Xray interpretation simply!! – June 4th

Xray interpretation simply!! – June 4th

Learning Outcomes:

  • Identify cardiothoracic anatomical structures demonstrable on a chest film.
  • Recognise a normal chest radiograph.
  • Recognise and interpret common abnormalities on chest x rays
  • Correlate physical signs and symptoms radiographic findings.
Hypovolaemic Shock – It is not a short pause before death – May 28th

Hypovolaemic Shock – It is not a short pause before death – May 28th

Learning Outcomes:

  • Explore the structured assessment of the patient in hypovolaemic shock in Emergency
  • Review clinical cases of patients in hypovolaemic shock in theED’s
  • Describe and apply up-to-date knowledge in the area of nursing a patient in hypovolaemic shock
  • Describe alternative management strategies and discuss controversial issues are encountered in daily practice


Challenging cases in paediatric emergency care – May 7th

Challenging cases in paediatric emergency care – May 7th

Learning Outcomes:

  • Explore the structured assessment of the paediatric patient in Emergency
  • Review clinical cases that present to ED’s
  • Describe and apply up-to-date knowledge in the area of paediatric emergency nursing
  • Describe alternative management strategies and discuss controversial issues are encountered in daily practice
Pitfalls of septic shock – March 5th

Pitfalls of septic shock – March 5th


Learning Outcomes:

  • Understand how easy it is to miss the diagnosis of sepsis at triage
  • Understand how the implementation of the Sepsis bundles and guidelines will impact care in your department
  • Examine the emerging evidence from recent studies that will inform the practice of managing sepsis
  • Outline the role of the Sepsis 6 in the early care of the septic patients


Support for Ratios for Aged Care

The College of Emergency Nursing Australasia (CENA), the peak professional association representing emergency nurses, unequivocally supports the Australian Nursing & Midwifery Federation’s campaign for Ratios for Aged Care. Residential aged care services provide care to one of our most vulnerable populations and the current nurse-to-resident ratios are woefully inadequate.

There is clear evidence that better levels of nurse staffing result in better patient outcomes and decreased risk of death and harm. The lack of nurse staffing in aged care not only places residents at risk of suboptimal care it also results in moving residents to emergency departments as aged care staffing does not enable nurses assess and manage residents who suffer clinical deterioration or an event such as a fall at their facility.

CENA Executive Director, Dr Julia Morphet highlights that “transferring older persons to emergency departments places them at unnecessary risk of harm”. “Movement to an unfamiliar environment is distressing for many older persons and their families and can cause delirium which is associated with increased risk of death.” “Being in an emergency department places older persons at higher risk of falls, pressure injuries, and unnecessary test and invasive procedures.”

CENA endorses that older persons deserve the best possible care which is not possible in the 2.86 hours of nursing care per day currently provided to residents. Nurse staffing in aged care warrants urgent attention and legislated nurse-to-resident ratios: make them law now.


Further information:

Dr Julia Morphet, Executive Director

College of Emergency Nursing Australasia


Future Emergency Nursing workforce, what is the evidence telling us?

Mrs Vanessa Gorman1

1The Royal Women’s Hospital, Melbourne, Australia

OBJECTIVE: High nursing turn-over, and low retention rates amongst the field of emergency nursing according to current evidence is a global phenomenon. How is the current evidence influencing managers and organisations to identify key factors that may improve not only retention, but recruitment, into the speciality of emergency nursing?

This study utilised a bibliographic search as well as the authors own experience when performing the integrative review.

26 articles were identified as meeting the criteria of the integrative review. Both national and international articles that met inclusion criteria were included.
4 key themes were identified that may impact on the recruitment and retention of emergency nurses: workplace environment, demands on emergency nurses, resilience, and education and training.
The key themes identified all impact on emergency nurse recruitment and retention, but the evidence is conclusive that a multi-level approach needs to be adopted internationally.

Emergency nursing recruitment and retention is a multi-faceted issue that requires urgent attention to develop tools and strategies to support organizations to build a sustainable workforce. This study has highlighted the need for further studies to understand why emergency nurses lack the knowledge or capability for a long-term career in emergency nursing.


Vanessa commenced her emergency nursing career in 1996 and across her career in emergency nursing she has held positions such as Nurse Unit Manager, Senior Policy Advisor – Department of Health, and State Trauma Manager. Vanessa is the appointed Emergency Services manager at the Royal Women’s Hospital, Melbourne. Vanessa is an appointed member of the International Advisory Council for the Emergency Nursing Association (USA), and is appointed to the CENA membership committee. In 2017, Vanessa was awarded the Australasian Emergency Nurse of the year as she strives to improve emergency care for both patients, and the nursing workforce, through various quality projects.

Do consumers who identify as Muslim experience cultural sensitive care (CSC) in the Emergency Department (ED)? A scoping review

Amy Johnston1,5, Mingshuang Ding2,3, Omer Mohammed3, Debbie Massey4
1Department of Emergency Medicine, Princess Alexandra Hospital, Metro South,2School of Nursing, Faculty of Health, Queensland University of Technology,3Department of Emergency Medicine, Queen Elizabeth II Jubilee Hospital,4School of Nursing, Midwifery and Paramedicine, Faculty of Health, University of Sunshine Coast,5School of Nursing, Midwifery and Social Work, The University of Queensland

Background: Lack of awareness about cultural and religious values and beliefs of patients presenting to emergency departments (EDs) can compromise patient care and safety. Muslim Australians represent the fastest growing religious demographic group, with over a 77% growth in the last decade [1]. The changing face of Australian population requires that Australian health care consider carefully the dominant western cultural paradigm currently underpinning of health care delivery [2-5]. This is particularly critical in EDs, commonly the entry point into healthcare services
Objectives: This scoping review explored evidence of key components and impacts of cultural safe care (CSC) in EDs for staff and care consumers who identify as Muslim.
Methods: A systematic search using electronic (five databases) and heading searching methods for primary research published between 2006 and 2017 was undertaken; followed by a rigorous screening and quality appraisal process. Included articles were assessed for similarities and differences, the content was grouped and synthesized and tested for clinical salience using the six-staged Arksey and O’Malley methodological framework. The Mixed Method Assessment Tool was used to appraise the quality of included literature.
Results: Three studies were included in the analysis.
Conclusion: Religious beliefs and practices are common. Such beliefs and practices could influence patients’ understanding of their conditions, their acceptance of care delivery, their processes of decision-making, and their commitment to treatment regimens and coping strategies. They could also impact on care seeking behaviours and on family and community acceptance of care delivery. There is a serious lack of evidence around the delivery of culturally safe care in EDs locally and internationally. While many EDs may have procedure documents or staff care guides, it is unclear on what basis these have been developed, as there is minimal published evidence exploring any issues around provision of CSC to Muslim ED care consumers


Amy Johnston is a conjoint senior lecturer in Emergency Care, based between Metro South Emergency Department (PAH) and School of Nursing, Midwifery and Social Work, The University of Queensland. She is deeply committed to bringing research skills and outcomes to emergency staff. She is a widely published and cited academic and registered nurse with experience in a range of research techniques. Her love of clinical research is heartfelt and (hopefully) infectious. She is involved in HDR student supervision and onsite development of ED staff research skills.

Exploring interventions used in emergency departments to reduce occupational stressors and or improve staff coping: A scoping review of the literature

Ms Elizabeth Elder1, Dr.  Amy N. B. Johnston2,5,6, Prof. Marianne Wallis2,4, Prof. Julia Crilly2,3

1School of Nursing & Midwifery, Griffith University, Southport, Australia, 2Menzies Health Institute Queensland Griffith University , Southport, Australia, 3Department of Emergency Medicine  Gold Coast Hospital and Health Service , Southport, Australia, 4School of Nursing Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Australia, 5School of Nursing Midwifery and Social Work, University of Queensland , Brisbane, Australia, 6Department of Emergency Medicine Princess Alexandra Hospital Metro South, Brisbane, Australia

Introduction: Emergency departments (EDs) are stressful places to work (1). Staff are exposed to many occupational stressors and rely on varying coping strategies (2). Exposure of ED staff to occupational stressors has been linked to increased absenteeism and burnout, higher staff turnover and low staff morale (3). The aim of this review was to examine and synthesize existing evidence relating to interventions designed to reduce the impacts of occupational stressors and/or improve ED staff coping.

Methods: The review involved searching five databases using terms related to stress/or, coping, and emergency department for papers published in English from 2007-2017. Study quality of quantitative studies was assessed using National Health and Medical Research Council Level of Evidence Guidelines (5).

Findings: A total of 45 studies met criteria for review inclusion. The level of evidence of included studies varied from level I (n = 1) to IV (n = 11). Interventions discussed in the literature that targeted occupational stressors included organizational/environmental redesign, policy/protocol change and staff education. Interventions targeted towards improving coping strategies of staff included mindfulness, debriefing and relaxation techniques. Most studies reported some degree of positive effect/s on either reducing exposure to occupational stressors and/or improving staff coping.

Conclusion: This review highlights the limited existing literature relating to interventions designed to ameliorate a wide range of occupational stressors experienced by ED clinicians. The findings of this review support the need for additional research to underpin and guide interventions designed to address occupational stressors and or improving coping strategies used by ED clinicians.


  1. Basu S., et al. Occupational stress in the ED: a systematic literature review. EMJ. 2017;34(7):441-7.
  2. Abraham LJ., et al. Morale, stress and coping strategies of staff working in the emergency department: A comparison of two different-sized departments. EMA. 2018.
  3. Ahwal S. & Arora S. Workplace Stress for Nurses in Emergency Department.
  4. Arksey H. & O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8.
  5. National Health & Medical Research Council. NHMRC Levels of evidence and grades. Canberra 2009.


Elizabeth is a credentialed emergency nurse with a passion for education, research and clinical practice.  Believing research is the juncture of clinical practice and academe Elizabeth enrolled in her PhD in 2016.

Staff wellbeing program

Mrs Elizabeth Bradbury1
Clinical Nurse Manager, Melbourne Health, North Warrandyte

The Royal Melbourne Hospital (RMH) is a state-wide trauma service seeing around 78,000 presentations annually. The ED management team recognises staff as our greatest asset and chose to invest in `Caring for the Carers’ by developing a wellbeing program which aligned strongly with our organisational vision to be `First In Care’ and to be an employer of choice.
The ED Leadership team worked in consultation with our the RMH Health & Wellbeing Coordinator to promote Compassion Fatigue workshops in 2017. The aim of these workshops was to increase staff education regarding psychological first aid, identify individual triggers and promote self-care strategies for staff. To compliment our wellbeing program we encouraged our nursing staff to join the MH peer support program, equipping and training this core group with skills to provide `real time’ support and care for clinical staff.
January 2018 marked the introduction of the Wellbeing Dog program which was trialled for 4 months at two days per week in our non-clinical space. The overwhelming response to this trial has now marked a Monday – Friday implementation with feedback from staff stating an increase in morale, reduction in stress and improved staff relationships.
Our ED Leadership Team is committed to the vision of being “First in Care” and an employer of choice. The introduction of our Wellbeing Program aims to promote mental health awareness, minimise the impact of OVA and trauma and implement staff support strategies. At RMH ED we fully acknowledge that these programs do not eliminate the volume, acuity and stress related to Emergency nursing, but we are very clear that we cannot achieve our vision without addressing the needs of the people that provide that care. We believe that we are getting a significant return on our most valuable assets through our innovative investments in wellbeing.

Liz Bradbury has over 30 years of emergency nursing experience. After completing her Post Graduate Emergency Nursing Certificate and a Diploma in Business, has progressed through CNS and ANUM roles and is currently the Clinical Nurse Manager in the Emergency Department at the Royal Melbourne Hospital.
Liz has dedicated years building teams and supportive environments to enhance the professional growth and development of her staff.
Liz has long advocated for a greater focus on wellbeing for Emergency Department nursing staff to support mental health, address the impact of occupational violence and aggression (OVA) and identify enablers for longevity in the emergency nursing role.
Liz has been involved in promoting and supporting departmental wellbeing tools to minimize impact of emergency trauma, Occupational Violence and Aggression (OVA) and aims for RMH ED to be recognised as an Employer of Choice

Breaking nursing silos: A collaborative approach to improving transitional care

Emma Staines1

1Clinical Nurse, Emergency and Trauma Center, Royal Brisbane and Women’s Hospital, QLD

The transfer of patients from emergency to the ward environment is a critical point in the patient’s journey, with wide ranging impacts on patient safety, patient flow, and staff relationships. Poor interdepartmental transitional care and nursing handover are associated with increased adverse events, errors, and poorer patient outcomes. Communication between emergency and inpatient departments must be clear, collaborative, and consistent, in order to ensure patient safety during this transitional point in their care. The Collaborative Care Enterprise (CCE) is a project developed at the Royal Brisbane and Women’s Hospital (RBWH) in 2017, specifically to address the relationship between emergency and inpatient nursing staff.

The CCE has been a collaboration between emergency and inpatient staff, bringing front-line nurses together to discuss issues and concerns related to transitional care, and forge actionable strategies for improved teamwork and patient care. Initiatives of the CCE include conducting education sessions regarding patient flow and scope of emergency care, inviting ward staff for structured walk-throughs of the department to increase understanding of departmental processes, and providing case studies of occasions when the transfer of a patient was concerning to ward staff.

The CCE has provided nurses in emergency and inpatient departments a platform for open dialogue regarding concerns, constructively discuss options for process and policy change, and develop a better understanding of their colleagues work environment. This has resulted in improved relationships and communication between departments, and process changes that have optimised transitional care for patients, such as facilitating ward staff to collect patients from emergency and collect data from the Emergency Department Information System.

Building on the success of the past six month, there are plans for the CCE to expand and incorporate other wards within RBWH, in order to further improve the safety of patients as they are transferred out of the emergency department.


Emma Staines is a Clinical Nurse in the Emergency and Trauma Center at the Royal Brisbane and Women’s Hospital. Emma holds post-graduate qualifications in Acute Care, Immunisation and Emergency Nursing and is currently undertaking her Master’s in Public Health, majoring in Disaster Health and Humanitarian Assistance. For the past year, Emma’s focus has been designing and implementing a quality improvement project targeted toward improving interdepartmental nursing team work, relationships and transitional care. Leading a multi-specialty nursing team, Emma is working toward breaking down departmental silos, turning clinical incidents in transitional care into practical change and thereby developing forward-thinking, professional, evidence-based clinicians.