A DUBLIN HOSPITAL emergency department nurse has said that it has become “common practice” for patients on trolleys to be “shoved” onto wards, and even at times into endoscopy theatres overnight, in an effort to lower the numbers recorded in the trolley counts conducted each morning.
Stephen McDonnell has 28 years of nursing experience, with 23 years in a Dublin hospital’s emergency department.
He said the situation with overcrowding has become “appalling”, and that he finds himself on every shift “apologising to people for the conditions we are caring for them in”.
McDonnell said that while patients who present at the ED should be triaged by nurses in the first 15 minutes, staff are so overwhelmed that this can be delayed by 3-4 hours.
He further said that after triaging, patients will often have to wait for as long as 16 hours before seeing a doctor, with this happening on a daily basis.
The Dublin nurse explained that as there is concern about the trolley figures being high in the counts conducted by the HSE and the nurses’ union each morning, patients on trolleys will be “shoved into wards where there is space” the night before.
“The reality is, under-reported figures look better. People have their tray taken off them at 7.30am, and are catapulted onto a ward. It happens late at night as well, and it is appalling.
“We have two bathrooms for what can be up to 200 people to use each day and one shower, and those on trolleys and visitors use the same facilities. Those transferred on trolleys in other parts of the hospital might be elderly, and find it hard to find a bathroom. For example – endoscopy theatres do not have bathrooms close at hand,” McDonnell added.
“We only have 28-30 trolleys in ED, that’s all we can fit, and after that people are on chairs. They are on drips on chairs, getting their vitals checked on chairs, sat on chairs for hours with a fractured leg propped on a stool in front of them. These aren’t nice, comfy chairs, they are like the plastic ones we had in school. Imagine an elderly person being sat in one of those for hours.”
He said that he feels that organisations would intervene if these conditions were being imposed on prisoners in Irish jails.
The nurse said that it can often be difficult to get patients at serious risk to where they need to be in the hospital, and that often the appropriate equipment isn’t available to get them there.
“You have times where you are trying to get a patient undergoing cardiac arrest to Resus (the resuscitation or ‘trauma’ area) through loads of people and halls with trolleys, it’s like jenga.
“We might not have trolleys to bring them there either. For example I’ve had to transport stroke patients to CT scans after they’ve seen our wonderful stroke team in wheelchairs, and that’s actually dangerous, they could be experiencing a brain bleed, and should be lying down,” McDonnell said.
He said that for an ED that has between 160 and 220 patient presentations each day, his team is usually comprised of 13 nurses.
“Now bear in mind, two are in triage, three are in Resus where they are needed to provide complex medical treatment, and that can leave seven or eight of us for over 100 pages. It’s not enough, the turnover is high, and we are permanently recruiting,” he said.
Health Minister Stephen Donnelly is set to address the Irish Nurses and Midwives Organisation (INMO) annual conference tomorrow.
His commitment that the INMO backed safe-staffing framework being implemented across a range of Irish healthcare settings would be pushed on at last year’s conference was welcomed by attendees.
However, General Secretary Phil Ní Sheaghdha has said this year that the HSE’s recruitment embargo is preventing safe staffing levels from being reached in a range of medical facilities.
McDonnell today said that nurses in emergency departments like him will be wanting to hear about plans to increase step-down facilities, and increase bed capacities in hospitals, as well as modernising EDs.
“The plan for our health service needs to be long-term, not one that changes government to government, and immediate action is needed to improve patient safety, because it’s of huge concern to us,” he said.
McDonnell said that he is seeing his colleagues burnout more often now, due to increased pressure.
“Before we talked about a seven year cycle for burnout in emergency medicine, now I am seeing it happen in three years. People are worried about their nursing registrations, because it is hard to perform your duties in the current conditions. Patients are meant to get their medication around 2pm say, but if your hospital is overcrowded, that could be hours late.
“Most of us are trying to get through the shift without any major incident happening,” he said.
Despite the challenges of working in emergency medicine, McDonnell said he loves his job.
“I love meeting and helping the people who come in, and most people are so appreciative of the work we do. I’m studying to be an Advanced Nurse Practitioner now,” he said.
McDonnell said that he has experienced serious physical assaults multiple times, which have involved three court cases over his career.
“We don’t report most of it unless it is really serious. People think that it must be those who are drunk or in a mental health crisis who lash out at healthcare staff, but a lot of the time, whether it’s verbal or physical attacks, it is ordinary people who are waiting with an elderly relative for hours, who are just driven to the brink,” he said.
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