Question

Compare and contrast the approach/method of patient care delivery of the emergency department (ED) nurse with the medical-surgical staff nurse.

Describe interactions you experienced with various members of the inter-professional team when in the ED: physicians, mid-level providers (nurse practitioners or physician assistants, Emergency Medical Technicians (EMS) personnel, respiratory therapists, trauma surgeons, flight nurses, scribes, etc.

Give examples of priority care given to the patients in the ED; include the Emergency Severity Index (ESI) with description.

Answer 1

Surgical nurses care for patients before, during and after surgery. Some nurses will prepare the patient for surgery, others serve during the actual procedure and additional nurses work in the recovery area. During the surgery itself, there are two main roles for nurses: scrub nurse and circulating nurse. There may be just one nurse in each of these roles, or there may be multiple, depending on the complexity of the case. Scrub nurses scrub their hands and arms with surgical soap and don a surgical gown and gloves. They anticipate the surgeon’s needs, selecting and passing instruments and supplies. The circulating nurse acts a runner and helps out wherever needed. The surgical nurse also provides psychological support to the patient before surgery.

On the other hand, medical nurses work to quickly assess the needs of each patient, prioritize care based on its critical nature, and work to stabilize a patient, treat the problem, discharge the patient after the emergency is over or make arrangements for a longer hospital stay. They work as a team of physicians, nurses and other health care professionals to monitor health, provide care and address long term needs of the patient. They are also to trained to use medical equipment and prioritize case according to triad support.

Generally, I have seen the whole team is very organized in dealing and identifying at risk patients. Everyone has a job to perform be it a physician who assess the patient, a surgeon who performs emergency surgery, nurse who carries out all the orders as prescribed by the physicians and following all the protocols. The paramedics are the first to gather information from as they are who bring in the patient in an emergency setting. I have felt the role of paramedics to be of primary importance as talking with them gives a very good idea about the state of the patient. Emergency medical technicians provide us with laboratory results and imaging at a quicker pace as they understand the patient is in a critical condition and rapid diagnosis is a must in such a case.

The ESI levels are numbered one through five

1 Resuscitation Immediate, life-saving intervention required without delay

2 Emergent        High risk of deterioration, or signs of a time-critical problem

3 Urgent             Stable, with multiple types of resources needed to investigate or treat

4 Less Urgent     Stable, with only one type of resource anticipated        

5 Nonurgent      Stable, with no resources anticipated except oral or topical medications, or prescriptions

Example include,

Level 1- Cardiac arrest, massive bleeding, respiratory arrest, multiorgan failure, road traffic accident with head injury

Level 2- Chest pain. Myocardial infarction, Angina, asthma attack, road traffic accident with multiple fractures

Level 3- Abdominal pain, high fever, cough

Level 4- Laceration, superficial injury to skin, sneezing

Level 5- Rash, chronic condition for follow up such as diabetes, hypertension and thyroid