The high pace of emergency room nursing

Theodora at the Resuscitation Room of Sengkang General Hospital’s Emergency Department.

Alumna Theodora Chia has been a nurse at Sengkang General Hospital for almost three years. Every shift has been busy and unpredictable, keeping her on her toes. Just the other night, a patient came in from a road traffic accident and it was two hours later, after she was stabilised and sent to the ward, that Theodora was able to take a short breather before attending to another critical case.

Never knowing how her day turns out is part of everyday work for Theodora, who is usually assigned to higher-acuity areas such as the Resuscitation Room or Triage. She hits the ground running five shifts a week, working a blend of eight-hour day shifts and 10-hour night shifts. A workday starts with a roll call to pick up the latest updates from seniors who are ending their shift. For the next eight to 10 hours, she will be going full throttle, caring for patients coming in with heart attacks, strokes, respiratory distress, abdominal pain, etc., plus those with broken bones, wounds or other less severe injuries. When at Triage, she has to determine the treatment priority of incoming patients based on her initial assessment. It is crucial that critically ill or injured patients are always given top priority.

“We have a young population living around the hospital, so the Emergency Department (ED) handles a fair number of paediatric cases and adults presenting with chest pain and stroke-like symptoms. We also see many elderly, bed-bound patients from the cluster of nursing homes around us,” she says.

Theodora relishes the challenge of handling new cases and helping different patients at the ED. “I love the fast-paced environment, which often requires us to apply critical thinking and independent assessment,” she says.

One of the challenges in the past four months has been working on the front lines of the coronavirus pandemic.

The Sengkang General Hospital serves mainly the population of northeast Singapore. The hospital has been deploying its doctors, nurses and staff to the S11 dormitory in Punggol, Singapore’s largest COVID-19 cluster to date, where they help to assess and provide basic medical care for the migrant workers.

Migrant workers who require additional medical support or management at the hospital are then transferred to the ED by designated ambulances. Theodora is charged with assessing these patients’ general conditions and vital signs and quickly facilitating their admission to the ward on the patients’ arrival.

“When Singapore saw a surge in local cases together with infections from the foreign worker dormitories at the beginning of the circuit breaker in April, it was a challenging time for the nurses at the resuscitation and isolation rooms as we had to treat each incoming sick patient cautiously and in a timely manner until we could ascertain their contact history,” she recalls.

Having always practised strict donning and doffing of personal protective equipment (PPE) in her daily operations and having attended prior Ebola drills conducted by the infection control team, she was familiar with the PPE guidelines that are crucial in handling infectious cases.

Despite the ebb in the number of COVID-19 cases, Theodora says the medical team at the hospital is bracing themselves should a second wave of infections occur with the opening up of the economy in Phase 2.

“It has been an honour to serve at the front lines of this COVID-19 pandemic. Everyone plays a role in fighting this virus, and we’ve been able to carry out our duties safely and efficiently, thanks to the heroes behind the scenes: our housekeepers, porters, engineering and operations colleagues, and more,” she says.