I had a great response to one of my earliest posts, 5 Things I Learned in Medical School I Wish I’d Learned in EMT School, with many people asking for more tips on improving as an EMT.
With that in mind, I realized that learning how to interact with the staff in the Emergency Department (ED) is also an art not often addressed in EMS education. Clearly you need to know and execute your protocols effectively – but how can you stand out as a respected EMS provider? Fortunately, I’ve been friends with an awesome charge nurse named Katie Arnold since junior high. She was kind enough to answer a few questions.
Steph: How long have you been a nurse, and how did you get to be a charge nurse?
Katie: I have been a nurse for 14 years this May 2015 – I have spent my whole career in the emergency department. I was selected for charge nurse by my manager, trained by another charge nurse and then started on my own around 2006-2007.
Steph: What do you like most about your job?
Katie: As an emergency nurse in general I love the unpredictable and unexpected. I tell new nurses, patients and their families all the time that it’s like a jigsaw puzzle: you get a piece here and a piece there but you don’t figure out the whole picture until all the pieces are in place. I love that I can have 5 patients all with the same chief complaint and each will be managed totally differently. As a charge nurse I love being a representative for the department, working with ancillary staff, patients, families, nurses, and EMS. I am there to control the flow of the department, to be a professional example for everyone and handle many administrative duties. It adds a whole other dimension to the role of nurse that allows further development of a holistic nurse.
Steph: Can you explain the goals and responsibilities of a charge nurse, in particular, ways you interact and work with EMS?
Katie: The duties are numerous and in depth. With EMS, we are the liaison between rescue and the ED. EMS providers are the eyes, ears and hands in the field; they are going to paint the picture the charge nurse needs to determine how each ambulance patient that arrives will affect the balance of the ED at every moment. You must appreciate their role in addition to the roles of the ED staff. Their resources are vastly different than the staff in the ED. I think staff nurses as well as some charge nurses lose sight of that fact.
Steph: What makes a good EMT in your mind?
Katie: A good EMT knows their role, provides an accurate concise report of what they are transporting to the ED. They demonstrate professionalism despite the stresses presented by the patient, the scene and the ED. A good EMT knows when to address concerns and when not to.
Steph: Do you have any pet peeves of EMS providers?
Katie: Lengthy reports of extraneous information and lack of recognition about valid concerns of the ED staff. One cannot expect the ED staff to appreciate EMS constraints but then not care about the concerns of the ED staff.
Steph: What can EMS providers do to make your life as a charge nurse easier?
Katie: As Charge Nurse, I have to decide what type of bed is appropriate for the patient based on the EMS report. Do they need a heart monitor, a psych bed or oxygen? Not all rooms are equipped with the same capabilities. A good report provides me with the information to make this decision. Helpful EMS providers also note when the ED is busy, and go the extra mile to be team players. Whether it’s cleaning a bed or hooking a patient up to the monitor, while not the job of the EMS provider, it helps the patient get care faster.
Steph: Which EMS providers impress you and why?
Katie: Those who are clear, concise, professional both in front of their patient and amongst colleagues on the EMS and ED side. Providers that are open to and understanding of constructive criticism.
Steph: Any tips for a brand new EMT?
Katie: I believe that when a new group of EMT’s are coming out they should have an initial interaction with a charge nurse or liaison at the ED to discuss these topics and allow for questions they may have to be asked prior to starting on the road. If that’s not done formally, then an individual EMT should feel free to introduce themselves to ED staff and seek feedback on reports.
Steph: And finally just for my own curiosity, what’s it like to be charge nurse on July 1 when the new Intern doctors start?
Katie: I love to teach and educate, so it does not bother me as it does others. ED Staff tend to become frustrated because each new class of Interns is unaware of how each ED operates with different patterns and order sets, goals and metrics. Some doctors are more receptive to that fact than others. It can drastically slow the flow of the ED and directly affect the care of the patients. New Interns are successful as long as they are willing to listen.
So there you have it, straight from the boss’s mouth. My advice, pick one thing to try and start there. Good patient reports are 90% of the game. Once you nail that, the rest falls into place.