Medic One Funded Projects


Vancouver, Canada
Ms Ray Middlemiss


I was fortunate enough to attend the NENA Conference in Vancouver this year, and what an absolutely fantastic experience it was!!  It all began last year with a meeting with my Senior Charge Nurse to discuss my professional development for the coming year and the idea of attending an international conference was born.  After a bit of research thanks to Google I discovered NENA 2013.  After contacting President Sharron Lyons who assisted me greatly to attend the conference and with the support of my own department I was all set to make the trip.  Prior to arriving in Vancouver I also contacted three of the local hospitals which I arranged to visit during my trip.  I felt that this combined with the conference, would allow me to make comparisons with that of my own department, and also potentially generate some new ideas for me to take home.

The department in which I work has an attendance of 113,000 patients annually (over the age of 13) and covering a population of 800,000.  We are also the only Adult Emergency Department within Edinburgh and the surrounding region.  We, as with the rest of the UK work under the Governments 4hr Emergency Access Standard where no patients have to wait more than 4hrs from arrival to admission to a bed in the hospital, transfer elsewhere or discharge.  Having done a bit of research on Canadian Quality Access Targets/Standards it was interesting to talk Emergency Nurses whilst I was at the conference and compare how these affect us and our patients.   Also by visiting the Emergency Departments of Vancouver General, St Paul’s and Lionsgate Hospitals this also gave me a real insight into some of the comparisons and differences between us.  

I found staffing is better within these departments than what we have within our ED and also other EDs in Scotland, given the comparison of volume of attending patients between departments.  Until the start of the year we worked with 13 Registered Nurses on a dayshift and 12 on a nightshift, this has recently been increased to 16 on dayshift and 15 on nightshift (12.5hr shift pattern).  Lengthy waits for patients to be admitted into the main hospital, both in Vancouver and with ourselves in Edinburgh is a problem, albeit we have significantly improved under the 4hr Access Standard and lengthy waits are now thankfully infrequent and 90% + of our patients meet the 4hr standard consistently.  Physical space and overcrowding is an issue within our departments on both sides of the Atlantic – where every cubicle, wall and corridor space is utilised for attending to patients. Acuity and volume of patients continues to rise yearly thanks to the ageing population and ease of access to ‘Emergency’ Care provided by our departments.  It was great to visit these departments to realise we face a lot of similar issues and also to see how they work and develop their systems to combat these problems.  As a result of my visit to these departments, and from information gained from the conference I have taken their lead and am currently developing a Rapid Assessment Zone within my ED.  Due to the ever increasing demand on our resources, lack of physical space and in order to provide a high level of patient care we are continually looking at how we improve patient flow through the department resulting in us becoming more streamline and efficient.

The conference itself was phenomenal.  The quality of speakers over the days was fantastic, some truly inspirational, and such a variety of subjects covered I would have liked to have attended all the talks.  I tried to pick topics that had relevance to UK practice and systems.  I attended talks which discussed things like nursing teams – how to recognise the strengths that each team member brings in order to develop high functioning teams, a must within the ED setting throughout the world; Cognitive bias and its impact on quality in healthcare – focusing on human error in patients care, currently a major topic within the UK;   Caring for the elderly in the ED - again another major focus currently throughout the UK National Health Service with Government targets being set, as a result of these my department has successfully implemented Care Rounding into the department this year with great success;  Patients on the move – all about streaming patients in order to make departments more streamline and improve patient flows, a familiar theme to any ED; and leadership & team building - all about change management.  I also attended a practical session on Cardiac Arrest which was interesting to see how the UK and Canada compare on their development and research of cardiac arrest care as my department undertakes a lot of research on cardiac arrest patients.  The final session of the conference was a very poignant presentation from an ED consultant entitled ‘Why I love Emergency Nurses’, sharing a few experiences and stories that he had had with ED nurses over the years, but the purpose of his talk was to thank us all for being who we are and the difficult job we do each day – something that no matter where we are in the world we can all relate to.  I know I do this job because I love it.

My whole trip to Vancouver was fantastic, meeting so many people from a variety of ED settings and being able to share and learn from each of them.  I would like to thank everyone I met for being so welcoming.

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