Clinical Initiative Nurse / Emergency / Specialties / Forums / NurseCentral

Where i worked most recently as a CIN, the role was integrally important in reducing waiting times and general levels of angst etc throughout the dept but particularly noticeable in the waiting room. The role involved a minimum of triage experience (therefore also substantial resuscitation / trauma experience) and a comprehensive education module involving teachers from medical specialities (emergency medicine orthopaedics and opthamology) , other senior nurses and ED physiotherapists over a period of about 4 months. The clinical standard of care provided by CIN's was equal if not better than many junior residents and certainly better than the majority of interns. I would however say that having shared some education sessions with nurses from other ED's within the same area health service, that our department had a significantly higher standard expected of trainee CINs/CINs. In addition to pathology ordering and review which was expected of all RNs working beyond 2year level, we ordered and reviewed limb xrays, intiated analgesia including parenteral morphine, inserted IVC's , initiated IV fluids, antiemetics, POP backslabs for limb injuries, wound management including suturing, eye care, burns managment plus loads of stuff i can't think of now but happens from time to time. The CIN role combined with a competent and confident triage nurse could easily manage the busiest waiting room thus freeing up the senior medical staff to attend to more complicated patients. The impetus for this role in my department was twofold. Firstly and foremostly, while patient presentations continued to increase (due primarily, i think, to the reduction of available GPs who bulk billed in the catchment area) the size of the staffing remained static and the physical layout barely changed. Secondly, the medical director of the ED was adamantly against the role of NP within ED as he felt it reduced the exposure of interns (every intern does a 10 week term in ED) to the nature of emergency medicine because nurses would be doing their job. Utter rubbish insofar as the demand for services always exceeded supply of skilled labour. You may have noticed i have not mentioned the hospital by name for fear of creating a ruckus with the medical director!

Author	Clinical Initiative Nurse
belle Joined: Feb 2006 Location: Posts: 2	Thu Feb 09, 2006 5:02 pm Hi I would like to hear peoples experience of the clinical initiative nurse role in the emergency department. I feel that our ED could benefit from this role and would like to work on getting it implemented. I am particularly interested in the benefits and pitfalls of the role, and of course patient perceptions. We already have a MET team, but the waiting room in particular gets very busy and crowded at times and patients get very aggitated at waiting times.

Glynis Joined: Feb 2010 Location: Wil Posts: 3	Feb 27, 2010, 03:04 am My brief encounter at the Royal Hobart Hospital ED was that the CIN certainly made a diffeerence. It also gave the nurses another pathway for career development as they had to pass numerous tests etc before they could take on this role. Iniating treatment streamlined the wait for patient s in ED.It also meant that patients were not stting in pain in the ED Department at least they had had some initial treatment whilst awaiting further investigations. Where I work now it is not necessary as patients are seen within a very short timeframe and the model does not work as we have no Doctor in the town 24/7 anyway.We are kind of CIN in disguise.

Andy Joined: Dec 2010 Location: Posts: 1	Today, 4:57 pm Where i worked most recently as a CIN, the role was integrally important in reducing waiting times and general levels of angst etc throughout the dept but particularly noticeable in the waiting room. The role involved a minimum of triage experience (therefore also substantial resuscitation / trauma experience) and a comprehensive education module involving teachers from medical specialities (emergency medicine orthopaedics and opthamology) , other senior nurses and ED physiotherapists over a period of about 4 months. The clinical standard of care provided by CIN's was equal if not better than many junior residents and certainly better than the majority of interns. I would however say that having shared some education sessions with nurses from other ED's within the same area health service, that our department had a significantly higher standard expected of trainee CINs/CINs. In addition to pathology ordering and review which was expected of all RNs working beyond 2year level, we ordered and reviewed limb xrays, intiated analgesia including parenteral morphine, inserted IVC's , initiated IV fluids, antiemetics, POP backslabs for limb injuries, wound management including suturing, eye care, burns managment plus loads of stuff i can't think of now but happens from time to time. The CIN role combined with a competent and confident triage nurse could easily manage the busiest waiting room thus freeing up the senior medical staff to attend to more complicated patients. The impetus for this role in my department was twofold. Firstly and foremostly, while patient presentations continued to increase (due primarily, i think, to the reduction of available GPs who bulk billed in the catchment area) the size of the staffing remained static and the physical layout barely changed. Secondly, the medical director of the ED was adamantly against the role of NP within ED as he felt it reduced the exposure of interns (every intern does a 10 week term in ED) to the nature of emergency medicine because nurses would be doing their job. Utter rubbish insofar as the demand for services always exceeded supply of skilled labour. You may have noticed i have not mentioned the hospital by name for fear of creating a ruckus with the medical director!

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