A dual-registration newly qualified nurse reflects on what she has learned in her first year working in the emergency department

I had always wanted to work in emergency care due to the variety of patients and scope for professional development.

After four years studying for my dual-registration nursing qualification, I graduated as a mental health and adult registered nurse in August 2018, and several months later started as a newly qualified nurse (NQN) in the emergency department (ED) at the John Radcliffe Hospital in Oxford.

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The department serves as a major trauma centre to the local counties and receives more than 130,000 patients a year.

The different areas of care in the department – triage, minor injuries, assessment, majors, resuscitation – mean every day is different.

Dual-registration nursing in the ED

In line with my dual qualification, I work across the physical and psychiatric disciplines of emergency care, looking after adults and children from a variety of cultures and backgrounds. My time is split between two roles.

I work part time for Oxford University Hospitals NHS Foundation Trust, in the main ED nursing team. This role involves assessing and treating patients with medical, surgical and trauma presentations.

My other role is with the ED’s specialist psychiatric liaison service, run by Oxford Health NHS Foundation Trust. I work with senior clinicians to formulate safety plans for patients requiring urgent mental health care, including those who are feeling suicidal or have self-harmed.

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This post is a unique band 5 development position, created with the aim of consolidating dual registration skills and widening experience through temporary placements in other mental health settings, such as acute inpatient wards.

‘I learned many lessons in a short space of time and not always the easy way’

Core nursing skills, such as communication, pain management and assessment, are fundamental across all areas, and I have also developed more specific skills in areas such as blood transfusions, airway management, performing electrocardiograms (ECGs) and applying plaster casts.

Structured preceptorship programme supported me in my first year

I knew that being an NQN in the ED would be a steep learning curve, but experiencing the rapid deterioration of a patient’s condition was a shock to the system, as was the seemingly endless list of new skills involved in ED care.

I learned many lessons in a short space of time and not always the easy way. But the structured preceptorship programme in place in both trusts has been invaluable in supporting me in my new role.

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Preceptorship support and training is in place for at least a year, with the option to extend this to a second year while learning more advanced skills and the opportunity to gain master’s level degree credits.

The preceptorship programme gives me protected time to discuss my experiences with other NQNs, including our responsibilities and the difficult decisions we face. Senior practice educators provide guidance and advice on how to manage and develop our roles.

Collaborating in the ED to deliver care

No matter how challenging a shift may be, the culture of collaboration among emergency teams is one of the best things about working in this highly specialised area.

I see the contribution of the whole multidisciplinary team, from the doctors, therapists, healthcare assistants and ambulance staff to the porters, housekeepers, administrators and chaplains.

‘The culture of collaboration among emergency teams is one of the best things about working in this highly specialised area’

ED staff also work closely with the police, social care and community nursing staff, with everyone pulling together to deliver high quality, patient-centred care.

Involving family and carers, with the patient’s consent, is also essential in providing holistic care in the ED.

Work-life balance helps keep stress in check

In emergency nursing, the ability to balance the worlds of work and home is so important – lying in bed replaying the decisions you made that day or hearing call bells in your sleep (it happens) is inevitable in this role, but it’s important to keep this in check.

Unmanaged stress can lead to burnout, so it’s vital to spend some time relaxing, doing things you enjoy and speaking to those you trust.

‘Having a professional curiosity is an invaluable nursing skill – it will help deepen your understanding of what you learn’

My commute is a brilliant time for reflection and grounding. I usually consider three things that didn’t go so well, three things to improve on and three things that I felt proud of. Taking the time to focus on my strengths boosts my confidence and helps me maintain a positive attitude after difficult days.

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In an environment such as the ED, where you have limited time with a patient in a critical condition, my advice is to question everything. Having a professional curiosity is an invaluable nursing skill – it will help deepen your understanding of what you learn in the department and encourage practice development.

Ten months into my role in the ED, I love being part of an amazing team that delivers first-class care to patients at their most vulnerable.

If you have a passion for high-paced, interventional nursing, why not give the ED a try?

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Anna Magdalena Miell is a staff nurse in the emergency department at John Radcliffe Hospital, Oxford