Being and old nursing hand with time on my hands, and the need for cash, I worked some shifts in the Emergency Departments of Sydney Hospitals over the Christmas New Year Break. Nothing changes! Governments and promises come and go, but EDs are just as busy, just as short staffed, just as poorly equipped as they always were. It amuses me angrily that governments and bureaucrats want ED Staff to speed up processing times, but they can’t even guarantee that there is the basic functioning equipment at every bed that every doctor and nurse needs to do their job. I am still after 30 years, wandering around looking for a working sphygnanometer, a working thermometer, or a working ECG machine, so vital when a patient has chest pain. But hey, you may have to fiddle while vital minutes go by, getting the old ECG machine you found in the corner to work, because the more modern one is in use, and present you with a readable ECG. Nothing changes!!
Some observations :
1. I noted particularly this year there seemed to be a lot of “family dumps” ie families sending older more embarrassing members of their family to ED around Christmas Day. Can’t have grandma, grandpa , aunt or uncle being an embarrassment when the rest of the family and friends come over on Christmas Day! One old lady was sent into hospital by her carers who seemed to be living in her house. She had nothing much wrong with her except a bit of diarrhoea that any competent carer should have been able to deal with. We did a full assessment on this lady, and sent her home with ambulance transport. One hour later she was back. The carers had sent her back to ED. They could not cope with her having diarrhoea!
2. Another variation on the older person presentation over the Festive Season – lonely, painfully lonely older people living on their own, presenting with a collection of minor complaints. The deep suspicion of the staff is that they come to hospital to have someone to talk to at Christmas, to get a decent feed, maybe a little gift, a bit of help with clearing their bowels, and then home to their loneliness again.
3. And another variation of the older person presentations are those that present from nursing homes and aged care facilities . Many of these facilities no longer have registered nurses working shifts, so the aged are cared for by Assistants in Nursing or Carers. If the resident becomes ill, the policy is to send them to ED. ED staff assess them, treat them, clean them up, and send them back with a new medication regime that is put in blister packs, and administered by the Assistants in Nursing or Carers, who have very little education in medication administration, the side effects and the nasty interactions that medications can cause. But hey, AINS and Carers are cost efficient to the proprietors, and that is what aged care is all about now, cost containment.
4. One tragic presentation was an old lady who had been found lying in her room covered in urine and faeces. She was deep blue. The ambulance staff picked her up, resuscitated her as best they could, and brought her to ED. The ED medical staff, unsupervised by a Senior Staff Specialist or a Consultant ( they are on holidays) did not run an organised resuscitation. Orders and counter orders were flying as the most senior of these junior doctors panicked, and then started arguing with the other junior medical staff. The nurses involved in the resuscitation were horrified. The patient deteriorated and vital treatment that should have been started early in the resuscitation was started too late. The patient died. Afterwards, in the staff room, the nurses fumed. One or two doctors joined them. How interesting that the reflection on this event was undertaken by the nursing staff, but not the doctors. The doctor in charge of the resuscitation refused to discuss what happened. That won’t be the end of this though. It should be a reportable event. There will be discussion with senior nursing staff on their return to work and there will have to be a lot of talking amongst the doctors to work through how to avoid such a messy situation in future.
Much is said by politicians and bureaucrats about Emergency Departments, their efficiency and how to improve things. Some of the solutions are very simple eg ensure that every bed in every ED has the basic equipment that the doctors and nurses need to do their job – a working thermometer, a working blood pressure machine, a working monitor, a bedside table, a bed that the patient is able to get on and off without scratching themselves, a chair and a bedside table. If every bed place in every ED had that, it would be a start.
Then of course there is the need to address bed blockages ie there are not enough open beds, and more need to be re-opened. To do that we need more nurses, not Assistants in Nursing, Registered Nurses. But where to get them from when there is a shortage of nurses? Agency staff, overseas backpackers on temporary contracts, new graduates looking for immediate work to pay off debts seems to be the answer, until we can find a way to encourage more of our youth into nursing, and more of our employers into employing them when they graduate.
EDs are a pressure point in our society. They care for everyone, high and low, every day of the year, day and night. They pick up the tired, the sore, the wounded, and the very sick, treat them, clean them, and care for them, while our society that just does not want to know, turns a blind eye to their suffering. ED staff are there, on the frontline, caring. It’s about time our politicians and bureaucrats recognised the needs, and stopped the point scoring.