Supporting student nurses on the ED placement

As an academic and emergency nurse I’m often asked how best to support student nurses during their A&E placement. As we all know, whilst emergency care can be exciting, it can also be a daunting experience for nursing students. I spoke to Aston Nicholls a third year nursing student at the University of South Wales about his experience and what he’d wished he’d known prior to undertaking his placement in the emergency department (ED).

"I have to be honest and say both of my emergency department placements have been rather tip top. Very good to say the least and I'm not totally sure that much could have been better for my individual case, but here are some overall points."

• Ensure the student is given a walk around and oversight of the department. An ED works (operationally) very differently to a ward-based setting with various department sub-areas, different computer systems and operational procedures which students can find daunting and overwhelming. Take time to explain how each sub-area is ran and how patients enter and leave the department. A formal induction on first day with a group of students works very well in regard to this.
• The ED (more so than other settings) relies on a total multi-disciplinary approach. You will have various level of nurse (NQN, ENP, ACP, NIC), doctor (SHO, SAS, consultant) from various specialities visiting the patients. It is imperative that you develop the skill and confidence to speak and collaborate with the MDT to enhance not only your own knowledge but patient outcome too.
• Don't listen when people say 'there's nothing to learn in triage'. Understanding the triage process is invaluable and helps the student to understand how people who don’t arrive by ambulance enter the department and how people are categorised and prioritised.
• Explain what medically expected/surgically expected/ENT expected? What is that? Never heard of it!?
• Explain what a post take ward round is?
• Explain what the Omnicell is - what's it all about? We've only ever seen drug trollies. Take time to explain how medication administration is different in an ED setting.
• Make sure students are aware they don’t have to work with their nominated supervisor at all times. Some nurses are favoured in one area, and student need to experience all areas of an Emergency department.
• Access to the department – many departments require access to clinical areas with ID cards, which students may not possess.
• Students can experience ED at any stage of the program. As ED is a very acute area, its vital that the student is reassured that their level of knowledge should reflect where they are in the programme.
• Include students on the 'board' allocation next to their supervisor. It can help them feel included and that people know their name, as its easy to forget.
• Encourage students to make spoke placements within the ED too - CCOT, radiology, ENP etc.
• A&E can arguably be more emotionally and physically demanding than other settings with a 24 hour service. Remember students are supernumerary and are often revising for exams or writing assignments. Be mindful of rota patterns and give consideration to reasonable personal circumstances.
• Explain what the impact of flow within the department and lack of beds on wards or in the community can mean for the department; breaches, red releases, escalating to senior level etc.
• Explain the paperwork within the department. Again, this can be very different to other settings like wards.
• Ensure adequate support for student who have witnessed distressing events such as cardiac arrests and make sure there is time for a debrief so any questions can be answered.

As both an academic as well as an ED nurse I would highlight the importance of ensuring adequate support for student who have witnessed distressing events such as cardiac arrests and make sure there is time for a debrief so any questions can be answered. This can be an new and very distressing experience for pre registration students. However through good debrief this can also be an invaluable learning opportunity, where students can focus on the biopsychosocial aspects of caring for such individuals and their families. As a practice assessor or supervisor be there for your student, check they have settled into their placement, offer support, and answer any queries, it will be truly valued by the student.