This week is my first set of nights working with the psychiatric assessment team in a general hospital.
Unlike during the day when referrals can come from throughout the hospital, the darkness belongs to A&E and the kinds of crises that you simply can’t have at 1.45pm on a sunny Tuesday afternoon.
First of all, I must emphasise how little time I’ve spent in A&E. I can neither swim nor ride a bike and, as a child, I preferred to sit and watch Animal Hospital rather than partake in the kinds of activities that would cause you to break an arm or lose a finger. The only experience I have had of emergency departments to this point were my sister’s ER videos.
“The darkness belongs to A&E and the kinds of crises that you simply can’t have at 1.45pm on a sunny Tuesday afternoon.”
During my first days on placement my preliminary ventures into A&E were the 8am doctors’ meetings wherein bleary-eyed night staff spoke in acronyms about what they had encountered and who they had discharged overnight. One day we looked at a CT scan; I did a lot of nodding and looked serious. This was all very foreign territory.
“I can neither swim nor ride a bike and, as a child, I preferred to sit and watch Animal Hospital rather than partake in the kinds of activities that would cause you to break an arm or lose a finger.”
No day shift in the emergency department is ever the same but often the mental health team receive a handful of referrals for people recovering from incidences of self-harm or overdose. We sit in little cubicles and talk about how they are feeling now and the events that led to them coming in.
As a student nurse, these little windows into people’s lives are an incredible privilege and the pain and heartache that many describe is humbling. The most important lesson I have learnt is to never underestimate what any person around me could be going through without ever saying a word about it.
“There is a sense of camaraderie that night staff have - a wide-eyed energy fuelled by coffee and necessity.”
Then they are gone (usually with a follow-up appointment booked with a community team or signposting to other relevant services) through a crowd of professionals that seem to ooze efficiency and competence.
As the sun sets, a “buzz” starts to spread. To me, t’s a feeling not dissimilar to twilight on the older adult ward where I was placed last year; a sense that something wholly unpredictable may be about to happen.
There is a sense of camaraderie that night staff have - a wide-eyed energy fuelled by coffee and necessity. It is the very nature of A&E that things can change in the blink of an eye and we need to work as a team to keep ourselves and those in our care safe.
“A feeling of warmth and companionship transcended the staff hierarchy and buoyed each person to carry on with the shift.”
The first assessment we were called to was one shortly after a serious incident. I saw staff comfort one other and reflect. A feeling of warmth and companionship transcended the staff hierarchy and buoyed each person to carry on with the shift.
As the night went on, a sea of people ebbed and flowed through the corridor. Police and ambulance staff passed through and became part of the ‘night family’. As a student mental health nurse, I have been welcomed and been made to feel part of something bigger.
Working a night shift on A&E is an incredible learning experience, both academically and socially. I sometimes feel like mental health nursing can be very isolating as many in role rarely work alongside other disciplines and professions, so to have this opportunity has been invaluable.
Working in an environment as fast-paced as A&E, where everyone has a role and is valued, illustrates how well the health service can work with staff collaboration. Bring on the next shift.
Hazel Nash is Student Nursing Times’ student editor, mental health branch