I‘ve often thought whilst working in A&E over the past 14 years that I should somehow document the experiences I have had. Some of them have been incredible like attending the Advanced Trauma Course with my colleagues/friends and lecturing at the RCN headquarters. Others have been heartbreaking and very disturbing, witnessing families falling apart and the horrors people face in everyday life.
I’ve decided to start writing a few of the experiences on my shifts, embarrassing moments, challenges we face in A&E/urgent care and the characters we meet whilst on duty.
My hospital’s A&E has transformed significantly over the past 14 years. We used to start having a meltdown if we reached 30 patients in the department, now we most often have over 100 in the department at any time of day. Its relentless and often exhausting both physically and emotionally. Most nurses in the acute sector work 12 hour shifts with one 30 minute break and rarely get the opportunity for a drink or toilet break. I must admit I am not a big fan of the 12 hour shifts-they have been proven time and time again to be ineffective and unsafe yet we just ignore this research as it suits our lifesytle so we only have ourselves to blame for this.
Being a clinician can be a difficult job, especially when you are striving to provide the best care possible for your patients. It can be discouraging when it feels like there is no way to reach that goal.
The NHS is currently facing a number of challenges that are being ignored by politicians, including the lack of resources and support for those who need it. This has resulted in a situation where people are unable to access the care they need, when they need it. The current system is not designed to meet the needs of those who require help and support, leaving them feeling helpless and without hope. Politicians must take action to ensure that everyone has access to the care they need when they need it, so that no one is left behind. I truly believe there is way too much red tape in the industry now. We have an excessive amount of managers and senior staff who have no idea how to manage, lack adequate knowledge and skills for their role and have just been given the job due to a lack of applicants. Then instead of sacking them for doing a bad job we just move them around and don’t resolve the issues.
Most days we are short staffed, have over 12 hour waits for beds if patients require admission, long delays for specialist reviews and lack adequate space and facilities to see and treat patients safely and effectively.
Believe it or not since Covid-19 I think care has actually slightly improved. We not longer assess, diagnose and treat patients in the corridor, however they can be left outside in the ambulance for several hours. For us as health care professionals working in the Emergency Department this feels much safer for the patient, but it can have a huge impact on the provision of care and arrival time of the ambulance service.
There were so many adverse events with patients being neglected in corridoors. I myself experienced a patient suddenly deteriorate in the corridoor. In the face of an emergency, we often have to make difficult decisions on how to best care for our patients. This can be especially challenging when there are not enough beds available in the hospital and treatment has to be carried out in the corridor. Such was the case when a patient had a cardiac arrest while being treated in the corridor due to lack of space. In order to save the patient’s life, we had to act quickly and move another critically ill patient out of their space and start treatment in that area. It was a difficult decision but it ultimately saved a life.
I still recall the good old days when between 2am and 6am you may get the odd patient arrive that was critically ill, now we are just as busy at night as we are during the day. People now often come at night with a shopping list of symptoms they have been experiencing for weeks, months even years, which has always perplexed me. We are human beings at the end of the day and are not meant to function at full capacity 24 hours a day. Night shifts have always been my most challenging shifts to work as there are less people around to help and you often you have the sickest/most demanding patients arriving. I also struggle to sleep after and it just isn’t natural. No matter how much sleep I get I wake up feeling like a zombie.
Throughout my time in A&E its always been the people I have worked with that have made it worthwhile. We are like one big family. We help each other through the highs and lows and despite what some may think we do wholeheartedly care about the service that we provide.
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