And another patient through the doors; they’ve had a fall and can’t stand up. Then, a patient with a head injury who’s on blood thinners. Abdominal pain, raised temperature and confusion. The paramedic crew thinks sepsis, straight through to resus. Another fall. Loss of consciousness. Chest pain. They keep coming, an endless trail of trollies into the cliche of the overcrowded winter A&E department where I am on a student placement. Patients should move up to the ward as soon as they are stable. However, a lack of beds in the hospital results in a stalemate of patients queuing in the corridors, euphemistically termed “overflow”.
Transferring patients to the ward is a task that I can do as a student nurse, and is good practice for handing over when I am qualified – so as long as the patient is stable I am happy to photocopy the paperwork and manoeuvre the trolley out of the department. The calm of the wards is refreshing. One particular patient, however, starts vomiting as we arrive. Immediately, the atmosphere changes and the ward will no longer accept the patient. This is stressful for me and devastating for the patient, who has been waiting for hours, and only after a heated exchange between the ward and A&E do they agree to accept them. Wrangling over patients is not uncommon and I wonder if ward staff are really aware of how many patients their A&E colleagues are seeing and treating. The volume of patients is not unique to A&E, but the finite capacity of beds on a ward means they are sheltered from endless trollies of people waiting patiently and impatiently for treatment.
Thanks to extensive media coverage of A&E winter pressures (Hospital bed shortages leave patients sleeping in the A&E department, 20 January), I expected this. I expected a busy department with chaotic human bodies, organised according to medical need. However, it is impossible to appreciate the violence of injury, the human cries and the complexities of professional interaction under extreme pressure. And no amount of studying can prepare for the feeling of failure to provide adequate care for patients. One colleague commented that A&E nursing is no longer just about providing treatment that will save a life, or settle pain or stop an infection before moving to a ward. Patients now have to wait so long in the department that ward-level care is required, but staffing levels, resources and lack of time limit our ability to deliver this type of care.
I love the NHS, but to experience exactly how strained it really is before I even start practising as a qualified nurse is disheartening. I am sure I am not alone in being devastated at the obvious limitations of the current NHS. However, pragmatically, we must find a sustainable solution that enables staff to provide adequate, safe and fair healthcare to patients.
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