team to join the trust last September during challenging times.
The trust was one of 11 placed in special measures in 2013 with concerns over high death rates. The ED has now been made safe for patients.
Why did you become an emergency nurse?
I love working in an environment of controlled chaos. The emergency care environment is one of the true multidisciplinary areas.
How and where have you developed your emergency care skills?
In a 28-year career I have worked in or with 19 emergency departments (EDs) and developed and taught several postgraduate programmes as an emergency care lecturer.
I have also served overseas in unorthodox environments. I did tours to Iraq in the parachute regiment. At the beginning of the Iraq War the Army wasn’t prepared for the casualties it got, there weren’t many emergency care trained nurses and civilian nurses were employed because of the shortage of Army nurses.
How does your current job make use of these?
I chose my last two EDs as they had been placed in special measures after extensive regulator criticism for providing unsafe and suboptimal care.
What tends to have happened in these departments is that you cannot provide good care to patients due to the lack of staff, poor processes or dysfunctional organisations. Regaining control means that you’ve made your area safe. You are making sure patient pathways work correctly and that patients receive proper, standardised care.
What do you enjoy most about your job?
Lots of people say they have the best job, I really do. I’ve always had a hyperactive mind and the emergency environment allows me to undertake several roles simultaneously.
I feel rewarded from seeing patients in all areas of the ED. I plan and deliver several teaching courses to all members of the team, I constantly look for ways to improve the care patients receive.
What is the greatest challenge you have faced, and how have you overcome it?
Coming to Medway, a trust and ED that has remained in special measures for more than three years despite dedicated expert support, was a great challenge.
The first phase for improvement focused on making the ED safe for patients, this is now the case. We still experience times of high risk but patient safety is paramount to everything we do. This has been an incredibly difficult time for the team. They are great and have gone that extra mile to ensure our strategy works 24 hours a day.
What makes a good emergency nurse?
What keeps you awake at night?
When you work in an ED that is deemed unsafe, has inadequate staff and hasn’t invested in educating its workforce, you leave work knowing that your department could become infamous at any point. Achieving the first step to establishing a solid level of patient safety is a fantastic feeling of relief.
What advice would give a nurse who’s starting out in emergency care?
Emergency nursing is a fantastic career. Learning to deal with the pressure associated with an environment always under extreme scrutiny, with high expectations from political organisations and the public, can prove a challenge.
Learn to deal with the stress and focus on providing the best care you can. Always have a rationale for what you are doing, and then you will have succeeded.
What is likely to affect emergency nurses most over the next 12 months?
The ongoing deficit of specialist nurses results in additional, unnecessary pressure. Inadequate staffing is the number one risk to effective patient care. Educational budgets are again being reduced this year, resulting in fewer nurses undergoing specialist training.
Emergency nurses may well face their departments having to close or reduce hours due to dangerous staffing levels.