Emergency nursing

Nurse with stretched arms, which signifies her asking for help while standing behind the Red Cross.

Emergency nursing is a nursing specialty concerned with the care of patients who are experiencing emergencies or who are critically ill or injured.

Emergency nurses frequently contact patients in the emergency department before the patients see physicians. In this situation, the nurse must be skilled at rapid, accurate physical examination, early recognition of life-threatening illness or injury, the use of advanced monitoring and treatment equipment, and in some cases, the ordering of testing and medication according to "advance treatment guidelines" or "standing orders" set out by the hospital's emergency physician staff. Emergency nurses most frequently are employed in hospital emergency departments, though they may also work in free-standing emergency centers or urgent care clinics. Behavioral health patients have become an increasing concern for emergency nurses.

Certified Emergency Nurse (CEN)

The Certified Emergency Nurse (CEN) designation is applied to a registered nurse who has demonstrated expertise in emergency nursing by passing a computer-administered examination given by the Board of Certification for Emergency Nursing (BCEN). The certification exam first became available July 1980,[1] and was accredited by ABSNC in February 2002, and reaccredited in 2007 and 2012.[2] The certification is valid for four years, and can be renewed either by passing another examination, by completing 100 continuing education units (CEUs) in the specialty, or by completing an online 150 question "open book exam."

As of 2015, the BCEN has designated over 30,500 active CENs in the United States and Canada.[3] The CEN exam has 175 questions; 150 are used for testing purposes (25 are sample questions). The passing score is 70% and the candidate has three hours to take the exam.[4] The test is administered internationally in Pearson Vue testing centers.[5]

Certified Pediatric Emergency Nurse (CPEN)

The Certified Pediatric Emergency Nurse (CPEN) designation is applied to a registered nurse who has demonstrated expertise in pediatric emergency nursing by passing a computer-administered examination given jointly by the Board of Certification for Emergency Nursing (BCEN) and the Pediatric Nursing Certification Board (PNCB). The certification exam first became available January 21, 2009,[6] and was accredited by ABSNC in May 2015.[7] The certification is valid for four years, and can be renewed either by passing another examination, by completing 100 contact hours (continuing education) in the specialty, or by completing 1,000 clinical practice hours and 40 contact hours in the specialty.[8] The CPEN exam has 175 questions; 25 are unscored sample questions.[9]

As of 2015, the BCEN and the PNCB have designated over 3,900 active CPENs.[10] The CPEN exam has 175 questions; 150 are used for testing purposes (25 are sample questions). The passing score is 87%[11] and the candidate has three hours to take the exam.[12] The test is administered in AMP testing centers internationally.[13]

Emergency Nurse Practitioner (ENP)

In the UK

A specialist nurse who will independently assess, diagnose, investigate, and treat a wide range of common accidents and injuries working autonomously without reference to medical staff. They primarily treat a wide range of musculoskeletal problems, skin problems and minor illness. They are trained in advanced nursing skills. Under the National Health Service grading system, ENPs are typically graded Band 6 or 7.

Additionally, some specialized nurses perform as [emergency care practitioner]s. They generally work in the pre-hospital setting dealing with a wide range of medical or emergency problems. Their primary function is to assess, diagnose and treat a patient in the home in an emergency setting.

In the US

An advanced practice nurse who assesses, diagnoses, and treats a variety of common illnesses, injuries and disease processes in emergency care settings. ENPs are trained in advanced nursing and medical skills such as x-ray interpretation, ophthalmic slit lamp examination, suturing, local and regional anesthesia, abscess incision and drainage, advanced airway techniques, fracture reduction, and casting and splinting.

In Australia

Australian nurse practitioners follow the clinical practice guidelines which have been developed by the Victorian Emergency Nurse Practitioner Collaborative (VENPC), who have supported nurse practitioner development in Victoria. This includes attending to minor head injuries, burns, open wounds, joint pain (Haemophilia), blood and fluid exposure, PV bleeding, suspected UTI, abdominal pain, cellulitis and more.[14]

In Asia

As a nurse in Asia there is a constant growth in number of emergencies and disasters in the Asia Pacific region. There are 3 main principles that they like to use in emergency situations and they are:

Reduction: Action to avoid or minimize the adverse health-related impacts of events likely to give rise to an emergency

Readiness: Includes planning, establishing and maintaining systems and undertaking training for an efficient and effective health sector response to a potential emergency.

Response: Immediately being able to mobilize and deploying health resources on a patient either prior or during an emergency. Collaborating with other services, ensuring that it is practicable and is providing relief and treatment for people who are injured or in distress. Avoiding or reducing ongoing health risks or personal health risks to all those effected by the event.[15]

Challenges Nurses Face on a daily basis within the job

Emergency nursing is a demanding job and can be unpredictable at times. Emergency nurses need to have basic knowledge on most specialty areas to be able to work under pressure and determine certain solutions. It can be quite draining both physically and mentally for many nurses. Australian emergency department treat over 7 million patients each year, so this means that they have to be on their feet all the time and ready for anything. Any ED (emergency department) nurses are highly exposed to traumatic situations such as heavy bleeding, dismemberment and even death, putting a lot of stress on them. Violence is another common challenge for many nurses in the ED, and nurses tend to receive both physical and verbal abuse from patients and visitors.[16]

When stabilizing patients, nurses are the first to be called upon to perform any number of medical procedures, they must be confident and familiar with these procedures. Some of these procedures include:

· Starting intravenous lines

· Administering medication

· Transfusing blood

· First aid

· Cardiopulmonary resuscitation

· Rescue breathing

· Bag-value-mask ventilation

· Intubation

· Setting broken bones and

· Delivering babies.[17]

Challenges for Nurses in Africa

Emergency nurses work in various places many of which are understaffed as there are nursing shortages across Africa. There is also a shortage of doctors, leaving many task for nurses to endure with very limited guidelines or standards to deal with, and for many emergency nurses the scope of practice is quite undefined. Many nurses are forced to work outside their scope causing frustration and increasing the opportunities for occupational health hazards, which can be speculated that triage protocols are either lacking or not being followed. There is also the limited basic knowledge and skill of emergency nursing included in undergraduate nurse training programs and limited number of nurse trainers which provides difficulty for many pending nurses to acquire the skills needed to work in emergency settings.[18]

History

Around the 1800s hospitals became more popular and there was a growth in emergency care. The first development of an emergency room was originally called ‘The First Aid Room’. Originally, nurses only dressed wounds, applied eye ointments, treated minor burns with salves and bandages, and attended patients with minor illnesses like colds and sore throats.[19] The rule of thumb was first in, first served but there were many cases where some people where in more need of emergency care than others and as the situation became more intolerable, one of the greatest medical developments came into perspective; triage. For centenaries triage had been used in war but was not yet established in the emergency department. The first time triage was referred to during a non-disaster issue was at Yale, Newhaven Hospital, USA in 1963, and since then has become developed and more defined.[20]

Additional emergency nursing training and qualifications

References

  1. ↑ "BCEN History". Board of Certification of Emergency Nursing. Retrieved 20 December 2015.
  2. ↑ "BCEN History". Board of Certification of Emergency Nursing. Retrieved 20 December 2015.
  3. ↑ "CEN Eligibility FAQs". Board of Certification of Emergency Nursing. Retrieved 20 December 2015.
  4. ↑ "CEN Eligibility FAQs". Board of Certification of Emergency Nursing. Retrieved 20 December 2015.
  5. ↑ "CEN Eligibility FAQs". Board of Certification of Emergency Nursing. Retrieved 20 December 2015.
  6. ↑ "CPEN Eligibility FAQs". Board of Certification of Emergency Nursing. Retrieved 20 December 2015.
  7. ↑ "BCEN History". Board of Certification of Emergency Nursing. Retrieved 20 December 2015.
  8. ↑ "CPEN Eligibility FAQs". Board of Certification of Emergency Nursing. Retrieved 20 December 2015.
  9. ↑ "CPEN Eligibility FAQs". Board of Certification of Emergency Nursing. Retrieved 20 December 2015.
  10. ↑ "CPEN Eligibility FAQs". Board of Certification of Emergency Nursing. Retrieved 20 December 2015.
  11. ↑ "CPEN Eligibility FAQs". Board of Certification of Emergency Nursing. Retrieved 20 December 2015.
  12. ↑ "CPEN Eligibility FAQs". Board of Certification of Emergency Nursing. Retrieved 20 December 2015.
  13. ↑ "CPEN Eligibility FAQs". Board of Certification of Emergency Nursing. Retrieved 20 December 2015.
  14. ↑ "Emergency Nurse Practitioners". Alfred Health Victoria. Retrieved 2007. Check date values in: |access-date= (help)
  15. ↑ Philippness, Manila (2011). "Asia Pacific Emergency and Disaster Nursing Network" (PDF).
  16. ↑ Margolis, R. "Issues Facing Emergency Room Nurses". Retrieved n.d. Check date values in: |access-date= (help)
  17. ↑ "Practise Standards for the Emergency Nurse Specialist" (PDF).
  18. ↑ Augustyn, J., Bell, S., Brysiewicz, P., Coetzee, I., Eeden, I., Heyns, T., Lobue, N., Papa, A., Pho, A., Qampi, M., Sepeku, A., Hangula, R., Wolf, L. (2012). Developing a framework for emergency nursing practice in Africa. African Journal of Emergency Medicine, 2(4) 174-181. doi:10.1016/j.afjem.2012.09.001
  19. ↑ Snydner, Audrey (01.06.2006). "From "First Aid Rooms" to Advanced Practice Nursing: A Glimpse Into the History of Emergency Nursing". Advanced emergency nursing journal. 28 (3): 198. Check date values in: |date= (help)
  20. ↑ Jones, G. (2010). History of Emergency Nursing. Retrieved from http://www.icn.ch/networks/history-of-emergency-nursing/
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