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A&E leaders confirm emergency pressures are ‘worst ever’

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Emergency care nurses and doctors are under increasing pressure in over-stretched A&E departments, as leaders confirm the situation is “the worst it has ever been”.

Anna Crossley, the Royal College of Nursing’s professional lead for acute, emergency and critical care, said nurses on the frontline were feeling the strain.

“Nurses don’t want to care for someone on a trolley in a corridor”

Anna Crossley

She said: “The over-riding message we are getting is that if you work in A&E you know it is going to be bad at the time of year, but every year it is getting worse, so every year is the worst year.

“It’s just that massive sense of frustration that people can’t care for patients the way they would like,” she told Nursing Times.

“You go home feeling really demoralised because you know that patient’s experience isn’t as good as it could be,” said Ms Crossley.

She added: “Nobody wants to be cared for on a trolley in a corridor and nurses don’t want to care for someone on a trolley in a corridor.”

Recently the Red Cross said the NHS was facing a “humanitarian crisis” as hospitals and ambulance services struggled to keep up with demand.

Ms Crossley said the situation was indeed the “worst it has ever been” due to the growing number of older patients with complex health and social care needs, alongside a shortfall of funding across health and social care.

“There is a lack of dignity in trying to care for a patient in a corridor”

Taj Hassan

Meanwhile, the over-stretched A&E environment had contributed to a “real recruitment and retention problem” in emergency care, she noted.

“There are so many things to love about working in the emergency – the variation, the fast-paced environment, the decision-making,” she said.

“But if you don’t feel you have the time and the space to do your job and use your skills properly you just feel demoralised, and people are voting with their feet and leaving because the pressures are so great they would rather work somewhere else,” warned Ms Crossley.

However, she said developing training and career paths for emergency care nurses – such as the RCN Emergency Care Association’s national competency framework for emergency nurses – could help.

Special investigation: Solutions to the A&E crisis

A&E diversion pilots hint at relief for nursing staff

Anna Crossley

Another solution could be the expanded use of rotational posts to give nurses a taste of working in A&E and “entice more people in”, she suggested.

Wider changes needed included greater integration between health and social care, robust A&E diversion schemes with GPs and pharmacists available on site and investment in mental health services to prevent those in crisis ending up in A&E.

Ms Crossley said the future could also mean more integrated urgent and emergency care, with the 111 number as the main portal to both. More patients would be redirected to clinicians like mental health nurses, district nurses and end-of-life care nurses working in a physical or virtual clinical assessment centre, which could also provide back-up clinical advice and support to paramedics.

The Royal College of Emergency Medicine agreed emergency departments were under greater pressure than ever and this was borne out by official figures on demand and waiting time performance.

“In the current environment that staff are working in the pressures are pretty significant, even in the best departments, and it is extreme in some of the worst,” said emergency medicine consultant and RCEM president Dr Taj Hassan.

“Independent measures of demand and performance show increased demand and that 4-hour performance has fallen,” he said.

“It is reasonable to suggest that the situation is probably the worst it has been in 15 years and, as a result, the pressures are very intense,” he told Nursing Times.

Taj hassan

Taj hassan

Taj Hassan

“We know that when you get crowded emergency departments there is an increased risk to patients and an increase risk of doctors and nurses making mistakes,” he said, noting that the situation was very stressful for doctors and nurses.

“Working in these conditions is pretty distressing, especially when you can’t provide the quality of care to a patient you would like,” he said. “There is a lack of dignity in trying to care for a patient in a corridor when you should be caring for them in a cubicle.”

He said the RCEM would shortly be publishing a strategy setting out its vision for emergency care up to 2020. Key priorities it would like the Department of Health to look at include optimising systems, staffing and resourcing.

The RCEM has called for the establishment of an Emergency Care Transformation Fund to help fix the current and ongoing crisis.

Dr Hassan said more emergency care doctors and nurses were needed with about £700m a year spent on locum and agency staff to fill gaps in A&E department rotas. More substantive staff would mean this money could be diverted into initiatives like the transformation fund.

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