Submitted 2022-06-26
For nurses, emergency management skills are now considered an entry-level competency, meaning that all nurses must be able to demonstrate that they have the knowledge and skills needed to respond in an emergency. This can be rather intimidating and challenging to new nurses with minimal experience, as healthcare teams often utilize a complex and multifaceted approach to respond to emergent clinical situations. This approach requires that all team members fully understand their role and responsibilities to ensure a seamless and efficient response. Each team member uses current research, clinical expertise, and patient preferences to guide their decision-making from moment to moment – each decision made must be congruent with the functionality of the team to ensure the patient’s survival. Accordingly, emergency management is a skill that is developed over time with plenty of practice and experience. Along with emergency management theory learned in nursing school, nurses are expected to maintain their competency by enrolling in formal education programs on an annual basis, such as Basic Life Support (BLS) or Advanced Cardiac Life Support (ACLS). These formal programs are critical in helping nurses build and maintain basic competencies regarding emergency management. Nurses can also supplement their education using informal sources, such as watching YouTube videos to clarify confusing concepts or practicing mock drills with colleagues to practice teamwork skills. These informal sources can help solidify information learned in formal training programs, as well as build confidence in emergency management skills.
It is important to understand that all fields of nursing use emergency management skills in some capacity. This includes Supportive Living and Long-Term Care facilities, which primarily house seniors requiring a higher level of care. Throughout Canada, seniors in Supportive Living and Long-Term Care environments have a legal document known as an Advance Care Plan in place. This document summarizes the resident’s wishes for the extent of medical treatment they would like to receive, including resuscitative measures and end-of-life care. Some residents elect to receive full resuscitative measures, including cardiopulmonary resuscitation (CPR), in the event of stroke or cardiac arrest. Unfortunately, particularly frail residents may experience multiple fractured ribs and extensive bruising because of CPR, factors that may impact the resident’s quality of life moving forwards. Considering this, some residents do not wish to be resuscitated, but would still like to receive less-invasive medical interventions and supportive measures. This can include suctioning and clearing the airway in the event of choking, an extremely common occurrence in residents with swallowing difficulty related to stroke deficits. Depending on the disease process(es) present, some residents may not wish to receive any form of resuscitation or medical intervention, choosing instead to focus on comfort care and supportive measures only. This option is typically chosen when the end of life is approaching and is designed to maximize a person’s quality of life in their final years. Nurses working in Supportive Living or Long-Term Care facilities must be aware of each resident’s code status and how to respond accordingly. Typically, the nurse will carry a “cheat sheet” containing the code statuses for each resident. This cheat sheet is regularly checked and updated to ensure accuracy. However, this approach to emergency response management is not mutually exclusive to all nursing fields. Emergency response practices in Supportive Living and Long-Term Care are often very different in more acute healthcare settings, such as in Emergency departments. In these settings, patients are typically younger and subsequently do not have an Advance Care Plan in place. In the absence of an Advanced Care Plan, the default emergency response procedure is full resuscitative care. These nuances truly highlight the complexity of emergency management in healthcare settings, which is precisely why adequate training and regular practice is crucial in building and maintaining emergency management skills.
Along with education and practice, another key component in building and maintaining emergency management skills is self-care. It is important for nurses to protect their physical and mental well-being to ensure they can respond to emergencies in a rapid and efficient manner. Nurses can protect their physical health by adopting healthy lifestyle measures, such as eating a healthy diet and exercising regularly. In the context of emergency response, it is important for nurses to ensure they have the energy and strength to provide high-quality chest compressions for an extended period, which can be quite physically taxing. Another dimension of health that is important in emergency management is mental health, which unfortunately is frequently neglected among healthcare workers. On particularly busy and chaotic days, it can be all too easy for nurses to skip breaks, grab a quick snack, and continue with work demands. However, this culture of self-neglect has negative consequences on physical and mental health, which can eventually lead to burnout and mental illness. This can have a negative impact on a nurse’s ability to think quickly and critically in emergency situations, which can have disastrous consequences. As such, it is crucial that nurses take steps to reduce their stress and protect their mental health, such as taking breaks as scheduled, practicing mindful meditation, and journaling. As caregivers, nurses are naturally inclined to prioritize the well-being of their patients over their own. However, it is important that nurses take care of our own physical and mental health first and foremost, as the quality of care we can provide depends on whether our own needs have been met.
For nurses, emergency management is a complex, highly nuanced skill that takes years of practice to develop. And at the end of the day, the grades we achieve or the praise we receive doesn’t matter when someone else’s life is in our hands. It’s not about being perfect, it’s about having the self-awareness to critically reflect on our own skills and attending to our learning needs as they arise. This is a highly vulnerable process that can be quite uncomfortable in the moment. However, the “fake it ‘til you make it” mentality is dangerous and can have potentially serious consequences when it comes to patient care, particularly during emergencies. Therefore, education, practice, and self-care are all key components in providing the highest quality of care possible in emergency situations.