Is there a need to define myself as a nurse?
Even though Mark Case has taken on a new advanced role, he still regards himself as a nurse and is proud of that label.
I was working in resuscitation recently when I was asked by one of my senior nursing colleagues if ‘I still considered myself a nurse?’
As a trainee emergency care advanced clinical practitioner (ACP) in an emergency department, who is working towards credentialing with the Royal College of Emergency Medicine, I was blindsided by this enquiry.
I believe it was a genuine question based on the fact I was in resuscitation managing a cohort of patients at the time.
Initially, I struggled to answer.
When people outside work ask what I do, I always say that I am a nurse. It’s simpler; the ACP role is difficult to sum up in a sentence for non-healthcare professionals.
More importantly I am a registered nurse and I am proud of that fact – I am not a doctor nor am I pretending to be.
My initial response was that my role is very different from that of my nurse operational role 18 months ago.
I don’t have a group of staff who I complete appraisals for or manage from a human resources point of view and I am no longer the lead for an area of the department. The day-to-day running of the department from a nursing perspective is no longer my responsibility.
'The memory of advanced practice has faded, and I hope that my ACP role is helping to normalise this again'
Instead, my role is now seeing patients in minors, majors, resus and the assessment area. I take histories, assess the patient and decide which investigations to request in order to exclude porential life-threatening casues of a patient's presentation, or in minors which imaging to perform, or how to treat a wound.
I interpret results and make plans based on these. As I am a trainee, these plans are assessed by a senior clinician.
I perform primary surveys, insert chest drains, reduce fractures and dislocations for patients requiring procedural sedation. I do things I never thought I would be doing five years ago. It's brilliant! But I also still perform ECGs, urinalysis, observations and, yes, I do empty and clean commodes.
But I am still a nurse and a role model. If I can become an ACP then many others can too.
I am doing things that are not traditionally in the realm of nursing and that haven’t been done in the department for a long time.
The departmental memory of advanced practice has faded, and I hope that my ACP role is helping to normalise this again, creating new opportunities for other nurses and the care that we deliver. One of the reasons we become emergency nurses is because the profession poses opportunities to do exciting, new things.
Present v future
In my advanced role, I am always in a state of tension between my traditional nursing position and the one I am working towards. At some point, something must give and that is often the tasks or functions that can be achieved by other members of the team not just by me.
At other times, there may be a task that I am expert in and it is, therefore, right and appropriate for me to carry it out to ensure the best care is delivered to the patient.
I certainly do not think I am better than anyone else I work with, although I worry that sometimes people think I do because I am working in advanced practice.
The truth is it's tough and I am focused on making sure I haven't missed anything with the patient I have just seen. Emergency medicine is challenging and difficult but also exciting and satisfying.
So, the short answer is: I am still a nurse, I'm just working in a new role. In another five years I doubt that will seem as unusual as it does now.
About the author
Mark Case @AENurseUK trainee advanced clinical practitioner