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Prioritizing Patient Care in WakeMed Emergency Departments

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I immediately volunteered to assist Christopher Fortin, (director of Emergency Services at WakeMed North Hospital) with the implementation of the Nurse First admission process when he joined the WakeMed team in September of 2017.

What is the ‘Nurse First’ Approach?

In Nurse First approach (sometimes referred to as the ‘Pivot Nurse’ approach), a nurse is the patient’s first point of contact which takes advantage of their ability to visually identify a patient’s distress level and quickly address their medical needs. Four of WakeMed’s seven emergency departments use the Nurse First and Pivot Nurse approaches and consider it best practice.

What is exciting about this program is that it’s so much safer for patients and less stressful for receptionists, who do not have the training needed to medically assess patients.

Considering this year’s record-breaking flu season and with the closing of Franklin Medical Center in 2017, the WakeMed North Emergency Department has been much busier. It’s a good feeling to know that an experienced nurse is constantly scanning the patients who are waiting to be seen to ensure that those in immediate need of treatment are addressed first.

I enjoy working at the Nurse First desk along with the receptionist because, although it can be a challenging role, it adds variety to my work week. It is so rewarding to personally identify and assist a patient in need of immediate care, especially when they do not realize the urgency of their health issue.

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The Nurse First Approach in Action

A 9-year-old boy, who looked composed, was standing in line to see me with his father, who also appeared to be very calm. When I caught his eye, something in his face did not look right to me – he was almost too calm.

I pulled him to the front of the line and discovered that he had burns on the front of his legs and abdomen because he had fallen into a campfire. Yet, he and his father were just patiently standing in line. I took him straight back to a bed – it was as if he came in by ambulance.

He and his father did not realize that they should be seen immediately.

[READ: Emergency Department vs. Urgent Care vs. Primary Care]

Giving Emergency Staff Peace of Mind

This system also gives the other shift nurses and emergency physicians piece of mind and a higher level of confidence because the Nurse First/Pivot nurses all have triage-level experience. Because of this, their assessment of patient symptoms is thorough and accurate.  

When a patient comes back, they have already been assessed twice. For example, when a level 3 patient (stable) is checked into a room while I am at the bedside of another patient, two nurses in addition to a triage nurse have assessed the patient to be at that level. I know they will be okay while I care for my current patient.

[READ: Why is the Wait So Long at the Emergency Department?]

Decreasing Wait Times & Minimizing Risk

While no one can know for sure what the impact of waiting a few more minutes prior to treatment means to a patient’s recovery, a delay can mean that a return to good health is less likely.

The Nurse First system successfully decreases wait times and minimizes this risk for all WakeMed Emergency Department patients.

This system is not just about moving patients through the system as fast as possible. It focuses on directing them to the proper channel needed for their particular health issue.

The fact that this streamlined approach speeds up the process is a fortunate side effect of more personalized patient care!


About Jenn Holley, BSN, RN

Jenn Holley is a clinical nurse in the Emergency Department at WakeMed North Hospital.

Learn more about the features and services offered at the WakeMed North Hospital Emergency Department.

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