July 13, 2013 | On Early Mornings, Emergency Nursing, and the Lessons That Follow Us Beyond a Rotation

At an hour when most respectable people are still negotiating with their pillows, I have been expected to appear at the hospital looking presentable, alert, and capable of making sensible clinical decisions. This is an impressive demand to place upon someone whose brain considers early mornings a personal insult. There is something particularly cruel about an alarm clock that rings before the sun has properly committed to the day. It has no sympathy for unfinished dreams, no interest in how comfortably one has been sleeping, and absolutely no appreciation for the extraordinary effort required to exchange a warm bed for a white nursing uniform. Nevertheless, for the duration of my Emergency Room rotation, I have been doing precisely that. And today, I am pleased to announce that my morning-shift alarm clock and I are finally taking a little break from our troubled relationship.

Goodbye, morning duty. I shall remember you with considerably more affection now that you are over.

Hahaha!

Today marks the end of my rotation in the Emergency Room at JGH, and I am writing this with the peculiar satisfaction of someone who is physically tired but genuinely happy. It has been an interesting introduction to hospital practice, particularly after spending approximately a year and a half away from regular clinical duty. Only recently, I was celebrating the opportunity to wear my white uniform again. I was meeting new colleagues, learning the routines of an unfamiliar workplace, and trying to recover the professional confidence that had become slightly dusty during my absence. Now, after completing my Emergency Room rotation, I find myself thinking about how much I have learned in such a short period.

The Emergency Room is not exactly the kind of place where life politely waits for everyone to finish their coffee.

People arrive with different illnesses, injuries, concerns, and levels of urgency. Some require immediate attention, while others can safely wait after an appropriate initial assessment. Situations change, new patients arrive, and the healthcare team must continually determine what requires attention first. For a nurse still gaining experience, it is an environment that demands both concentration and a willingness to learn quickly.

During nursing school, I encountered the principles of emergency care through lectures, clinical rotations, and examinations. We studied assessment, observation, prioritisation, and the importance of recognising patients whose conditions might deteriorate. We memorised terminology, answered questions, and discussed the actions nurses should take in various situations. I remember how easy it sometimes seemed to identify the correct answer when the circumstances were neatly arranged on paper.

Actual clinical environments have a rather inconvenient habit of refusing to resemble examination questions.

Patients do not arrive accompanied by four possible answers, one of which has been thoughtfully identified as correct. Their conditions may be complicated, their symptoms may change, and important information may not be immediately available. Nurses must observe carefully, communicate effectively, follow established procedures, and recognise when concerns require prompt escalation.

That is one of the most important things the Emergency Room has taught me.

Good observation is not simply about looking at a patient. It involves recognising details that may influence clinical decisions and appreciating that even apparently ordinary information can become significant when considered alongside the patient’s overall condition. A nurse may be responsible for recording observations, but the value of those measurements also depends upon understanding their meaning and responding appropriately when something is abnormal.

I am beginning to appreciate how much professional judgement lies behind activities that once appeared relatively straightforward.

During nursing school, taking a patient’s blood pressure was one of the first practical skills we learned. We practised the procedure, became familiar with the equipment, and tried to remember everything our instructors expected us to demonstrate. At the time, much of our concentration was directed towards performing the task correctly.

Now I am becoming increasingly aware that obtaining a measurement is only part of the responsibility.

The observations must be considered in context. The patient’s symptoms, medical history, current condition, and changes over time can all influence what those findings mean. A nurse must learn when to be concerned, when to seek assistance, and how to communicate relevant information clearly.

It is quite a responsibility for a profession whose uniform once made me feel that the greatest danger involved spilling something on perfectly white fabric.

Assessment has been another important lesson.

I am discovering that asking questions and gathering information require considerably more thought than simply following a memorised sequence. Patients may describe their symptoms differently. Some can explain their concerns clearly, while others may struggle because they are frightened, uncomfortable, or too unwell to communicate easily. We need to listen, observe, and gather information in a way that helps the team understand what is happening.

I have always believed that communication is an important part of nursing, particularly after a recent conversation with a patient reminded me how meaningful it can be simply to listen. In the Emergency Room, I am beginning to see another dimension of that responsibility. Listening is not only about offering comfort. It can also help us recognise information that may be relevant to assessment and treatment.

And then there is prioritisation.

Goodness, what a skill to develop.

I suspect anybody who has ever attempted to complete several urgent responsibilities at once will understand why prioritisation matters. Even outside the hospital, people struggle with deciding which task deserves attention first. I have occasionally spent so much time considering the order in which I should complete my personal responsibilities that I have accomplished remarkably little of any of them.

Unfortunately, that approach would be entirely unsuitable in an Emergency Room.

Clinical prioritisation requires nurses to recognise the relative urgency of patients’ needs and act according to their condition and the established care pathways. The person who appears most impatient is not necessarily the person who requires the most immediate clinical intervention. Likewise, a patient who is quiet may still be seriously unwell. Understanding the difference requires knowledge, careful assessment, teamwork, and experience.

I have observed how important it is to remain organised and focused when several responsibilities compete for attention.

There is an art to maintaining composure while the environment around you continues moving at a pace that does not particularly care whether you feel ready.

I am still learning that art.

And I suspect I will continue learning it for quite some time.

One of the most valuable things about this rotation has been the opportunity to work alongside more experienced healthcare professionals. There is an extraordinary amount of knowledge available within a hospital, although not all of it can be found in textbooks or lecture notes. Nurses who have spent years working in a particular department often possess practical insights that can help newer colleagues understand the routines, responsibilities, and challenges of the environment.

I have realised that asking questions is not something to be embarrassed about.

During my student-nurse years, I sometimes worried about asking questions whose answers I thought I should already know. There is a particular kind of embarrassment involved in approaching someone more experienced and admitting that you are uncertain about something. The imagination immediately becomes unhelpful. What if the question sounds foolish? What if they wonder how you passed your examinations? What if they think you have somehow misplaced your entire nursing education?

But I am beginning to understand that remaining silent simply to protect one’s pride can be far more problematic.

In healthcare, recognising the limits of our knowledge is an important professional responsibility. When we are uncertain about a procedure, an instruction, or a clinical concern, seeking appropriate guidance is part of practising safely. A question asked at the right time can clarify our understanding and prevent assumptions from influencing our actions.

There is no professional achievement in pretending to know something we do not.

I think I needed to learn that lesson as much as any clinical procedure.

The Emergency Room staff have helped me appreciate the importance of making use of opportunities to learn. Every department contains experiences that may not be repeated in exactly the same way, and every rotation offers the possibility of understanding something we previously knew only in theory. Of course, not every moment becomes a dramatic educational revelation. Some days involve routine responsibilities, repeated observations, documentation, and the ordinary work necessary to keep patient care organised.

But even familiar tasks can teach us something when we approach them attentively.

Sometimes learning involves observing how an experienced nurse communicates with a patient. Sometimes it means understanding the reason behind a particular procedure or recognising how colleagues coordinate their responsibilities. At other times, the lesson comes from making a mistake in our thinking, receiving a correction, and discovering a better way to approach the same problem.

I am grateful to the staff who have been willing to share their knowledge.

I know that teaching someone new can require additional patience, particularly in a department where time and attention are already in high demand. I appreciate those who explain, guide, and encourage us to ask questions rather than expecting confidence to appear simply because we possess a professional licence.

I hope that as I gain experience, I will remember what it feels like to be the person who is still learning.

Perhaps one day, when someone newer approaches me with a question, I will be able to offer the same consideration I have received.

There is another part of Emergency Room nursing that I have been reflecting upon, and it has less to do with clinical skills than with the people receiving our care.

During training, we are understandably taught to complete procedures correctly. We learn medication administration, monitoring, infection prevention, assessment, documentation, and the many responsibilities necessary for safe nursing practice. These are not optional tasks, nor should their importance be underestimated. Patients depend upon nurses being competent, careful, and accountable.

Yet I have begun to realise that the way we carry out these responsibilities can matter almost as much to the patient’s experience as the tasks themselves.

A patient may not remember the exact time a nurse checked their blood pressure or the technical details of an intravenous procedure. They may not know which observations were recorded or how many clinical responsibilities were completed during a shift.

But they may remember how they were treated.

They may remember whether somebody listened when they expressed a concern, explained what was happening in understandable language, or responded with consideration when they felt frightened or uncomfortable.

Of course, patients also benefit enormously from safe, timely, and technically competent care, even when they never become aware of the work involved. I would never want to suggest that compassion can compensate for inaccurate observations or missed treatment. Nursing requires both clinical competence and humane treatment.

But I am beginning to appreciate that completing a task and caring for a person are not always experienced in the same way.

Two nurses may perform the same procedure correctly, yet the interaction can feel very different depending upon their communication, patience, and consideration for the person receiving it.

One may approach the responsibility as something to finish before moving on.

Another may complete the same responsibility while also explaining what is happening, acknowledging the patient’s concerns, and treating them with dignity.

Both may perform the technical aspect of the task, but the patient’s experience may be quite different.

I think this is one of the lessons I want to remember beyond my Emergency Room rotation.

There is a tendency, particularly when we become busy, to begin thinking about our responsibilities as a collection of tasks waiting to be completed. There are observations to record, medications to administer, procedures to assist with, and documentation requiring attention. Time moves quickly, and before one responsibility is finished, another may already be waiting.

It is understandable that nurses must develop efficiency.

But efficiency should not require us to forget that each task involves a person.

A patient is not simply the next observation on a chart or another procedure on a list. They may be experiencing one of the most difficult days of their life, even if, for the healthcare professionals around them, the shift appears entirely ordinary.

I find that thought rather humbling.

What feels routine to a nurse may be unfamiliar and frightening to somebody receiving care.

A procedure we have performed repeatedly may be something a patient has never experienced before. A question that appears straightforward to us may concern an issue they have been worrying about for hours. A hospital environment we recognise as part of our workplace may feel strange and overwhelming to someone who would much rather be at home.

Perhaps remembering these differences can help us become more considerate.

I do not think compassion always requires grand gestures or lengthy conversations. In a busy Emergency Room, time and clinical priorities may limit what is possible. Sometimes it is expressed through a brief explanation, a respectful introduction, an attentive response, or an effort to preserve dignity while providing necessary care.

There may also be moments when reassurance involves simply being present.

I remember learning during nursing school that caring involves more than responding to physical symptoms. We discussed holistic nursing, therapeutic communication, and the importance of recognising patients as individuals rather than diagnoses. At the time, these concepts were familiar elements of our academic requirements.

Now, little by little, I am discovering how they appear in ordinary clinical practice.

And I think that is one of the most satisfying aspects of returning to nursing.

The knowledge I spent years acquiring is beginning to find its place among real responsibilities and interactions. Some concepts feel more meaningful now that I can observe their application. Others have become more complicated than I previously imagined.

Either way, I am learning.

Of course, I would be dishonest if I described this rotation as an uninterrupted series of fascinating educational experiences. There were tiring moments. There were mornings when my bed seemed considerably more appealing than the prospect of getting dressed for duty. There were occasions when I had to concentrate carefully to remember unfamiliar routines or understand what was expected of me.

And there were probably moments when I looked at the clock and wondered whether time had temporarily lost its ability to move.

Such things are part of adjusting to work, I suppose.

But despite the exhaustion, I feel satisfied.

I returned to regular nursing duty hoping to become more confident in my profession. I wanted to refresh my skills, become comfortable within a hospital environment again, and discover the clinical areas that might interest me in the future. The Emergency Room has given me opportunities to observe, ask questions, learn from colleagues, and reconsider what competent nursing care requires.

That seems a worthwhile beginning.

And now, another rotation is approaching.

ICU.

Yes, the Intensive Care Unit!

Of all the departments I visited during our hospital orientation, ICU was one of the areas that captured my attention most. I have always been fascinated by critical care and the specialised knowledge required to care for seriously ill patients. I know that the environment can be demanding, and I am under no illusion that enthusiasm alone will prepare me for its responsibilities.

But I am excited to learn.

This time, I will be assigned to the afternoon shift, which brings an additional reason for celebration.

Goodbye, sleepy mornings!

At least for now.

I would like to say that I shall miss waking up early, but I have decided that honesty is an important professional value, and therefore I cannot make such a declaration with a clear conscience.

My pillow and I have been through enough.

Still, I know that a change in shift schedule does not necessarily mean the coming rotation will be easier. Intensive care presents its own challenges, and I expect to encounter unfamiliar routines, complex clinical situations, and responsibilities that require careful attention. There will be more questions to ask, more concepts to review, and probably a few occasions when I wonder whether I should have spent additional time studying.

But I am beginning to enjoy this process of discovering what nursing involves beyond the classroom.

There is something encouraging about recognising that each rotation adds another piece to our professional understanding. I do not expect myself to become an expert after spending a short period in a department. What I hope is that I leave each experience knowing more than I did when I entered, with a greater appreciation for the skills I still need to develop.

Perhaps that is a reasonable way to approach the beginning of a nursing career.

I have also realised that professional confidence does not have to mean possessing every answer. It can involve knowing how to approach uncertainty responsibly, seeking guidance when necessary, and developing enough self-awareness to recognise when we need additional knowledge or support.

The Emergency Room has reminded me that there is no shame in being new.

There is, however, a responsibility to remain willing to learn.

As I prepare to move on, I find myself thinking about the people I have encountered during this rotation. The staff who answered my questions, the colleagues who shared their experiences, and the patients whose circumstances reminded me why nursing requires so much more than practical ability.

I may not remember every ordinary task I completed or every conversation that took place during these days. Some details will eventually blend into the familiar memory of my early hospital experience.

But I hope the lessons remain.

I hope I remember to observe carefully, assess thoughtfully, and recognise the importance of clinical priorities. I hope I remain willing to ask questions rather than allowing pride to interfere with learning. And I hope that as my responsibilities increase, I continue to understand that a patient’s dignity deserves attention alongside every clinical task.

It is easy to make promises about the kind of professional we want to become while we are still at the beginning of our careers.

The real challenge, I suspect, is remembering those intentions after the work becomes familiar.

When procedures become routine and shifts become busy, will I still recognise the importance of an ordinary conversation? Will I remember that patients may be frightened even when I am comfortable with the clinical environment? Will I make an effort to communicate respectfully when I am tired?

I hope so.

Perhaps these are questions worth carrying into every department, not only the Emergency Room.

And perhaps that is why I find saying goodbye to this rotation unexpectedly meaningful.

I arrived eager to refresh my nursing knowledge and develop confidence in an unfamiliar workplace. I am leaving with a greater appreciation for assessment, observation, prioritisation, teamwork, and the importance of learning from experienced colleagues.

But I am also leaving with a reminder that professional competence should never become separated from compassion.

Tomorrow, or whenever the next duty begins, I will put on the same white uniform and report to a different department. There will be new people, new routines, and another collection of responsibilities to understand.

The Emergency Room will continue without me, naturally. Patients will arrive, nurses will attend to their needs, and the familiar rhythm of the department will carry on. I suspect nobody will interrupt the day’s activities to commemorate my departure from the morning shift.

Which is probably just as well.

I have already prepared enough celebration for that particular achievement.

Still, I am grateful for my time here.

Thank you to the Emergency Room staff for your guidance, patience, and willingness to share what you know. Thank you to my fellow nurses for the company and experiences that made this rotation memorable. And thank You, Lord, for another opportunity to learn through the profession I have chosen.

I began this entry celebrating the end of early mornings, which I continue to consider a perfectly valid reason for happiness.

But now that I have spent some time reflecting, I realise that the most valuable things I am taking away from this rotation cannot be measured by how late I am allowed to sleep.

They are the lessons I hope will remain useful long after I have forgotten the exact details of these first duty days.

The Emergency Room has taught me that nursing requires alertness, clinical judgement, and the ability to recognise what needs attention first.

It has also reminded me that the person receiving our care should never disappear behind the responsibilities we are trying to complete.

And perhaps that is a lesson worth remembering in every department I enter.

So, goodbye for now, Emergency Room. Thank you for the experience, the guidance, and the professional lessons.

As for the morning shift, I wish you all the best in your future endeavours.

Preferably without me.

Hello, ICU. Hello, afternoon duty. Let another chapter of nursing begin!

July 13, 2013 — tired, happy, and grateful for everything the Emergency Room has taught me.

— Just Anj, RN, currently celebrating the possibility of sleeping past sunrise.