South Australian Stuart Smith has been an Emergency Nurse Practitioner for more than two decades.

Originally from the UK, Stuart works at Modbury Hospital, where he enjoys the diversity of the Emergency Department, with the bustling environment demanding leadership, emotional intelligence, compassion, and a broad scope of clinical skills.

Stuart spoke to the ANMJ about his role and why Nurse Practitioners can make a difference in ED.

What is your scope of practice?

I work in a team of five Emergency Nurse Practitioners. We are an established team and provide a service seven days a week from 8am to 11pm. We have excellent relationships with both our medical and nursing colleagues.

The ED sees around 45,000 patients a year. We have a broad scope of practice, though I would argue that our scope is very much of the traditional scope of an Emergency Nurse Practitioner. We often discuss that we should broaden our scope, however, I would argue that there is ample work for us to do in our current scope.

Take us through a typical day in the ED

Each day, as any Emergency Nurse will confirm, is a blend of challenging, diverse, frustrating and immensely rewarding.

We are fortunate to have our own consulting office right opposite the triage area. Thus, we have a protected space to manage patients without the challenge of being “creative” and finding space to assess and treat a patient. The vast majority of patients we see can be managed independently without consulting/referring to a colleague/specialist.

What key skills do you need to succeed as an Emergency Nurse Practitioner?

The first challenge is to get endorsed as a NP. That takes passion, energy and persistence. Once endorsed, the skills of leadership, relationship building and of course clinical expertise are crucial.

Visibility is also very important. We are arguably working as the “clinical pinnacle” of the nursing profession, so the above skills are crucial in order for the brand to be celebrated and respected. This takes time. Leadership is the standout skill I feel.

How do NPs make a difference in ED?

I love the autonomy/independence, the ability to manage the care episode all the way through to discharge or admission.

However, there are challenges. Referrals can sometimes be a challenge, incivility amongst some colleagues, sadly, occasionally continues. Kindness, compassion and civility to our colleagues is crucial.

What are the biggest challenges of your role?

We have virtually no restrictions on our scope of practice now. This again has been the result of persistence, leadership and building relationships with colleagues who can influence change. For instance, we prescribe medications to scope of practice, complete Workers’ Compensation Certificates, and most recently, carry out forensic blood tests. These changes took years of work, energy and leadership to make happen.

What do you love most about the job?

For all of the challenges of working in an Emergency Department, I still love my job as an Emergency Nurse Practitioner. It’s a cliché but I like to make a difference, working to my scope to help people get timely, safe and compassionate care when they are at their most vulnerable.

I do also enjoy the other domains of the role including teaching and research. Leadership is a passion of mine, I hope I have been able to influence change, which affects patient care.

We are all a work in progress and working in an Emergency Department enables me to still grow and learn.

What advice would you give an early career nurse looking to enter this field?

My advice here would be quite simple, please do it and please stick at it. It’s an immensely rewarding role and opens numerous opportunities. In my humble opinion, Nurse Practitioners are a potential solution to many of the challenges facing the health system. It’s a simplistic statement but we need more.

You need an organisation that recognises the importance and value of the role. Here in South Australia I have always felt that Nurse Practitioners are celebrated and respected.

Find a good role model/mentor and or coach and use their skills and expertise to make your journey easier. There is an abundance of excellent Emergency Nurse Practitioners out there who can guide you.