A day in the life of an emergency nurse practitioner

Myrtle works in an acute NHS trust as an emergency nurse practitioner (ENP) in the urgent care centre. We follow a typical day in her working life.

10am – shift starts

I’m starting at 10am today but I like that we have a rota request system. Shifts are usually 12 hours but there’s some flexibility to request different start times to help fit with family life.

Today I’m shift leader so I start with some administration. I have a handover from the previous shift leader, check the staff rota and arrange for replacements where needed, check equipment and look over the current waiting list of patients.

10:30 – into the throng

I’m taking a spell at the front desk assessing patients as they arrive. This is quite challenging as you only have 2-3 minutes to get a feel for their situation and prioritise them. I also watch over the waiting room to make sure nobody appears to be having difficulty, or looks like they need to be reprioritised.

One of the first people I see is a child whose heart is beating fast and feels breathless. I decide we need to take her for assessment immediately. Her pulse rate is very high and on further discussion with the mother, I find out she’s had this kind of episode before and has been diagnosed with Supraventricular Tachycardia (SVT) (where the heart has spells of beating very fast). I’m glad I uncovered this as it can be serious and could result in a heart attack, so I send her straight to the resuscitation team so she can be monitored closely.

Soon after, a construction worker comes in with a laceration on his arm. We assess his bleeding straight away but find it’s not as serious as it first looked and we feel satisfied he can book in as normal. I explain that he will be on a list along with other injured people waiting. He becomes very agitated about this, shouting that he’s ‘bleeding to death’. It takes a while to calm him down and get back to other patients. Around the same time, a carjack victim with facial injuries and several dislocated fingers books in and waits patiently, later thanking us all for the speed of service. I have a rueful smile at the contrast.

1:30pm – check on staff and paperwork

As assessing patients is such an intense task, we have a limit of three hours before taking a break from it. I take the chance to check on the team and make sure people that are due to take a break are able to.

2pm – investigation meeting

There’s an investigation into a patient that came into urgent care a while ago. He had been seen at another hospital after fracturing his leg and had extreme pain in his ankle – to a degree that was unusual for this kind of injury. All the normal checks, including x-rays, didn’t show up anything unexpected. Sadly, it later transpired that he’d been suffering from sepsis, which resulted in his leg being amputated. This was very difficult news for me as, although we took all the normal steps for the type of injury, there’s always a nagging doubt about whether you should have picked it up. It’s something that taught me about taking every situation individually and reminded me that instincts are important – there had been a nagging doubt that his pain was more intense than it should be, but at the time we thought we’d done all the necessary checks. 

3pm – back to urgent care

Back to seeing patients again. The next patient has a suspected fractured nose and since I started here, one of the suggestions I made was that we needed a care pathway for nasal fractures. They’re often difficult to diagnose in the early stages because of swelling. Instead of discharging patients to follow up with their GP after swelling reduces in 7-8 days, we now refer them for a follow up with our ear, nose and throat (ENT) clinic. This is since we found that patients would often leave it too late to follow up with their GP, leading to potential problems later with breathing, as well as cosmetically. I’m really pleased to work somewhere where suggestions like this are taken on board and we can improve outcomes for patients.

5pm – assessing patients again

I take another stint at assessing patients.

One of the patients is a woman who’s seven weeks pregnant and is bleeding. We assess the bleeding straight away but it’s not at a level we’re worried is immediately dangerous for her. She’s concerned she might be losing the baby but sadly at this early stage of pregnancy there would be nothing we could do. I explain she’ll need to wait to be seen by a doctor but her husband isn’t happy about this. He quickly gets aggressive and threatening. I end up calling security and then the police as the situation escalates. Later that evening, when I’m leaving, I take extra care going to my car as it rattles me a bit.

8pm – take a break

I finally get a chance to take my meal break and sit in the staff room for a while catching up on messages from family.

8:30pm – final patients

I see a child with a burn to his arm. The explanation his mum gives about how it happened has me suspicious – it doesn’t seem to add up but she’s insistent. This is one of the situations I find most challenging – you don’t want to make false accusations or cause unnecessary stress for a family. I end up referring to paediatric care so they can spend a bit longer assessing the situation and deciding if it warrants involving social services.

10pm – shift over

It’s been a long day and, as always, I’m exhausted. I always try to leave the stressful aspects there at work though. I get in my car, play some music and unwind on the way home.

Myrtle participated in A Mile in my shoes. Listen to Myrtle’s story.