Basic skills of an ED nurse

Such issues emerged here that can be regarded as especially typical requirements for an ED nurse. Four definite issues were revealed under this item, as shown in Figure 9.

FIGURE 9. Basic skills of an ED nurse.

Core ED nursing skills

These were skills to work in partnership with MDs and as a logistics manager, individual expertise in emergency nursing and general expertise with a wide variety as well as skills to ascertain uninterrupted transfer of patient data. This appeared to be a two-part issue. It was considered important that the ED nurse works in tight collaboration with MDs, especially when the care of critically ill and injured patients is in question. The implementation of trauma-teams to the initial care of high-risk trauma patients had influenced some respondents’

thinking, and one of the roles of an ED nurse was considered to be a ‘partnership’ role with the trauma-leader. All in all, a logistics manager is continuously needed, and this seemed to be a natural role for ED nurses. Someone is needed who thoroughly knows the protocols as well as unwritten agreements of the hospital in order to facilitate fluent activity.

On the other hand, individual expertise in terms of acute care and a wide variety of general expertise were considered to be essential parts of an ED nurse’s role. Capability to act according to one’s own assessment and to draw conclusions independently was also connected to the role:“A certain logistics manager is always needed.” “This trauma leader absolutely needs a partner.” “You should be ready to take orders and put them to action almost any time.” “You ought to be an expert in acute care, and also a general expert, from whom everyone expects to get the right answers immediately. “

Booking and ascertaining uninterrupted transfer of patient data was considered to be one of the core elements in ED nursing. All aspects of acute care and first aid should be mastered, as well as the comprehensive management of the situation in the ED. Someone has to keep the situation under control, and this seems to be conceived as an ED nurse’ s role. It was mentioned several times that in addition to the requirement of mastering the initial care of patients representing several medical specialisms and sub-specialisms, some aspects of intensive care should also be mastered. Examples of this were e.g. patients needing a ventilator, invasive monitoring, and vasoactive drugs:“You have to master the care during the initial phase.” “First aid in various situations for different kinds of patients, from babies to grandfathers, must be mastered.” “You must have preparedness for caring for patient needing intensive care including the post-resuscitation phase, when the patient needs a ventilator and all those lines and tubes and pumps.” “Booking all initial observations, and utilising that data when observing the patient continuously in order to be able to make interventions should the patient’s clinical state change.” “You must bear in mind the idea that what is the state of all the other patients, which are there in the ED at the same time.”

“And you should, of course, implement ED nursing according to your own conclusions, and partially according to the orders of an MD.” “The mastery of these urgent critical situations, recognition of the failing of vital functions...”

The perceptions of the cognitive requirements demanded of an ED nurse can be summarised into two fields. First, a wide knowledge of natural and nursing sciences should be possessed in order to understand, how the human body and mind normally function. Secondly, a thorough knowledge and understanding of pathophysiologic mechanisms enables understanding of why and how the human body functions when it has ceased being healthy.

Knowledge from different medical specialisms is required, and the knowledge should be quite comprehensive. The importance of the natural sciences was emphasised, and the knowledge base of nursing science was also considered relevant and important. However, the importance of the natural sciences was clearly stressed. Comprehension of pathophysiology enables the possession of a background and a deeper meaning for examining and observing patients and their signs and symptoms. Without knowledge there can hardly be understanding, and without understanding all the theory has to be learned by heart. Such an operational model is vulnerable, and not very effective in clinical situations: “…such knowledge that enables reaching diagnosis for patients.” “You should understand, why something is like it is, and what leads to where.” “For understanding, what you are doing and why.” “Our area is extremely large, all the specialisms should be mastered to some extent.” “It would be extremely important to know and master the theoretical background for these things.” “The knowledge base and practical competence.” “Anatomy and physiology should be emphasised.”

Possession of an adequate knowledge base and being able to apply it in clinical situations were considered prerequisites for ED nursing. An emphasis was placed on the skills, so that knowledge alone did not seem to make an ED nurse. The combination of knowledge and an ability to apply knowledge was a basic element of what was called clinical skill:“For you to be able to make decisions based on the theoretical knowledge and experience-based knowledge.” “A wide theoretical knowledge base applied to ED nursing.”

Skills to promote patient safety

Skills that enable the comprehension of the whole chain of survival were obviously appreciated. The issue of safety was highlighted, and it appeared to be the continuum of the care that caused concern. The whole chain of survival ought to be comprehended in order to enhance patients’ safety. If the whole continuum of the care is not known and comprehended, it is possible that information with clinical relevance is lost when patients are being Cognitive skills

transferred from ambulances to ED, and from ED to continuing care. This poses a threat to patient safety:

“There should exist some kind of understanding of the continuum of the care.” “They should understand a little about what happens there outside the hospital.” “The role and functions of the other stakeholders ought to be understood.” “The sources that feed us patients, and the patient receiving ones, ought to be known.”

Ability to keep up with the times

Being an active person appeared to be related to clinical skills, albeit indirectly.

Characteristics like being interested in everything that happens in the world around us were valued, and were interpreted as being features of an active person. In addition to preferring an active colleague to a more passive one, this phenomenon was, albeit indirectly, connected to clinical nursing: “You ought to be interested in everything that changes in the world.”

“Above all, you should live in a close connection with the time around you.”