Staff Nurse
Registered nurses who provide direct patient care in an institution are often referred to as “staff nurses.” Another common title is a “clinical nurse.” As this chapter and the chapter that follows demonstrate, emergency nurses can take on many roles, but the traditional role of the staff nurse remains the backbone of institutional nursing. Staff nurses either provide direct patient care to ED patients or delegate and oversee that care to other personnel with- in the department.
Staff nurses are often referred to as “generalists” and perform a wide variety of duties. The most obvious role of the emergency nurse is to apply the nursing process to the care of patients who present to the ED. The emergency nurse performs patient assessments and makes a judgment about the actual or potential health problem the patient has. Armed with this information, the nurse develops a plan of care, implements that plan, and then evalu- ates the effectiveness of the care.
The application of the nursing process is not unique to being a staff nurse in the ED; nurses in every clinical area utilize the nursing process to deliver care to patients. But several fac- tors create a unique environment that differentiates emergency nursing from other areas of nursing.
The first is the episodic nature of the ED. The arrival of patients and the acuity of those patients is unpredictable. The workload of the emergency nurse can change dramatically from literally one minute to the next. It’s possible that several patients may arrive in a short period of time with high acuity problems requiring intensive nursing care. A major event such as a multi-casualty trauma can result in the influx of numerous patients simultaneous- ly, or the lack of inpatient beds can result in the accumulation of many high-acuity patients requiring significant nursing care. Potentially, all of these events could occur simultaneously, and the emergency nurse must be able to prioritize and adapt to ensure high-quality and safe care. Because of this unpredictable workload, some of the qualities listed by the Emer- gency Nurses Association (ENA, n.d.) as advantageous for staff nurses include:
■The ability to shift gears and accelerate the pace of work as needed ■Multi-tasking ability
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■The ability to maintain calm amid chaos ■The capability to think fast and on your feet
■Good observation, assessment, and prioritization skills ■Good interpersonal and customer service skills ■Stamina
■Good personal coping skills ■Being an assertive patient advocate ■Having a good sense of humor
Another factor that makes staff nursing in the ED unique from other areas of nursing is the collaborative yet independent nature of practice created by the ED environment. In most EDs, physicians are physically present in the unit 24 hours a day, giving the emergency nurse immediate access for collaboration on patient care issues. Ironically, despite physical avail- ability of physicians for collaboration, emergency nurses frequently state that one thing that draws them to emergency nursing is the independence in practice that the ED allows. When nurses work in triage for example, they are usually physically isolated from the rest of the department and must make independent decisions directly affecting patient care. Many EDs have implemented standing orders or protocols that allow nurses to initiate radiology and other diagnostic tests to expedite patient movement through the ED. Multiple studies have shown that when protocols are appropriately implemented, length of stay decreases and patient care is improved (Robinson, 2013). It’s essential to remember that although protocols may give the impression of independent practice, they are approved by medical staff, and they should be carefully followed and only implemented when the patient fits the criteria outline in the protocol (Patrizzi, Gurney, Baxter, Bush, & Crook, 2013).
Standing Order or Protocol —“An agreed framework outlining the care that will be provided to—“An agreed framework outlining the care that will be provided to patients in a designated area of practice. They do not describe how a procedure is performed, patients in a designated area of practice. They do not describe how a procedure is performed, but why, where, when, and by whom the care is given” (Ebling Library, 2015).
but why, where, when, and by whom the care is given” (Ebling Library, 2015).
Another thing that makes emergency nursing unique is the varied population served by emergency nurses. Unlike other nursing specialties that may focus on a specific age range (e.g., pediatric or adult patients) or a specific body system (e.g., orthopedics or obstetrics), emergency nurses serve all ages experiencing disorders to every body system. In fact, the
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very definition of emergency nursing outlined by the American Nurses Association (2011) highlights this uniqueness:
“Emergency Nursing is the care of individuals across the lifespan with per- ceived or actual physical or emotional alterations of health that are undiag- nosed or require further interventions. Emergency nursing care is episodic, primary, typically short-term, and occurs in a variety of settings.” (p. 1) For this reason, emergency nurses have to have a broad knowledge base and skill set.
Common Educational Preparation
The minimum educational requirement for a staff nurse is an associate’s degree or diploma in nursing. As the profession of nursing has become increasingly complex, a push for a minimum of a baccalaureate degree to practice as a staff nurse has gained momentum. Some hospitals require nurses to have a baccalaureate degree as a condition of hire, espe- cially in critical care units such as the ED. Individuals interested in emergency nursing are strongly advised to seek a baccalaureate degree to increase their chance of hire into the ED. For additional information on nursing education and the baccalaureate degree as an entry to practice, see Chapter 4, “Education of the Emergency Nurse.”
Suggested Career Path
There are no national standards regarding the education and experience required to be a staff nurse except that the individual holds a license to practice as a registered nurse. There- fore, the suggested career path to being a staff nurse in the ED may be as varied as the number of EDs.
Although new graduate nurses sometimes get hired into the ED, this usually involves a lengthy and expensive internship or orientation program. For that reason, many EDs seek nurses with prior experience, even from different clinical areas such as the intensive care unit or cardiology. Even if the clinical area is vastly different from the ED, the nurse may have developed assessment and organizational skills that transfer nicely to the ED setting. Nurses interested in becoming emergency nurses may consider the following suggestions:
■Take numerous courses to improve skills in the emergency setting.Although these cours-
es are rarely required as conditions of employment, taking these courses prior to apply- ing for an emergency nurse position demonstrates the applicant’s dedication to the posi- tion and may make the applicant stand out from other nurses interested in the position. Courses that are required in many EDs include the Advanced Cardiovascular Life
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Support Course (ACLS), the Pediatric Advanced Life Support (PALS) Course, the Trauma Nursing Core Course (TNCC), and the Emergency Nursing Pediatric Course (ENPC).
■Gain experience and skills in other positions that translate into the skills required to be a staff nurse in the ED. Applicants who bring past experience as unlicensed assistive per- sonnel in an ED (e.g., emergency department technician), pre-hospital experience such as an emergency medical technician (EMT) or paramedic, and experience as a registered nurse in a different clinical area, especially one with a critical-care focus such as the intensive care unit, may make the applicant more marketable when seeking a position within the ED.
Specialty Areas Within the ED
In a smaller ED, the staff nurse may receive orientation to care for all ages and types of patients. In larger hospitals, the department may be divided into various sections, and the emergency nurse may be assigned to one section for a shift or part of a shift caring for a specialized subset of patients (e.g., trauma patients or patients with psychiatric illnesses). Sometimes the staff nurse may permanently work with a specialized subset of patients (e.g., permanently assigned to work in the triage or pediatric area of the ED). In EDs with spe- cialized areas, it’s not uncommon for the emergency nurse to be trained in one area at a time until the nurse demonstrates competency in all areas. Some common “specialty areas” contained in the ED include:
■Resuscitation rooms (Advanced Cardiac Life Support training is usually required to work
in this area.)
■Critical care area (Advanced Cardiac Life Support training is usually required to work in
this area.)
■Trauma rooms (A course in trauma nursing such as the Trauma Nursing Core Course is
usually required to work in this area.)
■Acute care area (This area may be further subdivided into areas such as obstetrics, gyne-
cology, isolation rooms, etc.)
■Low acuity area (sometimes called “fast track”)
■Pediatric area (A course in pediatric care such as the Pediatric Advanced Life Support
Course or the Emergency Nursing Pediatric Course is usually required to work in this area.)
■Psychiatric area
■Observation unit (an area designed for patients who do not meet criteria for hospital
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■Triage area (For more information on requirements to work in triage and the process of
triage, see Chapter 10, “The Emergency Nurse in the Role of Triage.”)