Opinion
Letter Paramedic practitioners I HAVE just read the latest edition of Emergency Nurse (December 2013) and found it to be informative and useful. However, I should like to clarify a point made by Nick Triggle, on page 8. He states that South East Coast Ambulance Service ensures that its paramedics can administer painkillers and antibiotics. In fact, all paramedics in the UK can administer certain single-dose painkillers and antibiotics. South East Coast Ambulance Service employs paramedic practitioners,
Board’s eye view who can administer to-take-out packs of painkillers and antibiotics. Paramedic practitioners are extended-skill paramedics, sometimes known as emergency care practitioners, community paramedics and specialist paramedics. Many thanks for a great journal; keep up the excellent work. Alex Walter is a paramedic practitioner at South East Coast Ambulance Service and an emergency care practitioner at Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex
Sara Morgan
The bigger picture THERE ARE few topics that stir up as much discussion among emergency department staff as the roster: who has worked every holiday for the past three years, who has every Friday night off, and who gets flipped from days to nights and back again seemingly every other week? As a staff nurse I know it can be easy to see the faults in a department’s roster without understanding the complex problems involved in drawing it up. Roster management is an art, in which competing priorities must be considered. First the roster has to deliver, as far as possible given a department’s vacancy and sickness rates, sufficient staffing on each shift to ensure safe patient care. Because of the nature of emergency care, this means that departments must be staffed at nights, weekends and holidays, as well as during the usual business hours. Emergency nurses have implicitly agreed to work to a model of care that is 24/7. Next, the roster should be fair to all staff. This means that everyone should have the same opportunity to make requests to work the shifts that they want and to swap shifts with their colleagues.
Most trusts offer staff guidance on how to balance their lives in and outside work, but roster managers must also juggle nurses’ needs for childcare, courses and health care with the needs of the entire department. Some nurses prefer to work during the day and others at night, and roster managers try to ensure they work their preferred shifts. This can be difficult, however, because they must also ensure that all nurses have equal access to education and development, yet most study periods and meetings occur during the day. There are also financial considerations to roster writing. For example, if annual leave is not spread evenly throughout the year, higher investment in bank and agency staff is needed when more staff are on leave, especially at nights. There are also safety implications if the proportion of bank or agency staff working at any one time is too high. Spare a thought then for the nurse or nurses in your department with responsibility for the roster. It is a tricky job and there is no such thing as a ‘perfect’ roster for everyone. Sara Morgan is a committee member of the RCN Emergency Care Association
What’s your view? If you want to express your opinions about any of the issues in the news, email the managing editor at [email protected] EMERGENCY NURSE
Keeping people safe STORIES ABOUT violence and its aftermath appear regularly in the media, yet violent incidents in the workplace often go unreported, particularly in urgent care settings. Violence can have long-lasting effects on emergency care staff by increasing anxiety and triggering depression, post-traumatic stress, aggression and self-harm. We nurses recognise that people, especially those who are experiencing pain, who misuse alcohol or drugs, or who have specific kinds of mental health problems, can act violently. In impoverished urban areas, where many patients that visit EDs are involved in gangs, the risk of violence in the workplace is usually increased. But recognising potentially violent client groups is only one way to reduce the risk of violence. Another is ensuring that the emergency department (ED) environment is as stress- and anxiety-free as possible. This may involve altering the layout of EDs so that there are no areas in which staff can be trapped by aggressive patients or ensuring that all rooms are well lit. It can also mean increasing the number of ED security personnel while restricting the number of people allowed to accompany or visit patients. Violence in EDs is a multifaceted problem that is especially difficult to solve when staffing levels are stretched thin and patients continue to use EDs as primary care sites. But the reduction of violence is fundamental to ensuring good quality patient care and preventing violence. We must be hypervigilant and proactive in maintaining safe environments for our colleagues and ourselves. Rachel Lyons is assistant clinical professor of nursing, at Rutgers University, Newark, New Jersey, and a member of the Emergency Nurse editorial advisory board February 2014 | Volume 21 | Number 9 15
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Letter Paramedic practitioners I HAVE just read the latest edition of Emergency Nurse (December 2013) and found it to be informative and useful. However, I should like to clarify a point made by Nick Triggle, on page 8. He states that South East Coast Ambulance Service ensures that its paramedics can administer painkillers and antibiotics. In fact, all paramedics in the UK can administer certain single-dose painkillers and antibiotics. South East Coast Ambulance Service employs paramedic practitioners,
Board’s eye view who can administer to-take-out packs of painkillers and antibiotics. Paramedic practitioners are extended-skill paramedics, sometimes known as emergency care practitioners, community paramedics and specialist paramedics. Many thanks for a great journal; keep up the excellent work. Alex Walter is a paramedic practitioner at South East Coast Ambulance Service and an emergency care practitioner at Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex
Sara Morgan
The bigger picture THERE ARE few topics that stir up as much discussion among emergency department staff as the roster: who has worked every holiday for the past three years, who has every Friday night off, and who gets flipped from days to nights and back again seemingly every other week? As a staff nurse I know it can be easy to see the faults in a department’s roster without understanding the complex problems involved in drawing it up. Roster management is an art, in which competing priorities must be considered. First the roster has to deliver, as far as possible given a department’s vacancy and sickness rates, sufficient staffing on each shift to ensure safe patient care. Because of the nature of emergency care, this means that departments must be staffed at nights, weekends and holidays, as well as during the usual business hours. Emergency nurses have implicitly agreed to work to a model of care that is 24/7. Next, the roster should be fair to all staff. This means that everyone should have the same opportunity to make requests to work the shifts that they want and to swap shifts with their colleagues.
Most trusts offer staff guidance on how to balance their lives in and outside work, but roster managers must also juggle nurses’ needs for childcare, courses and health care with the needs of the entire department. Some nurses prefer to work during the day and others at night, and roster managers try to ensure they work their preferred shifts. This can be difficult, however, because they must also ensure that all nurses have equal access to education and development, yet most study periods and meetings occur during the day. There are also financial considerations to roster writing. For example, if annual leave is not spread evenly throughout the year, higher investment in bank and agency staff is needed when more staff are on leave, especially at nights. There are also safety implications if the proportion of bank or agency staff working at any one time is too high. Spare a thought then for the nurse or nurses in your department with responsibility for the roster. It is a tricky job and there is no such thing as a ‘perfect’ roster for everyone. Sara Morgan is a committee member of the RCN Emergency Care Association
What’s your view? If you want to express your opinions about any of the issues in the news, email the managing editor at [email protected] EMERGENCY NURSE
Keeping people safe STORIES ABOUT violence and its aftermath appear regularly in the media, yet violent incidents in the workplace often go unreported, particularly in urgent care settings. Violence can have long-lasting effects on emergency care staff by increasing anxiety and triggering depression, post-traumatic stress, aggression and self-harm. We nurses recognise that people, especially those who are experiencing pain, who misuse alcohol or drugs, or who have specific kinds of mental health problems, can act violently. In impoverished urban areas, where many patients that visit EDs are involved in gangs, the risk of violence in the workplace is usually increased. But recognising potentially violent client groups is only one way to reduce the risk of violence. Another is ensuring that the emergency department (ED) environment is as stress- and anxiety-free as possible. This may involve altering the layout of EDs so that there are no areas in which staff can be trapped by aggressive patients or ensuring that all rooms are well lit. It can also mean increasing the number of ED security personnel while restricting the number of people allowed to accompany or visit patients. Violence in EDs is a multifaceted problem that is especially difficult to solve when staffing levels are stretched thin and patients continue to use EDs as primary care sites. But the reduction of violence is fundamental to ensuring good quality patient care and preventing violence. We must be hypervigilant and proactive in maintaining safe environments for our colleagues and ourselves. Rachel Lyons is assistant clinical professor of nursing, at Rutgers University, Newark, New Jersey, and a member of the Emergency Nurse editorial advisory board February 2014 | Volume 21 | Number 9 15
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