Kathleen E. Carlson, MSN, RN, CEN, FAEN, an ED staff nurse at Sentara Virginia Beach (Va.) General Hospital, is the president of the Emergency Nurses Association. Carlson worked the majority of her career as an emergency and trauma nurse. She held positions as staff nurse, nurse educator, nurse manager and trauma coordinator. In this Q&A, Carlson talks about emergency nursing and its challenges and changes over the years. She also shares her words of wisdom for those considering the specialty.
Q: In your experience, what do you think attracts RNs to become ED nurses and why do they choose to stay in the specialty?
KC: Some of the unique characteristics of emergency nursing that draw RNs to the specialty are the fast pace, excitement, use of wide-ranging assessment skills, variety of work, unpredictability and gratification of helping people during an emergency. Emergency nurses enjoy a challenge and the opportunity to be part of a dedicated team that saves lives on a daily basis. Emergency nurses stay in the specialty for the same reasons they are drawn to it. Emergency nursing can be stressful, but it’s never boring.
Q: What have you identified as effective ways for nurses to cope with burnout in the ED?
KC: It’s important we take personal responsibility for our health and well-being. The key to achieving and sustaining a state of wellness is work/life balance. This involves balancing time and energy. Take a deep breath, step away when you can, and strive for balance at all times.
Nurse executives and managers must develop and implement strategies to create safe and healthy environments for patients, nurses and all healthcare workers. Nurses and other healthcare workers must be allowed adequate breaks and be able to consistently leave at the end of their shifts. We must look out for each other; teamwork is extremely important. Encourage dialogue after difficult patient situations and be sensitive to others’ needs and moods.
Q: What have you seen as effective ways facilities and professional organizations support nurses who have experienced workplace violence by a patient or visitor?
KC: Educating nurses on how to mitigate violence and supporting them when violence does occur are two important goals. Institutions must have zero-tolerance policies in place, and we must report violence and press charges. Clinical staff and hospital leadership need to assess workplace violence challenges and create a proactive plan, and just as important, remove the culture of acceptance around violence. Thanks to a grant from the Occupational Safety and Health Administration, ENA developed “Workplace Violence: Know Your Way Out,” a free, two-hour online course designed to teach nurses, managers, and staff who work in emergency care settings how to recognize workplace violence risk factors; apply prompt and appropriate responses; implement organizational prevention strategies; and report and analyze patterns of violence.
Q: What words of wisdom do you have for nurses who are considering becoming an ED nurse?
KC: Emergency nursing is a great profession. While emergency care is its own nursing specialty, become familiar with the variety of career paths in emergency nursing. You may enjoy using your nursing skills in the following settings: hospital EDs; poison control centers, emergent care and crisis intervention centers; prisons and correctional facilities; businesses and corporations; federal and state government agencies; research institutions; military settings; emergency medical services; flight nursing; and professors at schools of nursing at universities and colleges.
I know a number of emergency nurses who split their time among several career paths. An emergency nurse may work in an ED and also work as an EMS and a flight nurse. Others are ED nurses who teach at the local university. The opportunities are endless.
Q: What preparation do they need? What resources can they use to help them in their decision-making?
KC: While emergency nursing is a specialty, emergency nurses must have a broad range of knowledge and skills. In the ED, you will care for children, the elderly and everyone in between. You need to have good observation, assessment and prioritization skills. Some personal characteristics that serve emergency nurses well are the ability to multitask, shift gears and accelerate work pace as needed. Emergency nurses also must have exceptional interpersonal and customer service skills.
In nursing, education never stops. At a minimum, emergency nurses should take the trauma nursing core course and emergency nursing pediatric course during the first year. Certification in emergency nursing is strongly encouraged after practicing two years.
Q: What positive changes have you seen in the specialty over the recent years? What challenges does the specialty face in the months and years ahead?
KC: Some improvements in delivering safe patient care include barcode scanning for medication administration, second checks for all high-risk behaviors, clinical decision support and EHR alerts for patients who meet sepsis, fall or psychiatric criteria.
The ever-changing world of insurance coverage and reimbursements contributes to the challenges, and customer service initiatives and metrics also create additional challenges. The ED is also where many patients go for primary care, so we need to do a better job of educating the public about what does and doesn’t warrant a trip to the ED.
As baby boomers are reaching retirement, we need to have appropriate nurse staffing allocations so we can provide comprehensive care instead of episodic care, and take care of ourselves as well. The workforce is also aging, so we’ll have to ensure our young nurses are properly trained and everyone is keeping up with new technology. It’s an exciting time to be in healthcare.