NHS Staff insight: Life in the Emergency Department (ED) from a senior sister’s perspective
The Urgent and Emergency care results give us an insight into the patient experience of being cared for in the ED, but what is the staff experience of providing the care?
Jacky has been working as a senior sister in a major ED for 14 years, and her role is to ensure the smooth running of the department. By understanding her staff’s specialities and the issues her patients have, Jacky can ensure that everything’s flowing and that everyone is safe. We asked her for her perspective on a range of issues that are important to patients.
What has affected waiting times?
“The department is now much busier than it was five years ago with around 180-200 patients coming through the door in a day, compared with 120-150 five years ago. The focus is on getting patients seen and moved on as quickly, efficiently and as safely as possible. We are now better at getting through the queue of patients and the care has improved. We are aware that the more time patients spend in the department the higher the mortality and morbidity rates.”
How well staffed is the department?
“The number of doctors and nurses in the department has increased in line with patient numbers. However, there is now a noticeable national shortage of doctors and nurses, which makes recruiting and retaining staff much harder.”
“Having more staff in the department with different skills makes the work less stressful, as there is always someone knowledgeable to ask if a more complex case comes in. Many patients come in with multiple co-morbidities and the only way we can deal with these patients is to treat the presenting condition. These patients can often feel they don’t know who is looking after them, but we hand them over to a speciality team.”
How do you maintain patients’ privacy?
“Privacy will always be difficult in the ED. We can pull a curtain, however, this doesn’t help with delicate conversations. Where possible these conversations take place in the relatives’ room so they can’t be overheard. It’s not realistic to provide rooms for patients as they need to be monitored by the nurses for their safety. Patients also start to feel isolated if they are left alone.”
“Staff always make the effort to take patients out to the toilet, to maintain some level of dignity. Privacy is an area that isn’t well thought out but staff do what they can with the private rooms and curtains.”
“Last year ED wasn’t seen as a ‘place of safety’ but it now is. This means police can bring a mental health service user to us rather than a mental health hospital. These patients can be quite difficult to treat in an open ward as we don’t have a secure place to put them and they can be disruptive to other patients.”
“Often this vulnerable group of patients are already known to psychiatric services. Since September 2019, we’ve had a psychiatric liaison in the building who we can call on 24/7 and between 9am – 5pm we have an onsite addiction nurse. We also now have a specialist local drop-in centre open from 5pm until midnight to help those struggling with mental health issues. The centre is open access service for adults and we can signpost there as long as the person is medically fit.”
How clear do you think communication is between staff and patients?
“Communication skills are now a much bigger focus during training for junior doctors and nurses, so they are much better at talking to patients. We try to give the same message to patients but it may be worded differently. You can get one consultant who will advise something slightly different to another, but this is based on their experience of the situation.”
“Staff will vary the message depending on what they believe is best for the patient and the circumstances. Like most workplaces, some people are better at communicating than others. We often call the family, talk through the discharge plan with them, and get clarification that they understand what’s going on.”
What are your main frustrations?
“Some patients that come to ED don’t need to be there and would be better served going to an urgent care centre, pharmacist or GP. We have debated the value of having a GP available within the ED to deal with these patients.”
“My main frustration is the lack of beds and the way the bed system works. If I want to get a bed on a ward, I have to get the Clinical Site Manager to allocate a bed. Before I can send the patient up to the ward, I have to call and check they’re ready, but if the Ward Nurse is busy there is a delay. I’d like the wards to be more proactive in ringing ED to offer beds as soon as they become available, rather than me having to continually chase and check with them.”