Nursing: Accident and Emergency

The drama of the A&E room is just one aspect of the role.

The Accident and Emergency department at Salford Royal Hospital is nothing like the television series Casualty or ER, says staff nurse Sarah Cottam. “It’s nowhere near as glamorous,” she laughs. “But I love it. I love the fast pace of it and I love the diversity of the work. One minute you might get someone who’s banged their toe, so you can put a plaster on it and send them on their way, then the next you get someone who’s had anasthma attack and needs referring on. Then there’s the patients who need life saving procedures, for example, in the case of a cardiac arrest.”

Cottam decided to give up her job as a civil servant and become a nurse in her late twenties. “I liked the idea of patient contact and the opportunity to make a difference,” she says. Cottam also welcomed the huge changes that have taken place in adult nursing in the last decade or so. There are, for instance, a far wider set of roles you can go into – among them nurse consultants, nurse specialists and modern matrons. Environments are more diverse too, with some nurses working in hospitals, while others work in the community or in teaching. As nurses have increasingly taken on responsibilities such as prescribing, they have become far more influential and empowering wherever they work. Cottam’s diploma in adult nursing took three challenging years, but she was surprised to find it wasn’t as academic as she’d anticipated. “I’d say the emphasis was on the practical training, with the academic side of things existing as a foundation.

In many ways, the training is there to give you a snapshot of different areas of nursing and practise the skills you’re taught in each of them – you work in surgery, medicine, specialised surgery, geriatrics, intensive care, and accident and emergency, among others.”

In March 2005, when Cottam graduated, she took a job in an intensive care unit. “I picked it because of the challenge,” she says. “It’s hands-on clinical work, so it gives you a really good start in a nursing career. In fact, they like having newly qualified people because of that.” In the two-and-a-half years she worked there, Cottam admits there were some heartbreaking moments. “You’d get a lot of young adults coming in and it was very sad. But my role was very much about taking a family approach, listening to and supporting them, as well as explaining what was going on. When people got better, that was the pay-off. Nursing an individual back to a point where they could regain their independence was very special. You knew you’d made a huge difference to that person and their family.”

Eight months ago, Cottam felt ready to move roles and she joined the accident and emergency department. “I felt I wanted to further develop my skills and here you’re at the front line, dealing with minor injuries through to resuscitation,” she says.

The new four-hour target means there’s a lot of pressure on medical staff to get people treated or referred on in record time, she says. “That can be hard because there’s not always a steady flow. One minute your department can be empty and the next, you have 15 ambulances you have to react to. You might not have enough beds and it can be really difficult. But you find ways round it and manage to help people recover.” While Cottam may sometimes be called on to do high-tech clinical procedures, other times it’s her empathy and sensitivity that’s required. “One lady was brought in who’d recently lost her husband. She’d had a fall and broken her arm and hurt her nose. She was upset. She always used to hold her husband’s hand and when she went out without him for the first time after his death, she fell over. She had a cry and I listened to her. She just needed some time and reassurance and she wrote a thank you card to me for being there.”