Now Ye're Talking - to an Emergency Department Nurse

Boards.ie: Niamh

Bed shortages and patients on trollies are frequently in the news and just two days ago the INMO voted in favour of strike action over chronic overcrowding and understaffing. So what is it like to work in this type of environment? One of our members who is a nurse in a busy hospital emergency department has agreed to answer some questions for us this week so you can find out what it's like to work on the front lines of the health service.

She says:

Day by day in work I get frustrated with people not understanding how the system works which by no means is their fault. I want people to be able to understand that the reason they are waiting 12 hours is not due to us ignoring them but may be due to having a trauma and 3 arrests behind the doors that they cannot see. I also think many people are interested in knowing what goes on but only have a programme like 24 hours in A&E as reference

Our AMA candidate will be online later today; in the meantime feel free to get the ball rolling with some questions. Thanks

Mousewar

In your opinion, what percentage of patients who show up to Emergency department actually need to be there as opposed to those who really could have just visited their GP or an outpatients clinic (or even just taking some paracetamol or whatever)?

job seeker

What's the worst accident you've seen in your career and how do you manage to stay calm?

seamus

Funnily enough, the frustration with "people not understanding how the system works" was going to be my question.

What can the hospital administration/HSE do to improve this? I think key to reducing tensions and annoyance about A & E is simply ensuring that people know what's going on. It's unreasonable to expect patients to understand the system and unreasonable to expect nursing staff to spend their valuable time responding to "when will I be seen" questions.

Case in point - attending a small public emergency room recently, you had a door with word "Emergency Room" written on it, and a printed sign that said, "Please knock once and take a seat". There's a waiting area with other patients sitting around. You knock, and you sit down. And nothing. 10 minutes go by, nobody appears at the door. More patients appear, knock, sit down, nothing. A nurse appears, brings in some of the patients who were there before you, and a doctor pops her head out the door calling out names.
Hang on, nobody even know we're here, let alone what our names are. More patients appears, knock, sit down, and the nurse and doctor seem to be attending to other patients you haven't yet seen. But not to you or anyone else who arrived after you.
Eventually an hour later the nurse reappears and asks, "Right, who's next?". Of course there's some confusion, but once you speak to her it becomes clear that she's the triage nurse who takes your details and then the doctor calls you in.
Funnily enough we were only there for an hour and a half, with the first hour spent in complete confusion waiting for someone to answer our random knock on a door.

I guess this is kind of what you're talking about when you talk about frustration. The nurse and doctor there know the system. And no doubt get annoyed if someone pounds on the door demanding to be seen. But the patients don't know the system and as far as they can tell they're attending an A&E but they're being ignored.

So, what do think is the best way to resolve this? In my example, if there was someone at a desk who did a "check-in"; it could even be the security guard, this could solve a whole lot of problems. You give him your name, you go onto the "triage list" for the A&E and the triage nurse(s) come out and call your name in turn. They then assess you and place you on the treatment list in order of priority. For bonus points you could give each patient a number and display a "waiting list" on screens in the A&E to show every patient where they are in the queue.

Of course, when you check-in initially you get a leaflet that explains this system and what to expect, including, "More severe cases will be placed on the list in front of you" and so forth.

celligraphy

Excuse my ignorance but why is there a bed shortage? I always thought maybe it's because some people go for the most stupid things e.g headache , cough , spraining ankle etc..

Sunny Dayz

I know a lot of people will post here giving out about the health system, looking for gory stories etc


But I was wondering about the positives: what are your favourite aspects of your job and what have been your best moments in your nursing career to date?

Timberrrrrrrr

I don't have a question, just wanted to say thanks for all the hard work you guys do, Underappreciated, underpaid and overworked yet you still go in every day.

Dozen Wicked Words

Do you think there is a case for strike action across the country? Do you think the INMO is any good as a union?

I'm an Emergency Dept nurse, AMA

Mousewar wrote: »

In your opinion, what percentage of patients who show up to Emergency department actually need to be there as opposed to those who really could have just visited their GP or an outpatients clinic (or even just taking some paracetamol or whatever)?

Hi Mousewar, great question to start off! It really does depend on the day but quite a lot of patients, perhaps 20% or more could go to a GP or as you say just take paracetamol to get rid of a pain but tend to run to their nearest ED with any sort of pain or strain. It is quite irritating when a patient comes in saying they have 10/10 pain but they haven't even tried taking pain killers at home before they came in and then an hour after they have had some paracetamol their pain is gone and they are all better. What is maddening though is the amount of patients referred in by their GP when they could easily be treated with oral tablets or have their GP send off bloods instead of them having to come in and wait hours to be seen.

job seeker wrote: »

What's the worst accident you've seen in your career and how do you manage to stay calm?

Hi Job seeker. Some of the worst things I have seen are probably crush injuries. These patients tend to have massive injuries and need a lot of different teams to intervene. Another thing was a patient who almost amputated their arm... they punched a glass window and the top of the window fell down like a guillotine and left their arm hanging on by a piece of skin. It sticks in my mind mainly because I actually thought it was quite cool
Traumas are nerve wracking but because there are usually so many people around it is easy to stay calm as you have enough support. Everyone usually knows their role and pulls together. In other situations it is not as easy to stay calm I guess but the rush of adrenaline always gets me through.

seamus wrote: »

Funnily enough, the frustration with "people not understanding how the system works" was going to be my question.

What can the hospital administration/HSE do to improve this? I think key to reducing tensions and annoyance about A & E is simply ensuring that people know what's going on. It's unreasonable to expect patients to understand the system and unreasonable to expect nursing staff to spend their valuable time responding to "when will I be seen" questions.

Case in point - attending a small public emergency room recently, you had a door with word "Emergency Room" written on it, and a printed sign that said, "Please knock once and take a seat". There's a waiting area with other patients sitting around. You knock, and you sit down. And nothing. 10 minutes go by, nobody appears at the door. More patients appear, knock, sit down, nothing. A nurse appears, brings in some of the patients who were there before you, and a doctor pops her head out the door calling out names.
Hang on, nobody even know we're here, let alone what our names are. More patients appears, knock, sit down, and the nurse and doctor seem to be attending to other patients you haven't yet seen. But not to you or anyone else who arrived after you.
Eventually an hour later the nurse reappears and asks, "Right, who's next?". Of course there's some confusion, but once you speak to her it becomes clear that she's the triage nurse who takes your details and then the doctor calls you in.
Funnily enough we were only there for an hour and a half, with the first hour spent in complete confusion waiting for someone to answer our random knock on a door.

I guess this is kind of what you're talking about when you talk about frustration. The nurse and doctor there know the system. And no doubt get annoyed if someone pounds on the door demanding to be seen. But the patients don't know the system and as far as they can tell they're attending an A&E but they're being ignored.

So, what do think is the best way to resolve this? In my example, if there was someone at a desk who did a "check-in"; it could even be the security guard, this could solve a whole lot of problems. You give him your name, you go onto the "triage list" for the A&E and the triage nurse(s) come out and call your name in turn. They then assess you and place you on the treatment list in order of priority. For bonus points you could give each patient a number and display a "waiting list" on screens in the A&E to show every patient where they are in the queue.

Of course, when you check-in initially you get a leaflet that explains this system and what to expect, including, "More severe cases will be placed on the list in front of you" and so forth.

Hi Seamus, This is another really good question and one which needs to be addressed on a nationwide scale I think. I am lucky enough to have only been in emergency departments that have a registration process.... In fact I didn't know there was any that wouldn't have this very basic step. In all departments I have been to a patient comes in and registers and then is called in turn by the triage nurse.

As for informing patients... I think posters on walls of waiting rooms are essential explaining how things work. Even a quick explanation of the triage system and the usually routine a patient will go through for example Registration-Triage-Doctor or nurse specialist-test results etc. I think this would be great for a patient who feels like they are just forgotten about in the waiting room when this is not actually the case.

I have worked in hospitals where there is a time to be seen board which is helpful in some situations but the fact is that this board will change all of the time which will end up angering patients who can't understand why.

I hope this sort of answers what you asked?

celligraphy wrote: »

Excuse my ignorance but why is there a bed shortage? I always thought maybe it's because some people go for the most stupid things e.g headache , cough , spraining ankle etc..

Hi Calligraphy. The bed shortage which I think you mean is actually inpatient beds within a hospital. When these are full it means no patients can be moved to a ward as there are no beds available. This leads to elective surgeries being cancelled and leads to patients being left on trolleys. You would hope that all inpatients actually require their beds so they cannot be blamed on the bed shortages. Some beds on wards cannot open due to staff shortages meaning the nurses are already over stretched and patient safety would be compromised if patients were sent to those beds.

seamus

I'm an Emergency Dept nurse, AMA wrote: »

I hope this sort of answers what you asked?

Yeah. I guess I was asking whether you feel there's anything glaringly missing in the process?

Perhaps all A&E departments should be standardised? I'm usng the Argos model here only to be illustrative and simplistic. So in Argos you know that you go and queue at the tills (triage), then you get a number, it pops up on the screen and when your number is called, you get your stuff (get seen).

And this is the same whether I go to Argos in Blanchardstown or Mahon Point. Or indeed it's the same on Oxford St in London.

But if I go to A&E in Tallaght, it will have one system. And if I attend Naas the next week it'll be something else entirely.

Do you think making the A&E process standardised across the country would help alleviate the confusion/frustration, or am I looking at it far too simplistically?

eeguy

Do you do manual handling courses?

I've heard many nurses suffer from bad backs due to lifting and moving patients, beds and equipment?
Have you noticed any of this yourself?

I'm an Emergency Dept nurse, AMA

Sunny Dayz wrote: »

I know a lot of people will post here giving out about the health system, looking for gory stories etc


But I was wondering about the positives: what are your favourite aspects of your job and what have been your best moments in your nursing career to date?

I have a lot of favorites :P I obviously love seeing patients get better.... it makes the job worthwhile. Getting somebody back from a cardiac arrest is an amazing feeling even if its only for a short amount of time in which their family get to spend time with them or to say goodbye properly. Seeing someone improve after you give life saving drugs is an incredible feeling.... I am often moved to tears when a stroke patient regains their speech or movement One of my favorite things (very morbid) is when I have a dying patient and I can help to make them comfortable or help their family in one of their worst times of their lives by explaining things or giving them a hug.
The thing that keeps me going is so simple though and that is when someone says thank you.... Its pretty sad but it really doesn't happen too often.

Timberrrrrrrr wrote: »

I don't have a question, just wanted to say thanks for all the hard work you guys do, Underappreciated, underpaid and overworked yet you still go in every day.

Thank you Timberrrrrrrr

Dozen Wicked Words wrote: »

Its only Beaumont INMO that have had a vote on strike action.

Do you think there is a case for strike action across the country? Do you think the INMO is any good as a union?

I think there is a need for something to be done to ensure the HSE is able to retain nurses, to ensure that nurses are kept safe and most importantly that our patients are kept safe.

I don't know if I actually believe that an all out strike will achieve this but I do think that work to rule is beneficial in some way if only to highlight how poorly a department works with nurses only doing their actual nursing jobs without all the other jobs we are expected to do.

I think people would be happier with the INMO if there were changes made but that isn't really their fault. It all lies with the government at the end of the day. The INMO are trying to fight our corner from what I can see but at the end of the day I don't know how changes can be achieved no matter what they do. That may be a negative point of view but I think this is a pretty shared view amongst nurses at the moment.

Toto Wolfcastle

Do you think Leo Varadkar is doing a good job as Minister for Health? He recently responded to an email I sent him and it seems to me that he has some good ideas but they're impossible to implement due to budget constraints. I'd be interested to find out if someone working in the health service thinks he's doing enough.

iPhone.

Well done Nurse!! Good on you for giving your time to answer the questions boardsies might have.

I don't have a question myself, just wanted to say how fantastic you Nurses are and I hope things improve work conditions wise in the near future!

moleyv

Having to attend A+E regularly with a relative something I notice is a lot of gardai having to be in attendance with people in custody or from prison.

I have seen fights break out etc.

In light of this, have you ever feared for your safety? Including patients not under garda supervision.

Do these patients under supervision get pushed up the line to get them out quicker?

everlast75

hi there,

As I have two parents who are quite elderly, I just wanted to say thank you to you and your colleagues. Under tremendous pressure, you still manage to do a fantastic job.

I have one question - do you think that there is too much managerial staff in the HSE; could that number be reduced and that money saved used to recruit more nurses?

Also, whilst not a question I'd like to say that what irks me beyond belief is that the government talk about keeping tax breaks and high levels of wages to "attract the best and brightest" into this country, and use the excuse that TDs should be well paid for the same reason, yet when it comes to determining a reasonable level of pay for nurses, they fight tooth and nail.

Yakkyda

First of all, thank you for taking the time to do this ama, it'll be very interesting.

Secondly, yis do an amazing job(was in jamses last year for four days , wisdom teeth, required surgery . Was on septic shock watch for two days!)the nurses were fcukin amazing, kind and caring even under pressure and dealing with some right dickheads. It takes a special kind of person to do what you do, it's a shame the hse can't get its act together . Undervalued and under appreciated imo. You guys are the backbone of the health service, the only thing that makes a hospital stay bearable.

No question, keep up the good work, you guys are fcukin amazing!

I'm an Emergency Dept nurse, AMA

seamus wrote: »

Yeah. I guess I was asking whether you feel there's anything glaringly missing in the process?

Perhaps all A&E departments should be standardised? I'm usng the Argos model here only to be illustrative and simplistic. So in Argos you know that you go and queue at the tills (triage), then you get a number, it pops up on the screen and when your number is called, you get your stuff (get seen).

And this is the same whether I go to Argos in Blanchardstown or Mahon Point. Or indeed it's the same on Oxford St in London.

But if I go to A&E in Tallaght, it will have one system. And if I attend Naas the next week it'll be something else entirely.

Do you think making the A&E process standardised across the country would help alleviate the confusion/frustration, or am I looking at it far too simplistically?

You know despite you thinking its far too simple this is exactly what I think needs to happen. All departments do work on a triage system but I do think that it should be a standardised process across all departments that a patient from Cork, Donegal or Dublin hospitals know what to expect when they have to attend an ED.

eeguy wrote: »

Do you do manual handling courses?

I've heard many nurses suffer from bad backs due to lifting and moving patients, beds and equipment?
Have you noticed any of this yourself?

Hi eeguy, Yes everyone does manual handling courses and everyone has to keep them updated. I myself suffer with a sore back and to be really honest despite having regular manual handling classes I do think that sometimes you just have to do what is necessary in that moment if it goes against manual handling techniques or not!

easygoing1982

Another poster sort of pushed on it but how would grade the levels of violence in A&E towards staff.Would you ever have to deal with violent people or does security step in straight away.

How could you class your working relationship with the likes of security etc.

How would you describe the facilities for mental health patients.

I'm an Emergency Dept nurse, AMA

Toto Wolfcastle wrote: »

Do you think Leo Varadkar is doing a good job as Minister for Health? He recently responded to an email I sent him and it seems to me that he has some good ideas but they're impossible to implement due to budget constraints. I'd be interested to find out if someone working in the health service thinks he's doing enough.

Hi Toto Wolfcastle. I won't lie, I do think that from the time I have become a nurse he is the best health minister we have had so far although after reading that he said he is disappointed with nurses decision to go on strike he isn't in my good books. I don't think anyone including himself realise the stress hospital staff in general are under especially in emergency departments. He is not there to see our frustrated tears or to see how stressed we are. I understand there are budget constraints but that doesn't negate the fact that changes need to be made to keep patients safe. The closure of departments around the country put a massive amount of pressure on other emergency departments and hospitals. We may no longer have staff to open these departments but I think reopening departments is something that needs to be considered. I'd love to know what his ideas are :P I think it would do no harm for there to be a team looking at what works elsewhere in the world and trying to introduce those initiatives here. It has been done in Scotland and massive advances in patient care have been made there, I cannot understand why that cannot be done here too.

iPhone. wrote: »

Well done Nurse!! Good on you for giving your time to answer the questions boardsies might have.

I don't have a question myself, just wanted to say how fantastic you Nurses are and I hope things improve work conditions wise in the near future!

Hi iPhone, thank you!

moleyv wrote: »

Having to attend A+E regularly with a relative something I notice is a lot of gardai having to be in attendance with people in custody or from prison.

I have seen fights break out etc.

In light of this, have you ever feared for your safety? Including patients not under garda supervision.

Do these patients under supervision get pushed up the line to get them out quicker?

Hi moleyv. I have often fared for my safety and the safety of my colleagues and patients. If I do a full week of nights I can honestly say I may not receive some sort of verbal abuse on only one or two of those nights. I have been physically assaulted on more than one occasion as have many of my colleagues. This may only be a scratch or a punch but it always sticks with you and ultimately makes me more weary of people.

In my department all patients are triaged and seen in turn as per their category. A person under supervision from the gardai may be moved from the waiting room to a cubicle out of the way but they will still be seen in turn.

everlast75 wrote: »

hi there,

As I have two parents who are quite elderly, I just wanted to say thank you to you and your colleagues. Under tremendous pressure, you still manage to do a fantastic job.

I have one question - do you think that there is too much managerial staff in the HSE; could that number be reduced and that money saved used to recruit more nurses?

Also, whilst not a question I'd like to say that what irks me beyond belief is that the government talk about keeping tax breaks and high levels of wages to "attract the best and brightest" into this country, and use the excuse that TDs should be well paid for the same reason, yet when it comes to determining a reasonable level of pay for nurses, they fight tooth and nail.

Hi everlast75. Thankfully all the management I come into contact with are a necessity and do a fantastic job as far as I am concerned. I think any management assosicated with an Emergency Department have a very stressful job which is often overlooked. My hospital in general seem to have amazing and necessary management who all seem to do a fantastic job with what resources they have. I think in general there have always been complaints about too many managerial and administration staff in the HSE so I am sure this is true... I do however think this is slowly changing.

Yakkyda wrote: »

First of all, thank you for taking the time to do this ama, it'll be very interesting.

Secondly, yis do an amazing job(was in jamses last year for four days , wisdom teeth, required surgery . Was on septic shock watch for two days!)the nurses were fcukin amazing, kind and caring even under pressure and dealing with some right dickheads. It takes a special kind of person to do what you do, it's a shame the hse can't get its act together . Undervalued and under appreciated imo. You guys are the backbone of the health service, the only thing that makes a hospital stay bearable.

No question, keep up the good work, you guys are fcukin amazing!

Hi Yakkyda, I am glad to hear you had a positive experience despite being unwell, glad to hear the nurses were great On a side note, I think it is incredible how the care of sepsis in patients has improved so much in the past few years and is ultimately saving lives.

I'm an Emergency Dept nurse, AMA

easygoing1982 wrote: »

Another poster sort of pushed on it but how would grade the levels of violence in A&E towards staff.Would you ever have to deal with violent people or does security step in straight away.

How could you class your working relationship with the likes of security etc.

How would you describe the facilities for mental health patients.

Hi easygoing1982. One thing I will say about security is if differs in every single hospital. Some hospitals have a zero tolerance approach, some have security who are like ornaments and cannot really intervene and some have no security at all. Someone earlier said about standardising emergency departments and I think security should be something that is standardised in every department.

I think there needs to be emergency mental health centers in Ireland instead of patients having presenting to an emergency department. It puts so much pressure on both the patient and the nurse caring for them. That nurse may have 8 other medically unwell patients who require a lot of care and then have a patient who has a mental health illness who requires a lot of reassurance and assistance with getting transferred to a specialist facility. I think a a patient with a mental health crises require more than any busy emergency department can give. I think we all try our best but I think the mental health services in Ireland need a serious overhaul as soon as possible.

fussyonion

What would happen if you could not control someone's heartbeat?
Say they had A-Fib and no amount of amiadrone/beta blockers etc could slow it, what's the last resort?

allandanyways

Firstly, well done on doing what you do - nurses are the unsung, underpaid heroes of this country.

My question is this:

What are your feelings on drug addicts who present minor injuries in A&E for the sole purpose of getting pain meds/extended methadone prescriptions?

I ask because I was in the Mater not too long ago and while I was waiting for an ultrasound, I saw no less than 4 nurses trying to restrain a whacked out of it junkie and his girlfriend. He had a sprained wrist or something, nothing serious or visible.

Anyway, the next thing, the girlfriend is wheeling him (now calm and arm in a sling) out of the A&E and meets the nurse along the way and says "Now, will ya ask the doctor to write him up for a week's worth of methadone so he doesn't have to go down and get it, and give him 2 weeks worth of the painkillers as well?". From her body language and tone of voice, it was clear that was an instruction, not a request.

I don't know what happened after that as they walked away together but I felt really uncomfortable in that moment, and it was said loud enough (I would imagine) so that if the nurse said no, then she would have made a scene. I felt really bad for the nurse, and thought "I wonder how many cases like that she sees every week?".

Obviously drug addiction and heroin use in particular is a huge problem in Dublin/Ireland - does it have much of an impact on your work?

I'm an Emergency Dept nurse, AMA

fussyonion wrote: »

What would happen if you could not control someone's heartbeat?
Say they had A-Fib and no amount of amiadrone/beta blockers etc could slow it, what's the last resort?

Hi fussyonion, Fast Atrial Fibrillation is a funny one as it can actually come on due to something like an infection, in that case its important to actually treat the infection rather than the rhythm which will in turn control the rhythm if that makes sense? In a patient who is symptomatic or unstable with a fast afib we will cardiovert (shock) the patient. This is a controlled situation different to a cardiac arrest defibrillation/shock. Many patients sit happily enough in afib and you have time to wait and see if they will revert to a normal rhythm and have time to thin their blood and take them back for a cardioversion at another time.

allandanyways wrote: »

Firstly, well done on doing what you do - nurses are the unsung, underpaid heroes of this country.

My question is this:

What are your feelings on drug addicts who present minor injuries in A&E for the sole purpose of getting pain meds/extended methadone prescriptions?

I ask because I was in the Mater not too long ago and while I was waiting for an ultrasound, I saw no less than 4 nurses trying to restrain a whacked out of it junkie and his girlfriend. He had a sprained wrist or something, nothing serious or visible.

Anyway, the next thing, the girlfriend is wheeling him (now calm and arm in a sling) out of the A&E and meets the nurse along the way and says "Now, will ya ask the doctor to write him up for a week's worth of methadone so he doesn't have to go down and get it, and give him 2 weeks worth of the painkillers as well?". From her body language and tone of voice, it was clear that was an instruction, not a request.

I don't know what happened after that as they walked away together but I felt really uncomfortable in that moment, and it was said loud enough (I would imagine) so that if the nurse said no, then she would have made a scene. I felt really bad for the nurse, and thought "I wonder how many cases like that she sees every week?".

Obviously drug addiction and heroin use in particular is a huge problem in Dublin/Ireland - does it have much of an impact on your work?

Hi allandanyways, I hope you got sorted with your ultrasound and that all was ok.

I won't lie about addicts.... many can be a pain in the arse but I generally have good time for them once they are not abusive or destructive. I am very straight up and I am never afraid to tell them how it is and usually they will listen to that. Id say I can safely guarantee that no patient in any department in Ireland ever gets a prescription for methadone from an emergency department, in fact, any departments I have worked in have a strict policy that the patients methadone clinic is called to check their prescription before any is prescribed. If it is out of hours then a minimal amount of methadone is prescribed to prevent detoxing until their usual dosage is clarified.

As for the pain killers, patients usually will get a prescription if required for 3-5 days and they are informed to visit their GP if they require anymore.

It puts pressure on us when a patient comes in overdosed or abusive. Many patients are revived by paramedics only to come around and be abusive because the drug given to reverse heroin has taken away their buzz. Then they get angry because their clothes have been cut off in an attempt to save them.... I feel like we look bad on front of people if we are annoyed at these people on front of other patients who don't know what has gone on before they see us arguing :P:rolleyes:

Clearlier

What do you think about the changes in education requirements for nurses over the past 15 - 20 years? Is there a danger of it becoming a bit too academically oriented to the detriment of recruiting hands on practical people?

I've also heard that there's something of a glass ceiling in place with respect to promotion where a masters is basically a requirement - is that ruling out nurses who may be extremely capable but not academically oriented?

I'm an Emergency Dept nurse, AMA

Clearlier wrote: »

What do you think about the changes in education requirements for nurses over the past 15 - 20 years? Is there a danger of it becoming a bit too academically oriented to the detriment of recruiting hands on practical people?

I've also heard that there's something of a glass ceiling in place with respect to promotion where a masters is basically a requirement - is that ruling out nurses who may be extremely capable but not academically oriented?

Hi Clearlier, This is a great question. Nursing is defiantly more academic based now and it almost feels like nurses are replacing medics in a lot of cases. Nurses are learning from medical science meaning that we are becoming more advanced with our practice. Taking emergency nursing as an example, we make decisions re patients care, we interpret bloods after we take them. We take and interpret ECGs. We are able to diagnose without being able to diagnose Although I think all of this knowledge is great in one respect I can see such a massive change in nursing now compared to years ago.... Doctors rely on us so much more to have answers whereas that used to be their job. We are expected to do so much more and what worries me is that this is leading to a decline in actual nursing care. We no longer seem to have time to sit and talk to our patient and I am afraid that nursing care will be forgotten as nurses are too busy doing jobs that only the doctors used to do!

I think a nurse can advance to a manager in most cases whether they have a masters or not but I do think that a nurse should be doing whatever courses are available when they can to keep up to date.... These are the nurses who will advance to management and rightly so. I do not think it is enough to just look after your patients anymore without updating your skills and knowledge and expect to advance in your career.

Fluorescence

Excellent thread so far! Thank you for all your hard work, nurses are some of the best people in the world

My question is if there was any one thing that made you want to become a nurse in the first place? An event, a person, a childhood dream? And, if you weren't to be a nurse, what other career could you see yourself doing?

TG1

I don't really have a question but wanted to chime in as someone who spent 24 hours in a&e recently with a fractured pelvis, the work a&e staff do is amazing, and the manner in which patients are dealt with in such a busy environment is phenominal. I was so well looked after by the nursing staff, both in a&e and later on the ward, they really made a horrible experience bearable! The experience has just put me in awe of the work you do and the positive attitude you maintain while doing it in incredibley stressful conditions, and I think this should be highlighted at every available opportunity!

whiskeyman

Firstly, thank you on doing what you do.
There's no way in hell I could do it, and I see it as a vocation, one that you need to be better praised and paid for!

With the Christmas season coming up, are you dreading the increase in already problematic incidences of alcohol abuse / violence to staff etc...?
As you're one of the many people on 'the front line' when it comes to our alcohol abuse problem, is it as bad as the media make it out / are you shocked by it yourself?

Eugene Norman

Who is ultimately responsible for patients on trolleys? Is it funding or mismanagement and if the latter is it hospital level mismanagement or a higher regional level, or the health executive or the minister.

irishgeo

What you like to see change in A and E depts to makes things easier/better for nurses and everyone else?

allandanyways

Thank you for answering my question in so much detail - from the patient's side, it looked as though the nurse was being threatened into prescribing, so I'm glad to hear that there are such strict regulations around that sort of thing.

Just coming back to your point about dedicated mental health emergency centres - I agree wholeheartedly. Can I be so bold as to ask a second question in relation to this?

I've been in hospital a few times with panic attacks where I genuinely thought I was having a heart attack/stroke/asthma attack. I've had varying levels of concern from nursing staff - from very sympathetic and kind to impatient and frustrated.

What is it like on your side when the patient is adamant there's something really seriously wrong with them and you know from their chart that they're actually fine? Is it hard to bite your tongue and refrain from telling them to just calm down? I'm just curious how you handle it personally, as I know when I'm in the middle of a full blown attack and convinced I'm dying, I just lose the plot completely and nothing the nurse says can tell me otherwise and it's only afterwards I think what a headwreck I must have been!:o

wonderfulname

Brilliant thread, thanks for doing this OP, it's very informative.

So I'm taking the time atm to rebuild a solid first aid kit and knowledge both for day to day and when I'm back outdoors come spring.

My question is what do you think is the most important thing for a person to know, be it recognising a stroke, treating a minor sprain or just eating and drinking right, and equally are there any mistakes people tend to make that just make your job harder when a patient gets to the ER?

kowloon

As serious as A&E is I'm sure you've seen some things that you can't help but laugh at. What's the funniest/dumbest thing you've seen?

DeltaWhite

I don't even have a question Just wanted to commend you for all your hard and selfless work that you do.

The Intensive Care nurse who looked after my Mam in her final days was honestly such a comfort to my family in those gut wrenching hours. Sometimes I wonder how she managed to sit there all day watching us in complete and utter despair. In my opinion it takes a special kind of person to be a nurse. I wish things were better in the health system, personally I think our Government are completely out of touch with reality when it comes to the current issues in hospitals. I hate to be negative, but I genuinely cant see anything changing.

Well done on all you have achieved and I wish you the very best in your career.

I'm an Emergency Dept nurse, AMA

Fluorescence wrote: »

Excellent thread so far! Thank you for all your hard work, nurses are some of the best people in the world

My question is if there was any one thing that made you want to become a nurse in the first place? An event, a person, a childhood dream? And, if you weren't to be a nurse, what other career could you see yourself doing?

Hi Fluorescence. Thank you, I agree, nurses are great!

I had a little cousin who was very sick and I think that is what first sparked my interest..... I also had a mother telling me not to go into nursing but I did as any teenager would do and went against what she told me to do :P I guess I always had an empathetic side to me and acted as a bit of a counselor in school so I'd say I would have went down a social work or counselling route if I didn't become a nurse. I would absolutely love to pack it in some days though and go work in a nightclub :cool:

TG1 wrote: »

I don't really have a question but wanted to chime in as someone who spent 24 hours in a&e recently with a fractured pelvis, the work a&e staff do is amazing, and the manner in which patients are dealt with in such a busy environment is phenominal. I was so well looked after by the nursing staff, both in a&e and later on the ward, they really made a horrible experience bearable! The experience has just put me in awe of the work you do and the positive attitude you maintain while doing it in incredibley stressful conditions, and I think this should be highlighted at every available opportunity!

Hi TG1, I am glad your experience was made that little bit better by the care you received! Always great to hear good stories

whiskeyman wrote: »

Firstly, thank you on doing what you do.
There's no way in hell I could do it, and I see it as a vocation, one that you need to be better praised and paid for!

With the Christmas season coming up, are you dreading the increase in already problematic incidences of alcohol abuse / violence to staff etc...?
As you're one of the many people on 'the front line' when it comes to our alcohol abuse problem, is it as bad as the media make it out / are you shocked by it yourself?

Hi whiskeyman, I think the stories in the media are pretty accurate but what I find is more of an issue are the people who we see again and again and again with drink problems no matter what time of year it is. It is sad in one way but completely frustrating in another. I also think people have the wrong idea when it comes to people getting a trolley just because they are drunk.... don't get me wrong, I would rather that trolley going to someone elderly or sicker but what people don't realise is that person who is drunk may be so comatosed that they need assistance with breathing not to mention intravenous fluids to maintain their blood pressure which tends to be low along with a whole other host of things. People don't realise that someone may be drunk but they may also be seriously ill.... until the drink wears off and then they get up and leave

Eugene Norman wrote: »

Who is ultimately responsible for patients on trolleys? Is it funding or mismanagement and if the latter is it hospital level mismanagement or a higher regional level, or the health executive or the minister.

Hi Eugene Norman, My honest answer as stupid as I may sound is I really don't know. I feel like it is a higher up issue. I honestly feel like hospital management do try their best. I feel like the closure of some departments has left horrific strain on others. The lack of staff and beds meaning that patients need to wait longer in the department is a huge issue but from what I can see hospitals are trying to fix this with little support so I guess it does lie in the hands of the department of health but that would be my own opinion.

myshirt

I have two questions:

1. A lot of the newer nurses are better trained, better educated, and better motivated. How do senior nurses in the department reconcile in their conscience what they/your union done to student and young nurses in favour of the retention of benefits for the older members of the union? Particularly at a time of need for new thinking, and for an errosion of youth unemployment.

Are your pensions and benefits way too high? Will nurses voluntarily concede on these and allow the money to be spent on younger nurses?

2. Is it fair to say that a lot of bullying goes on in the profession? How do you cope with this in the face of pressures on the service? Do you take your work home with you?

I'm an Emergency Dept nurse, AMA

irishgeo wrote: »

What you like to see change in A and E depts to makes things easier/better for nurses and everyone else?

Hi irishgeo, What I would love to see is a system more like the UK. Take a northern Ireland hospital I have been to for example. They have a system where you go into triage and there is a doctor there who does a quick assessment, orders what needs to be ordered, does bloods, refers patients on where they need to be referred to. This does happen in some hospitals here but I think this should be a nationwide initiative. I think it would speed everything up for patients, nurses and the doctors. They also have GPs within emergency departments in the UK who can see a patient and quickly send them on their way if they do not need further investigations or admission. To me these are small, easy initiatives that yes would cost money at the start but I think it would save massive amounts in the long run.

allandanyways wrote: »

Thank you for answering my question in so much detail - from the patient's side, it looked as though the nurse was being threatened into prescribing, so I'm glad to hear that there are such strict regulations around that sort of thing.

Just coming back to your point about dedicated mental health emergency centres - I agree wholeheartedly. Can I be so bold as to ask a second question in relation to this?

I've been in hospital a few times with panic attacks where I genuinely thought I was having a heart attack/stroke/asthma attack. I've had varying levels of concern from nursing staff - from very sympathetic and kind to impatient and frustrated.

What is it like on your side when the patient is adamant there's something really seriously wrong with them and you know from their chart that they're actually fine? Is it hard to bite your tongue and refrain from telling them to just calm down? I'm just curious how you handle it personally, as I know when I'm in the middle of a full blown attack and convinced I'm dying, I just lose the plot completely and nothing the nurse says can tell me otherwise and it's only afterwards I think what a headwreck I must have been!:o

Hi again allandanyways, I won't lie, it can be incredibly frustrating when dealing with someone who is panicking but I can't actually imagine how frustrating it must be to have someone telling you you are ok when you feel like you are dying! I am quite stern and I find this usually works. In my experience I think if you tell someone in a nice but firm way that they need to calm down and most importantly explain why they feel like they do then they usually can calm down. I think it is so important to tell someone that the reason their lips are numb and their hands are locked is because they are breathing too quickly and that once they concentrate on their breathing that this will begin to ease. One thing I try and do is I try to distract someone, for example I ask them to name 5 things beginning with a certain letter around them.... almost like i spy :P Distraction methods are a great way for people to end a panic attack! And also always remember if you are having a panic attack and are able to say the words I can't breath then you can and are breathing and try to distract yourself

wonderfulname wrote: »

Brilliant thread, thanks for doing this OP, it's very informative.

So I'm taking the time atm to rebuild a solid first aid kit and knowledge both for day to day and when I'm back outdoors come spring.

My question is what do you think is the most important thing for a person to know, be it recognising a stroke, treating a minor sprain or just eating and drinking right, and equally are there any mistakes people tend to make that just make your job harder when a patient gets to the ER?

I am going to do a separate post for this actually wonderfulname, It deserves a long reply

DeltaWhite wrote: »

I don't even have a question Just wanted to commend you for all your hard and selfless work that you do.

The Intensive Care nurse who looked after my Mam in her final days was honestly such a comfort to my family in those gut wrenching hours. Sometimes I wonder how she managed to sit there all day watching us in complete and utter despair. In my opinion it takes a special kind of person to be a nurse. I wish things were better in the health system, personally I think our Government are completely out of touch with reality when it comes to the current issues in hospitals. I hate to be negative, but I genuinely cant see anything changing.

Well done on all you have achieved and I wish you the very best in your career.

Hi DeltaWhite, I am sorry to hear about your mam It is so difficult to see a family or a friend fall apart and it is so difficult to try and remain professional and not cry your eyes out with them especially if you have built a bond with the patient or their family or in a sudden death situation. I recently stood with a family in a room with their mam while she took her last few breaths, It was very difficult to remain professional and not cry with them and I also found it difficult to know how to say their mam had died even after all these years. You know that they are the words they will remember anytime they think of that moment. I do think it is made so much easier when you know that you really have done everything you possibly can to make that patient comfortable though.

I sadly agree with nothing changing anytime soon as difficult as that is to even think about especially as every department in the country seems to be close to breaking point at the minute.

Thank you for your kind words x

kowloon wrote: »

As serious as A&E is I'm sure you've seen some things that you can't help but laugh at. What's the funniest/dumbest thing you've seen?

Hi kowloon, There are days and nights where we end up falling around laughing at the silliest of things that people end up doing. One funny story that I was told and we have had many laughs at since was someone who turned up to a department on Valentines night with a Rose in his Penis.... he thought it was a romantic gesture until he realised there were little thorns left on the stem.... Do not try at home folks...

beertons

Can I just say, I think you do a great job.

Now, when were you in Coppers last?

GLaDOS

What sort of shifts do you usually work? What's the longest Shift you've ever done?

mirrorwall14

Just want to say thanks. I've been to A&E twice in recent years with bad asthma attacks and you guys are fantastic

Yintang

I agree wholeheartedly with the other posters with regard to the trojan work nurses do - how you manage to do such much under such constraints is beyond me. Thank you all for everything you do for us!

Two questions - is the hand hygiene of doctors improving? I had heard the spread of the likes of MRSA etc was largely due to doctors either not observing correct hand washing techniques, or things like their ties being a source of germ transmission. Do you ever have to pull up your doctor colleagues on this, and how do they react?? Or are hygiene practises across the board just very under-par?

Secondly, do you sometimes find it hard to switch off and leave the more disturbing incidents behind you after a shift?

Thanks again for taking the time on this thread, really interesting insights!

I'm an Emergency Dept nurse, AMA

wonderfulname wrote: »

Brilliant thread, thanks for doing this OP, it's very informative.

So I'm taking the time atm to rebuild a solid first aid kit and knowledge both for day to day and when I'm back outdoors come spring.

My question is what do you think is the most important thing for a person to know, be it recognising a stroke, treating a minor sprain or just eating and drinking right, and equally are there any mistakes people tend to make that just make your job harder when a patient gets to the ER?

I think this is a great question wonderfulname.

So as far as a stoke is concerned... FAST.
Face-look for a droop on one side, get someone to smile and show you their teeth to make this more obvious
Arms-this could be someone not able to hold onto a cup or dropping something, get them to hold out both arms, palms facing upwards, close their eyes and hold them there for 10 seconds, if one drifts or drops this is a major sign of a stroke.
Speech-A persons speech may be slurred or they may be unable to find the words they are looking for or have confused speech patterns this is a sign.
Time-Call an ambulance or get the patient to an emergency department as soon as possible.
It is really important to note the time of onset as treatment such as a clot busting treatment should be administered within 4 hours of onset.
There are two types of stroke, a bleed and basically a blockage. If its a blockage a clot busting drug may improve this but it needs to be within those 4 hours.
There are also other signs of a stoke such as sudden onset of vomiting, dizzyness and headache.

Heart attack symptoms include jaw pain, arm pain, back pain, shortness of breath, discomfort in chest. If someone shows symptoms of a heart attack you can offer them 300mg aspirin to chew (disprin is a good one for the first aid kit) as long as they have no previous history of9 a bleed in their bowel or stomach or blood disorders. And obviously call an ambulance.

If someone is bleeding apply pressure.... I often see people bleeding even after a IV cannula is removed from their hand or arm and they hold their arm out with blood dripping everywhere... pressure and bandage.

Some simple mistakes people make are things like when a tooth is knocked out and they don't bring it in to hospital with them.... if it is a clean knock out with root still attached the tooth can be put back into the gum and saved but put it in a glass of milk until you get to hospital. Another mistake is when people chop off the tip of a finger or get part of their ear bitten off... do not put it straight onto ice as this will kill it. Put it into a bag of water and put the water onto ice and bring it into the emergency department.

Eye injuries are something people do not look after at all. Wash it out and keep washing it out for at least 10-15 minutes.

Burns.... when anyone burns their hand or finger they tend to just run it under the tap for a minute (myself included) Keep the burned area under a tap for at least 10 minutes. A cement burn continues to burn inner layers of the skin. A cement burn could need up to an hour under cold water to prevent further burning.

Electric shocks are a weird one. Someone should always have their pulse checked after an electric shock as it may be enough to cause a cardiac arrhythmia. Electric shocks can also cause internal burns so if it is a significant shock a person should always get checked out to be on the safe side.

Seizures. Wait for a seizure to pass. Do NOT put anything in a persons mouth including fingers. Place something under the persons head and make the area safe around the patient. After a seizure a person may become aggressive or may be confused, just try to keep them safe.

If someone collapses, call for help. Check if they are breathing for up to 10 seconds. Start chest compressions, 30 compressions then 2 breaths if willing to give mouth to mouth. I would advise EVERYONE to do a basic life support class.... you never know when it could be needed. Bystander CPR gives someone a real fighting chance.

I'm an Emergency Dept nurse, AMA

myshirt wrote: »

I have two questions:

1. A lot of the newer nurses are better trained, better educated, and better motivated. How do senior nurses in the department reconcile in their conscience what they/your union done to student and young nurses in favour of the retention of benefits for the older members of the union? Particularly at a time of need for new thinking, and for an errosion of youth unemployment.

Are your pensions and benefits way too high? Will nurses voluntarily concede on these and allow the money to be spent on younger nurses?

2. Is it fair to say that a lot of bullying goes on in the profession? How do you cope with this in the face of pressures on the service? Do you take your work home with you?

Hi myshirt. I agree that newer nurses are coming in with a better academic background and the newest knowledge and skills but they get trained on the wards by the senior nurses. Yes their motivation may be better but no-one can deny that we need the experience of the senior nurses to help teach the newer nurses that come along. No nurse gets to sit back now and not keep up to date with courses or new knowledge and skills. It is a requirement for us to keep our portfolios up to date and these portfolios can be spot checked at any time. I think the very high majority of senior nurses deserve their pensions and benefits. Pensions because they have paid into them for starters. Benefits wise why shouldn't senior nurses with a wealth of experience and service get particular benefits. As far as I am concerned the government should not be cutting new nurses wages. The health service should concentrate on the retention of experienced staff as well as the employment of newly graduated nurses. Would you feel happier on a ward with 3 newly qualified nurses running it or 3 senior nurses? I know which I would choose.

Nursing is a predominately female career, girls in my opinion can be quite bitchy and cliquey but this is the same as any career. People do get bullied but I don't think it happens any more in nursing than it does anywhere else.

Yes I take my work home with me. It is difficult not to especially when working in an emergency department. I am quite happy and jolly in work and quite cranky at home a lot. This is something I need to learn to deal better with. Ill get there some day.

beertons wrote: »

Can I just say, I think you do a great job.

Now, when were you in Coppers last?

Hahaha Beertons. I haven't been in Coppers in years. Last time I went there i was grabbed and not even on the boob or bum so I vowed to avoid it ever since.... it's working so far!!

ScienceNerd wrote: »

What sort of shifts do you usually work? What's the longest Shift you've ever done?

Hi ScienceNerd. Nurses usually work 3 to 4 13 hour days (12 not including breaks) per week and a week of night duty every 4 to 5 weeks. This week of nights is either done all in a row or 4 nights one week and 3 the next.

mirrorwall14 wrote: »

Just want to say thanks. I've been to A&E twice in recent years with bad asthma attacks and you guys are fantastic

Hi mirrorwall14, Thank you Asthma is a tricky and scary one to get into the emergency department. I hope it is well under control in this changeable weather

Yintang wrote: »

I agree wholeheartedly with the other posters with regard to the trojan work nurses do - how you manage to do such much under such constraints is beyond me. Thank you all for everything you do for us!

Two questions - is the hand hygiene of doctors improving? I had heard the spread of the likes of MRSA etc was largely due to doctors either not observing correct hand washing techniques, or things like their ties being a source of germ transmission. Do you ever have to pull up your doctor colleagues on this, and how do they react?? Or are hygiene practises across the board just very under-par?

Secondly, do you sometimes find it hard to switch off and leave the more disturbing incidents behind you after a shift?

Thanks again for taking the time on this thread, really interesting insights!

Hi Yintang. I think, or at least I hope, hand hygiene is improving across the board. I don't think it is fair to solely blame the doctors however they used to be pretty poor at it. As far as I can see everyone in my department is very good at it. I have never had to pull anyone up on it and have never been pulled up on it myself but I think it is much better nation wide.... although I do put this down to all the information put out during outbreaks of the winter vomiting bug. Health promotion works when it works

Yes I defiantly find it very hard to switch off a lot. If I see something traumatic it may take me days to get over it. There are still days where I will think back to a disturbing incident and still feel shook from it. Ill be fine in work as you have to act professional but I come home and am a thundering cow. I have a few friends in different areas of nursing who I get to talk to and it's great but unless friends or family are in the same field they will never understand as much as they try to. The way I try to see it though is that I have gained invaluable experience from these events and if I can teach someone what to do in the same situation or know what to do next time then that has to be a good thing

Does Pharmacy have any involvement in your ED department?

devnull

I'm an Emergency Dept nurse, AMA wrote: »

Hi irishgeo, What I would love to see is a system more like the UK. Take a northern Ireland hospital I have been to for example. They have a system where you go into triage and there is a doctor there who does a quick assessment, orders what needs to be ordered, does bloods, refers patients on where they need to be referred to.

This does happen in some hospitals here but I think this should be a nationwide initiative. I think it would speed everything up for patients, nurses and the doctors. They also have GPs within emergency departments in the UK who can see a patient and quickly send them on their way if they do not need further investigations or admission. To me these are small, easy initiatives that yes would cost money at the start but I think it would save massive amounts in the long run.

A quick question on that.

I've been in an A&E and it's pretty obvious I need blood tests or xrays etc the moment I arrive. However I have to wait 10 hours to be seen by a doctor, who then sees me for about 30 seconds and sends me for a blood test or an xray that I then have to wait hours for results for.

In the UK some nurses and Nurse Practitioners will order these tests straight from triage so when you see the doctor they already have the results rather than having all of this wasted time, that is what should be done here, it makes the system far more efficient.

When I was in Manchester a few years ago, I went from Triage to x-ray to doctor to leaving in about 90 minutes, despite the fact that there was 15 people ahead of me, since triage sent me for an x-ray. more or less straight away.

Also there are a number of arrogant doctors in the profession who have no people skills whilst others are really great with people, how do you find it coping with the wide range of personalities you have to work with? Generally nurses come across as more kind-hearted and has there ever been an occasion where you felt a doctor wasn't sensitive?

allandanyways

Your answers are so insightful, considerate and really show how much you love helping people - you've definitely found your calling and I hope you enjoy your career and continue to help people as much as you have already!

I'm an Emergency Dept nurse, AMA

Deleted User wrote: »

Does Pharmacy have any involvement in your ED department?

Hi The_Dazzler. Yes pharmacy have a huge involvement in any department in a hospital. They supply all the drugs we use. Keep us stocked with what we need and ensure that patients are receiving their correct meds and dosages.

devnull wrote: »

A quick question on that.

I've been in an A&E and it's pretty obvious I need blood tests or xrays etc the moment I arrive. However I have to wait 10 hours to be seen by a doctor, who then sees me for about 30 seconds and sends me for a blood test or an xray that I then have to wait hours for results for.

In the UK some nurses and Nurse Practitioners will order these tests straight from triage so when you see the doctor they already have the results rather than having all of this wasted time, that is what should be done here, it makes the system far more efficient.

When I was in Manchester a few years ago, I went from Triage to x-ray to doctor to leaving in about 90 minutes, despite the fact that there was 15 people ahead of me, since triage sent me for an x-ray. more or less straight away.

Also there are a number of arrogant doctors in the profession who have no people skills whilst others are really great with people, how do you find it coping with the wide range of personalities you have to work with? Generally nurses come across as more kind-hearted and has there ever been an occasion where you felt a doctor wasn't sensitive?

Hi Devnull. To be honest with you, our department does bloods and gets doctors to order an x-ray before they are seen by a doctor but sometimes this cannot happen due to the pressure the nurses may already be under that day or night. They may be already looking after 12 patients in an area you can't see.
I do agree with you though, if this could be done all the time and if nurses could order x-rays this would save valuable time. When I do a patients bloods because they think there is an infection somewhere, at least I can say to them your bloods are clear but it is up to you if you want to wait 6 more hours to be seen.

In an emergency department you come across so many doctors from all different teams. Many are nice because they want to keep us on side for when they want us to do bloods etc for their patient. Like any job though there are some absolute pricks walking around the place. The stratagy I use these days is I call them out on it by saying something like 'we all work as a team here, there is no need to be so rude' and I generally find this works. Many of these people appear as if they have spent their lives being spoiled and I honestly think they do not know when they are out of order. There are of course nurses who still walk around as if they own the place.... You just try to let them at it and ignore but I have always been a bit of a sensitive soul and I sometimes find it hard to ignore things.

allandanyways wrote: »

Your answers are so insightful, considerate and really show how much you love helping people - you've definitely found your calling and I hope you enjoy your career and continue to help people as much as you have already!

Thank you allandanyways. Best of luck with everything and remember distraction.

IvyTheTerrible

Do you have colleagues that don't pull their weight?
Have you ever had to report a colleague for not doing their job properly?
Why do you think absentee levels are high among nurses in Irish hospitals?

killswitx

why i was charged 75euros for 4 days(=300e)? in the hospital on emergency when i was not there those days anyway (because i have left the hospital after waiting 3 days, and i have signed that i have refused treatment)

Dubl07

Does it bother you that some of us can access better urgent care by paying for it? The last time I was seriously unwell I paid a private hospital's ED rather than contend with the local teaching hospital. I felt it was money well spent, even though it seriously affected my spending for a couple of months. The previous south Dublin public hospital I attended has great nurses and doctors but it's an abject pigsty on a busy night with inadequate facilities especially when V&D are put into the mix. I now try and keep some funds aside to pay for private care. I begrudge having to do so but it might be the difference between walking out or being carried.