Nurse practitioners - What do they do? Who are they?
A DAY IN THE LIFE OF…
| Name: | Natasha Jennings |
|---|---|
| Employer: | The Alfred Emergency and Trauma Centre, Bayside Health Service |
| Location: | Melbourne |
| Endorsed as an NP: | 2006 |
| Area of NP practice: | Emergency Nursing |
- 5.20am
- Wake up with alarm, drag myself into the shower and get dressed.
- 5.40am
- Kiss the husband goodbye, grab my lunch prepared from the night before, and start the drive in from East Geelong.
- 6.00am
- Driving past BP service station at Avalon, drinking my Up and Go, listening to Nova.
- 7.00am
- ED handover takes place with overnight and oncoming medical staff, resource nurse, NUM, disposition nurses and allied health staff. Anywhere from 14 patients to 44 patients. Liase with ED consultant who is the Nurse Practitioner (NP) mentor for the day.
- 7.30am
- Head out to the fast track area and log onto the computer to the ‘waiting to be seen' screen. This gives me a list of all patients in the ED that has not yet been assessed medically. It also gives you details such as age, triage category and the type of presentation for each patient, eg Joe Black, M, 22 years, 12 minutes, chest pains. Pick up next patient waiting to be seen within scope of practice of ED NP.
- 7.45am
- Walk patient from triage area into fast track. Mr A is a 32-year-old builder who has slipped while cutting some Aggy pipe at work this morning. Presents with wound to thigh. Complete initial assessment and treatment and arrange a plan of care. Liase with ED consultant with plan of care, order and give analgesia, Tetanus prophylaxis etc. and move patient into suture room.
- 8.15am
- Next patient waiting to be seen I bring through to fast track area. Ms A presents with dysuria and frequency of urine. Complete initial assessment and treatment and arrange a plan of care. Liase with ED consultant with plan of care, order and give analgesia and perform analysis of urine. While waiting for patient to provide urine specimen check ‘waiting to be seen' screen and collect new patient from triage.
- 8.25am
- Mr B 21 year old inversion injury to right ankle while playing basketball last night. Complete initial assessment and treatment and arrange a plan of care. Send patient off for X-Ray.
- 8.45am
- Start wound closure – sutures on patient Mr A. Chat about family, weather and life. Five deep dermal sutures and 15 epidermal sutures. Dressing and wound care instructions discussed. Local Medical Officer (LMO) letter written and patient discharged home.
- 9.15am
- Ms A urine analysis shows evidence of infection after reassessment and after consultation with ED Consultant diagnosed with cystitis. I write discharge prescription and send off urine for pathology to lab and LMO letter written. Cystitis instructions, education and follow up discussed. Patient discharged home.
- 9.30am
- Mr B is still waiting for his x-ray. I reassess pain scores and ankle. Grab a apple and drink and check waiting to be seen screen. Identify another patient waiting and pick patient up from triage.
- 9.45am
- Mr C is a 38-year-old with cellulitis to lower leg post spider bite. Presents via LMO. Has had a trial of oral antibiotics but nil improvement. Complete initial assessment and treatment and arrange a plan of care. Liase with ED consultant with plan of care, order and give analgesia and tetanus prophylaxis. Order pathology and wound swabs. I put in IV and page Infectious Diseases (INFD) team for referral.
- 10.15am
- Mr B returns from X-ray showing lateral malleolus hairline fracture. Liase with ED consultant and move patient to plaster room for application of plaster cast (POP). INFD Reg returns page and will come to see Mr C after clinic. Administration of IV antibiotics as per our Clinical Practice Guideline.
- 11.00am
- I apply below knee POP to Mr B. Fracture clinic referral and appointment made. Discharge prescription for analgesia prepared and LMO letter. POP and crutches care discussed and patient discharged home.
- 11.45am
- Pathology results show Mr C has evidence of an infectess. INFD team has reviewed patient and referral to Alfred at Home for treatment. Admission paperwork completed and bed assignment aware.
- 12.00pm
- Triage nurse telephones you in fast track stating she has a male patient Mr F with partial amputation of distal phalanx right hand index finger at triage. I head straight out to triage and bring patient through to lie down. Looking a bit pale and sweaty, I lie him down and chat to him and his work mate. Complete initial assessment and treatment and arrange a plan of care. Liase with ED consultant with plan of care, order and give analgesia and commence rest, ice, elevation (RICE). Part of distal tip wrapped in gauze and put in ice slurry. Xray ordered and plastics team referral. Plastics Reg consultation within 5 minutes and will take patient to theatre for repair of digit this afternoon. Admission paperwork completed and bed assignment informed. Dressing applied and reassessment of analgesia performed. IV Abs ordered and given. Patient aware of surgery and telephone given to ring wife and let her know what is happening.
- 12.30pm
- Finish up patient notes and check waiting to be seen screen. What could be next?
- 1.00pm
- Ms E 82 year old presents via ambulance into fast track area with right arm and hip pain post fall on tram. Take patient handover from ambulance and commence initial assessment. Complete initial assessment and treatment and arrange a plan of care. Liase with ED consultant with plan of care, order and give analgesia (RICE). Due to patient's age and findings of social circumstance referral to allied health team arranged. X-ray of focal tenderness and routine pathology arranged. Assist medical students with their first attempt at a venipuncture.
- 1.15pm
- Other NPC (Belinda Free) starts and handover of my patients Mr C who is still waiting for Alfred at Home to be finalised and Ms E for allied health and results completed. While Ms E is in XR try and get a bite to eat. Mr F is ready for theatre waiting a time.
- 2.00pm
- New patient from waiting to be seen screen sore throat? Tonsillitis presents from triage. Complete initial assessment and treatment and arrange a plan of care. Liase with ED consultant with plan of care, order and give analgesia. Due to patient's assessment findings, dehydrated and decreased oral intake due to swelling and pain, refer to INFD for admission. I gain IV access take routine bloods and commence IV fluids as per CPG. Patient informed of need for admission.
- 3.00pm
- Ms E's X-rays show no injury detected. Food and fluids given to patient and allied health review complete. Patient not safe for discharge home, unsteady on her feet and generalised soft tissue injury post fall. Disposition nurse in ED notified and bed made available at CGMC. Caulfield AO notified and admission arranged. Ambulance booked for transfer.
- 3.30pm
- Finish up paperwork, ensure Mr C's Alfred at Home admission completed and patient discharged home. Race to the car park to Kings Way before it becomes grid locked. Head home ready to return tomorrow at 1300hrs.