I am writing this based on a biased opinion as I work in an A&E that is over-stretched, over-worked and well over tipping point, I believe the system is in crisis based on this. The daily grind is to fight fires in the ED and not to deliver a systematic approach to good healthcare when patients need care rapidly, safely and at their most vulnerable. This is a major, chronic headache in our ED, and even though we try new approaches there seems to be no cure.
The words of the RCN Chair, Peter Carter, is extremely fair, saying that A&Es are not coping and trying to find a scapegoat in the Government and the NHS without actually finding and thinking of solutions, whilst we on the front line are still working away. The reality is, A&Es are set to major incident mode regularly, ques of patients on chairs and trolleys stacked either side of the corridors is a daily sight, the sickest of patients don't have space in cubicles to be treated privately because its taken up by less sick patients, who quite frankly, don't need to be in A&E but demand and get a cubicle. Its a real issue.
The questions that arise for me whilst at work are:
1.) Because of legalities we have to do a full work up based on a sketchy and blase medical history from patients who then have gastroenteritis or such like? Surely these patients should be turned away, and we should have total backing from our trusts and councils to do this rather than waste time and money doing full work ups, but yet, we don't?
2.) Single point of access? Getting GP referrals, or medical admissions, on top of A&E admissions? The work goes up, however, it seems we have no resources to do this, no increase in our teams budget yet we must work to the same targets and same standards with no regard and no backing for ourselves? (Though not sure if this is a national standard).
3.) Mental Health admissions? These take up a lot of time and wasted resources. We have MHLT on site but yet don't come until medically fit (so hours of withdrawal from alcohol and hours of medical treatment with unstable mental health needs), we as nurse's (I personally not trained in mental health and neither most of my colleagues) have to deal with this, therefore leaving me to listen, follow, 'keep an extremely vigilant eye' on mental health patients whilst my other sick patients are left. These mental health patients are getting unfair treatment from unqualified staff, and the other non mental health patients are getting a right raw deal. To conclude, why isn't there a dedicated A&E for mental health patients with mental health nurses running the unit? This, to me, would be very efficacious to my primary care area indeed.
4.) Patients seem to think that having one episode of sickness requires an A&E admission? Patients need to be well educated on health and medically related problems. Health promotion in medical awareness needs to be greatly enhanced to all our patients from all walks of life. Our fantastic primary care teams should be rewarded for their excellent work in keeping patients who are not sick, away from the acute setting, however, the primary care teams should also think about promoting patients to stay away from A&E unless they are in a real emergency and this should be promoted from a very early age.
I think I have exhausted my main list and thank you for reading this post. I believe my opinion is fair and just and as a nurse, I will say, patient care is at the top of my list and unfortunately, daily, I am unable to provide the care I want to give and have been trained to give because of the pressures in the ED.
I do hope this post is read by senior folk and they agree something needs to be done, quickly and urgently and find real solutions that will really help! Whether or not that costs more money now.