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Column: ‘The system is sick’ – inside a hospital emergency department

Dozens of patients on trolleys and a handful of nurses struggling to keep up – emergency department nurse Anne Burke tells about a system in crisis.

File photo
File photo
Image: Tim Ockenden/PA Archive/Press Association Images

Anne Burke is a senior nurse in the emergency department at Galway University Hospital. Here she tells about a health service in crisis – as seen from the inside.

IN MY HOSPITAL, the situation has deteriorated drastically. In October of last year, we had a total of 350 patients on trolleys over the month. This year, it was 735.

There are days and nights when there are people waiting nine and ten hours to be seen by a doctor. People who have already spent nine hours waiting could be coming to me, saying ‘When am I going to be seen?’ And I’m having to tell them, it’ll be another one or two hours before you’ll be seen by a doctor. And that’s only the start, when they do get to be seen.

It gets worse the later in the day you arrive. As soon as 12 o’clock comes in the day, it starts peaking.

Beds are closed because of a funding issue, what our management call ‘cost containment issues’. Plus the recruitment embargo has had a direct impact on the opening on those beds. It’s well and good suggesting that beds would be opened, but if you don’t have the nursing resources, you can’t open a ward. We’ve lost 170 whole-time-equivalent nurses since January 2009. And they’re not being replaced.

When you have seven nurses on duty, with 104 patients in the department – and each one of those patients has to be assessed, diagnosed, have some sort of treatment – the numbers never match. If I was working in a bank or somewhere where the transactions didn’t involve human health, I would say OK, the queue can go out the door, and people are going to be mad. But when you have a patient in pain, that patient cannot wait.

‘Morale is very low’

I think sometimes people think that patient safety is about whether you stay on a trolley, or fall off a trolley. But safety is about the fact that when you’ve got an acute illness – say, if you’re a stroke patient – that you have a nurse that’s coming in and assessing you frequently, as opposed to infrequently. Are you getting your medication on time? Are you getting your drip on time? Are you waiting a further two hours before you get seen by a doctor? That’s all safety. Safety is about providing timely nursing care. And it is being compromised.

Morale is very, very low. It’s low because of the frustration of working in overcrowded, congested departments. The crisis is not just an emergency department problem, it’s a hospital-wide problem. For instance, in Galway, there are nearly 40 patients throughout our hospital who are waiting to go to long-term care, because of the Fair Deal issue.

Now, we had 42 patients on trolleys this morning. If they could be up in the beds of the people that should be in nursing homes, then we would be able to get to our acutely ill people that are just coming in the door with their injuries. But we can’t do that. The system is sick. The system itself is sick.

Nine or ten years ago, if we had half this number of people overnight on a trolley, it was the talk of the hospital for a week. Now, we have patients on trolleys for four nights sometimes, and nobody’s blinking an eye. We have been conditioned. We’re exposed so much to the abnormal, that we have been conditioned into believing that the abnormal is now the normal.

‘Nobody blinks an eye anymore’

Last Wednesday morning we had 51 overnights, and on Thursday there were 32. Somebody rang me during the day, and I said “We only have 32 today”. I had to correct myself, and say “We have 32”. It’s that ‘only’ that is the problem. Nobody seems to blink an eye any more when it’s thirty.

There are days when, as one of my colleagues always says: “We’re only winging it here, Anne.” We’re only getting by on a wing and a prayer. How close you come to making mistakes when there are so many people in the department. So many people shouting at you, making demands of you.

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Now when I go into work every day, I brace myself, so that I practice safely. When I leave the training room in the morning and head out onto the floor, it’s always are to forefront of my mind. ‘Practice safely today, Anne.’

We need the people who are decision-makers to see the problem on the ground. I believe that the people who are in the position of making decisions for the health services are seeing or hearing about the problem second-hand.

All you have to do is walk into the emergency department, and see the patients on trolleys. In our department, the overnight patients are on trolleys. But that’s not the case at all hospitals throughout the country. Some people are on chairs.

Anne Burke is Clinical Nurse Manager Two in the emergency department of Galway University Hospital, and a representative of the Irish Nurses and Midwives Organisation.


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