Now Ye're Talking - to an Emergency Department Nurse

I'm an Emergency Dept nurse, AMA

bleary wrote: »

Do you think the quality of doctors in the country has suffered with the emigration of newly qualified doctors .
Is there an issue with a lack of assessment of doctors in the country before taking up contracts , I have seen a number of cases with doctors lacking basic skills being reported weeks into their contracts by their colleagues.

What do you think about introduction of theatre assistants and other new grades to take up some nursing duties . It seems like a sensible approach to me especially when we just can't recruit nurses, I have never met a nurse who wants to spend their time in theatre but the inmo opposes it

are nurses still limited in what they can do in comparison to their practice in the uk. This was the case 40 years ago and still is I think, taking bloods etc

Hi bleary. I really don't think the quality of doctors has suffered at all from an emergency department point of view. The high majority of doctors I come into contact with are amazing in my opinion but then I think you have to be to be an ED doctor. I do think that there will always be some doctors who really don't have a clue and who you stand back and actually think that they bought their qualification without going to any college at all.... I think that has always been the case but I really don't come across many of them in recent years.

I think as nurses are more stretched in what they are expected to do, the introduction of assistants is necessary but I think whoever governs these roles has to be really careful that these people are able for the tasks they are given!

I don't think nurses are limited at all now compared to the UK.... Well from an acute hospital point of view. Nurses in Ireland do bloods, ECGs, diagnose, prescribe. Things have changed and nurses in Ireland are incredibly advanced now compared to years ago.

FGR wrote: »

Hi there!

Just a question from outside of the box. How do you feel about the HSE using the A&E as a place of safety for children taken into care outside of social services working hours? I know gardaí aren't happy with that arrangement as neither them nor ye have the facilities to ensure safety - especially if the juvenile is of special needs or of an angry disposition.

PS I think they also know you guys are already up to your necks in work as it is :pac:

Hi FGR, I think that although it is a safe environment for a child it is a really bad idea. If it is a last resort then by all means once a child is safe and cared for but what if an emergency came in and that nurse had to leave the child who needs proper care and attention. This is another area that needs to be addressed as quickly as the mental health services.

Slutmonkey57b wrote: »

With the decision by the HSE to effectively close many Dublin a&e departments in favour of the big ones Vincent's, Blanch, etc, this has led to a situation where effectively there is one a&e for the whole of South Dublin, Wicklow, Wexford; all of whose population now has to funnel into the country's busiest a&e, with 4 triage bays, and an a&e ward full of pensioners with chronic conditions or fall injuries who could (and should) have facilities better suited for their long term needs elsewhere, meaning there are no beds in either a&e or inpatient wards for "unpredictable" cases that a&e are there to treat.

In retrospect, would you characterise this decision as stupid, moronically stupid, or farcically stupid?

Why not turn loughlinstown into a specialist hospital for the elderly, given that it's already equipped?

Hi Slutmonkey57b. In my honest opinion I think it is ridiculously stupid closing all these departments and I completely agree that a hospital like Loughlinstown should be used for something like what you mentioned or even opening up a place that takes care of all elective surgeries... To me these solutions would lead to more acute beds being available! It seems simple really

miamee wrote: »

Do you ever do practice runs in the hospital or in your specific department for major incidents? Like say, for example, something like happened in Paris happened here or a large car pile up or train crash or something with large numbers of patients all needing treatment at the same time - would the hospital and staff be ready to deal with that type of thing?

It sounds like a very satisfying but difficult job, I don't think I could do it but I have great admiration for those of you who do!

Hi miamee, Every hospital has a major incident plan and all staff are aware of it (I hope :P) I honestly think the department I work in would get through a major incident as difficult as it would be.... but I am biased I guess :o

faceman wrote: »

Hello friendly neighbourhood Emergencey Dept Nurse! I respectably say, I don't envy your job, I'm terrified of hospitals. The smells, the systems, the sense of unknown when you're there. I can never wait to leave when visiting someone. To work there everyday, does that ever desensitise your humanity? Not to inquiries but to the plight of patients and their families? Asked with respect of course.

My other question is this. I've never worked in healthcare or the public service so perhaps this question is naive. Every time I hear of the health system running out of funds or needing more funds, it always troubles me. Do you feel resources are used in an efficient manner? If not, how much of that is the problem of the government or senior civil servants, or lack of flexibility in relation to work changes and improvements on the parts of unions? Do you think unions take into account patient needs when fighting for medical staff's employment conditions?

Final questions. Do you watch hospital dramas on TV? 

Hi faceman. That is actually a really difficult question that has me thinking about how I really feel. My hubby thinks I am desensitised to an extent.... I don't believe I am. I have always been a sensitive person and I think I have become more aware and sensitive towards people in recent years. However, I am not too sympathetic towards people who complain about things like when they have a flu or even something slightly more serious as I have seen so many really bad situations over the years and I get annoyed with them for complaining about something that I believe is so trivial. If i hear about somebody dying that has been sick for a while I see it as a good thing that they are out of their misery and pain whereas other people are so upset and sad.... this is where the hubby thinks I am desensitised. I also think the fact that I enjoy a good trauma call is weird and probably means I am quite desensitised :eek::o

I think a lot of money is spent on stupid things in the health service that could be used elsewhere. Why does a hospital need a fancy ornament or fancy paintings that cost thousands... I understand that this is for the patients benefit too but why not get a load of cheap prints that still look nice and spend those thousands on better equipment or new centers that will mean patients can be seen quicker without having to queue for hours to be seen or weeks/months/years for a simple procedure.... I don't know if that actually answered your question at all or if it just led me into a rant I hope unions take patients needs into account but I don't think the unions can actually do much with the governments we have had over the past number of years!!!

And yes I do LOVE 24 hours in A&E (which I often sit and cry watching) and other hospital programmes which the hubby cannot understand for the life of him!!

I'm an Emergency Dept nurse, AMA

Galwayguy35 wrote: »

In recent years have you seen an increase in men choosing nursing as a career?

Honestly Galwayguy35, no Although one thing I have noticed is there are a lot of men in senior nursing roles who are incredibly knowledgeable and great role models. Its a pity because men really seem to do great in nursing!

Odus fell down wrote: »

Do you think there should be more options for people who need to see a doctor out of hours? Should there be better availability of minor injury clinics with long opening hours around the country to ease pressure on A&E?

Hi Odus fell down. Yes I totally agree that if there were minor injury clinics and GP surgeries with long opening hours or weekend clinics then this would take a massive amount of pressure of emergency departments around the country especially on a Monday. Mondays are busy.... people wait all weekend and get sicker and sicker and end up needing a hospital visit whereas if they were seen maybe on a Saturday or Sunday this could be avoided. I wish this was trailed somewhere to see if it actually made a difference.... I honestly believe it would.

Neverforgotten wrote: »

Are a&e nurses trained in how to handle situations like mental health crisis? I have been handled differently by staff and wonder is there any training provided.

Also, I wouldn't be here if it wasn't for the a&e staff and paramedics so am really grateful for your job and I don't envy it at all.

Hi Neverforgotten. I am glad to hear you are still here with us thanks you some good people and well done to you too I think every one receives some amount of training but I think a lot of it is learning on the job and even then I think some people are suited to dealing with a mental health crises more than others which training unfortunately wouldn't help

sunbeam

Dubl07, Yes I think it is irritating that this is the case but I can honestly say if anyone needs urgent care then they will still always be looked after in any public hospital. Plus from having experience in both the public and private hospitals I know that I would choose a public over a private hospital any day as in my opinion (and I stress it is my opinion) I believe the care is better. Yes if you pay you can go have a CT/MRI or whatever on the same day but as far as I am concerned if you urgently need a CT or whatever other tests they will be done in a public hospital as quick.
I do think that busy emergency departments do put people off though.... I can fully understand that and really don't blame someone for attending a private emergency department for that reason alone.

So are you or would you be willing to rely solely on the public system for your own care and not take out health insurance?

Also, how do you feel about patients with mental health issues being told that A&E should be their first port of call in any mental health crisis? I was repeatedly told this by a former member of my CMHT even though I informed them that my GPs had reassured me that my first point of contact should be with whichever of them was on call. GPs are three miles away. My nearest emergency room is over 40. I do not drive and was told by the same former CMHT member that I should call out an ambulance-most likely from the far side of the county-to get me there.

bob50

Hi ED Nurse
Your posts are brilliant may i ask you I have a chronic illness called broncheastis Any needed to go A&E depts a few times this year with flare ups and some depts were great in getting me fixed up with nebs & steroid injections to get breathing under control. But my local hosp just left me waiting in waiting room for 8 hrs before i was seen by a doc, who ordered up bloods & cxr I know you said earlier the triage in some places that A&E depts can do blood tests and have that info ready for doc when your see the doc But can all triage nurses not do this ?

Another question do you think it would help if there was a drying out centre in the hosp for people may be drunk and all they need is to sleep it off ? i know they might be sick as well maybe a rapid injury clinic funded by the HSE would ease your workload

Many thanks

Rob

Gloomtastic!

Hi bleary. I really don't think the quality of doctors has suffered at all from an emergency department point of view. The high majority of doctors I come into contact with are amazing in my opinion but then I think you have to be to be an ED doctor. I do think that there will always be some doctors who really don't have a clue and who you stand back and actually think that they bought their qualification without going to any college at all.... I think that has always been the case but I really don't come across many of them in recent years.

So you have worked with Doctors who may have bought their qualifications. Can you give us more details please? How long before they were sussed, were patients put at serious risk, have you ever refused to carry out a doctor's instructions?

easygoing1982

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

And yes I do LOVE 24 hours in A&E (which I often sit and cry watching) and other hospital programmes which the hubby cannot understand for the life of him!!

Does your A&E have a red phone?:o

Would a trauma call go the same way in an irish hospital as it does on the programme.

Gloomtastic! wrote: »

So you have worked with Doctors who may have bought their qualifications. Can you give us more details please? How long before they were sussed, were patients put at serious risk, have you ever refused to carry out a doctor's instructions?

:rolleyes:

I'm an Emergency Dept nurse, AMA

sunbeam wrote: »

So are you or would you be willing to rely solely on the public system for your own care and not take out health insurance?

Also, how do you feel about patients with mental health issues being told that A&E should be their first port of call in any mental health crisis? I was repeatedly told this by a former member of my CMHT even though I informed them that my GPs had reassured me that my first point of contact should be with whichever of them was on call. GPs are three miles away. My nearest emergency room is over 40. I do not drive and was told by the same former CMHT member that I should call out an ambulance-most likely from the far side of the county-to get me there.

Hi Sunbeam. Yes I fully rely on the public system and kinda refuse to pay health insurance. I think private hospitals over charge for literally every test you have done not to mention the tests that are done that don't necessarily need to be done. I think that if you save a bit of money aside for a rainy day that this could pay for a scan or a private consultants appointment if you want them quicker. I won't deny that private health insurance is great if you need a quick elective procedure or if you need a quick test or if you like a private room (never guaranteed though) I still maintain though that once you are sick and in need of this care any public hospital will sort you in no time.
I suppose if you really thought that you were at risk of harming yourself or others then you should always call an ambulance... At least then you will have the knowledge that they are on their way. But seeing as your GP would be 3 miles away I don't know why this wouldn't be your first port of call. At least they could refer you into an emergency department or perhaps even prescribe you something you may need. I really think there need to be specialist mental health emergency care throughout the country where people can present instead of to an emergency department which may make their crises worse.

bob50 wrote: »

Hi ED Nurse
Your posts are brilliant may i ask you I have a chronic illness called broncheastis Any needed to go A&E depts a few times this year with flare ups and some depts were great in getting me fixed up with nebs & steroid injections to get breathing under control. But my local hosp just left me waiting in waiting room for 8 hrs before i was seen by a doc, who ordered up bloods & cxr I know you said earlier the triage in some places that A&E depts can do blood tests and have that info ready for doc when your see the doc But can all triage nurses not do this ?

Another question do you think it would help if there was a drying out centre in the hosp for people may be drunk and all they need is to sleep it off ? i know they might be sick as well maybe a rapid injury clinic funded by the HSE would ease your workload

Many thanks

Rob

Hi Bob50. Yes I would say that all triage nurses are able to do bloods but I think we cannot always get them done due to what is happening behind those triage doors. You may be trying to get through 10 other people for triage which unfortunately leaves no time for doing bloods.
They do have drying out centers in the UK but I really don't know. People come in so sick when they are so intoxicated that you would still need doctors and nurses to run the place i'd imagine. I don't think they would work here to be honest. It would be great but I just think it would lead to a whole load of other problems.

Gloomtastic! wrote: »

So you have worked with Doctors who may have bought their qualifications. Can you give us more details please? How long before they were sussed, were patients put at serious risk, have you ever refused to carry out a doctor's instructions?

Hahaha Gloomtastic, I definitely do not think I have actually ever worked with anyone who has bought their qualification, I just said that sometimes you'd wonder but not in a serious way. There have often been times where I have questioned a doctors orders yes and I have refused the odd time but this is always talked through with that doctor or their team. All doctors have different approaches to different situations. This is the same as any other job. I think the Irish health service is very very lucky from my experience with the majority of doctors.

easygoing1982 wrote: »

Does your A&E have a red phone?:o

Would a trauma call go the same way in an irish hospital as it does on the programme.

:rolleyes:

Hi easygoing 1982. Yes all the hospitals have a pre alert phone that either the HSE or the Dublin fire brigade can phone to pre alert. You always get a little rush of adrenaline when the phone goes. The calls could range from a cardiac arrest to a patient with sepsis to a patient who has been crushed by equipment.
The centers that see a high volume of trauma calls would work much smoother than hospitals that wouldn't. Once you have enough of a pre alert, teams are available and waiting on the patient and everything is ready to go!

max life

I have spent a few weeks in hospital in the last couple of years. I was in a ward with 5 other men ( mostly in their 70s ). The nurses would come around and check blood pressure, temperature etc. A couple of the guys would scream and roar at the nurses and totally verbally abuse them. However, when the nurse would go to the next bed, she would be totally calm and friendly. How do ye not let that get to you? I have nothing but admiration and huge respect for all nurses and doctors. Its crazy when you see how much politicians earn, in comparison with nurses.

I'm an Emergency Dept nurse, AMA

max life wrote: »

I have spent a few weeks in hospital in the last couple of years. I was in a ward with 5 other men ( mostly in their 70s ). The nurses would come around and check blood pressure, temperature etc. A couple of the guys would scream and roar at the nurses and totally verbally abuse them. However, when the nurse would go to the next bed, she would be totally calm and friendly. How do ye not let that get to you? I have nothing but admiration and huge respect for all nurses and doctors. Its crazy when you see how much politicians earn, in comparison with nurses.

Hi max life. Sometimes it gets to you but usually I end up laughing after I get abuse thrown at me. People will always be grumpy with you as a nurse. Some people honestly don't seem to realise that you are only there to help them and sometimes you'd also rather be anywhere else but there But I really do find it funny most of the time which is probably a bad thing

Dubwat

Great thread!

Has being a nurse/health professional changed your outlook on life? You've seen that people can die from 101 different things and, often, quite randomly from things like car accidents? Do you lead a healthy lifestyle or do you take a 'devil may care' attitude because you're seen how people can die from almost anything?

TG1

Do you think there's an issue around patients being brought to the wrong emergency departments? To clarify, my experience recently involved a lovely ambulance man arguing with the control centre 3 times before they agreed that based on his assessment of my injuries he should bring me to a hospital further away but better equipped for dealing with my injury, rather than bringing me to the closest hospital. I was told afterwards that this saved me one whole day of sitting in a hospital only to be assessed and transported to the bigger center anyway. I was talking to another patient afterwards who had been transported to the hospital I was in after a full 24 hours in a&e in her local hospital, so it seems to be correct!
Is this something that happens regularly and do you think finding a better comprise between getting to a hospital asap and getting to the right hospital would make the process more efficiant for patients and nurses/doctors etc.?

Brussels Sprout

Do nurses in general find it irritating that they often are referred to in the same breath as teachers in the media when it comes to listing the conditions for public sector workers?

As far as I can see nurses have it way worse in terms of hours, holidays, danger, stress, shift-work, working environment, regular breaks, pay etc etc

newwan

If the department gets very busy and you cant do bloods etc who does them then? And is that person not equally as busy?

CameraBag

What is your opinion of the relationship between emergency departments and nursing / medical students? Should they play a large role, or are emergency departments too hectic to provide extensive training?

Stheno

I recently had to go to Beaumont as I had severe chest pains.

I was seen by a nurse, who did an ECG, checked it with a doctor (within half an hour of arriving) and told me it was unlikely I was having heart problems, but that I needed a blood test and would have to wait up to four hours to have the blood test and then wait for the result.

That doesn't fit with what you are saying about nurses taking bloods.

I left after being told it was unlikely I was having a heart issue, and it subsequently turned out to be true.
If a nurse had been able to take the bloods and order the test I would have stayed within reason, it was after 6pm, and I'm bemused from your posts as to how the system seems so different in different hospitals.

Were it before 6pm I could have gone to numerous private a and es and had the test done, which I would have if I'd the choice.

Instead as it was outside 9-6, I'd the choice to clog up an Ed as a patient waiting for a test that probably takes minutes, and adding to waiting lists.

I got no explanation as to why I'd to wait for a doctor to draw blood, and send it off and it was incredibly frustrating.

I'd be of the opinion following that experience that a root and branch review of a and e and how it operates here is required, that there should be a minors clinic available to deal with such issues as I had, and then the major trauma area.

Do you think this would work?

I'm an Emergency Dept nurse, AMA

Dubwat wrote: »

Great thread!

Has being a nurse/health professional changed your outlook on life? You've seen that people can die from 101 different things and, often, quite randomly from things like car accidents? Do you lead a healthy lifestyle or do you take a 'devil may care' attitude because you're seen how people can die from almost anything?

Hi Dubwat, I don't lead a healthy lifestyle at all really.... i wish I did but I don't. Unfortuately I do see healthy people coming in dead and dying as much as the people who totally abuse their bodies. I have become a more anxious person since I have been an emergency nurse as I see how fragile life can be.

TG1 wrote: »

Do you think there's an issue around patients being brought to the wrong emergency departments? To clarify, my experience recently involved a lovely ambulance man arguing with the control centre 3 times before they agreed that based on his assessment of my injuries he should bring me to a hospital further away but better equipped for dealing with my injury, rather than bringing me to the closest hospital. I was told afterwards that this saved me one whole day of sitting in a hospital only to be assessed and transported to the bigger center anyway. I was talking to another patient afterwards who had been transported to the hospital I was in after a full 24 hours in a&e in her local hospital, so it seems to be correct!
Is this something that happens regularly and do you think finding a better comprise between getting to a hospital asap and getting to the right hospital would make the process more efficiant for patients and nurses/doctors etc.?

Hi TGI, Yes I guess this is an issue in all emergency departments for a few reasons. For starters people begin to avoid their own catchment area emergency department and go to others which then puts more pressure on the emergency department that they attend. Patients tend to do this to avoid a department that they think is not suitable for their needs or a department that they do not trust. The other thing which you did point out is that some departments are not equipped to deal with certain things and these patients need to be moved on. This is sometimes due to closure and degrading of departments which I do not agree with.
A patient will also generally have some time to wait because a bed or procedure in another hospital takes time to be organised.

Brussels Sprout wrote: »

Do nurses in general find it irritating that they often are referred to in the same breath as teachers in the media when it comes to listing the conditions for public sector workers?

As far as I can see nurses have it way worse in terms of hours, holidays, danger, stress, shift-work, working environment, regular breaks, pay etc etc

Hi Brussels Sprout. I can't speak for everyone but I know this does pi$s me off to some extent. I would love the holidays teachers get for starters. I do think that teachers do an incredibly important job but I am honestly jealous of all my teacher friends. Yes they have stressful jobs but I honestly don't think they are anywhere near one another in terms of stress but that is my own opinion. I also get jealous when I see the gifts they get at Christmas or at the end of the year and nurses struggle to just get a thank you even after saving someones life.

I'm an Emergency Dept nurse, AMA

newwan wrote: »

If the department gets very busy and you cant do bloods etc who does them then? And is that person not equally as busy?

Hi Newwan. The patient has bloods done by the doctor when they are seen to. It is generally up to the nurses to do bloods if they can. If they can't then unfortunately that patient has to wait until they are seen.

CameraBag wrote: »

What is your opinion of the relationship between emergency departments and nursing / medical students? Should they play a large role, or are emergency departments too hectic to provide extensive training?

Hi CameraBag. I think emergency departments can be an excellent place to learn but I think you hit the nail on the head by asking if it is just too hectic an environment. I love teaching students but sometimes you are just too busy ensuring your patient is well looked after and this sometimes means that unfortunately your teaching slacks. I feel sorry for some students who genuinely appear lost when they have no-one showing them or telling them what to do as sometimes you are involved in an emergency and they are left standing.

Stheno wrote: »

I recently had to go to Beaumont as I had severe chest pains.

I was seen by a nurse, who did an ECG, checked it with a doctor (within half an hour of arriving) and told me it was unlikely I was having heart problems, but that I needed a blood test and would have to wait up to four hours to have the blood test and then wait for the result.

That doesn't fit with what you are saying about nurses taking bloods.

I left after being told it was unlikely I was having a heart issue, and it subsequently turned out to be true.
If a nurse had been able to take the bloods and order the test I would have stayed within reason, it was after 6pm, and I'm bemused from your posts as to how the system seems so different in different hospitals.

Were it before 6pm I could have gone to numerous private a and es and had the test done, which I would have if I'd the choice.

Instead as it was outside 9-6, I'd the choice to clog up an Ed as a patient waiting for a test that probably takes minutes, and adding to waiting lists.

I got no explanation as to why I'd to wait for a doctor to draw blood, and send it off and it was incredibly frustrating.

I'd be of the opinion following that experience that a root and branch review of a and e and how it operates here is required, that there should be a minors clinic available to deal with such issues as I had, and then the major trauma area.

Do you think this would work?

Hi Stheno, I do not understand why you are so bemused. Every hospital is different. I don't know why it would be difficult to understand that every emergency department is different too. I am sorry that you would have had to wait for these bloods to be done. Did you ask why you had to wait? This nurse may not have had her venepunture course done. She may have been too busy trying to get other patients triaged and may not have had time to do your bloods. I know nurses in Beaumont can take and order bloods but maybe there were other factors behind why they couldn't do yours.
No chest pain patients would ever go to a minors clinic. That completely undermines what a minors department is for. Chest pain is not a minor condition.
Many hospitals do have a minors clinic but this is for minor injuries only.
Hopefully all emergency departments will become standardised at some stage. I cannot see this happening anytime soon though.

diomed

I was released from hospital a few days ago. When I reached A&E a week earlier I waited my turn, but as I got to the top of the queue my arms and legs started shaking. A quick triage and I was getting drips, antibiotics, blood taken. After a night in A&E I was upstairs in a bed. It was blood tests, drugs to suit, and in a day or two I was recovering.

They are dealing with many medical situations and different patient personalities yet they keep going.

One patient beside me wanted to leave although there was a high probability of a heart attack.
Another started their story six months ago and related everything that happened to them (none of it medical) until finally in one sentence they said why they were in A&E.

A big thumbs up to A&E staff. It must be one of the most stressful jobs ever.

brianc123

Hi,

Very interesting thread,

Over the last couple of years I’ve had a couple of trips to a&e with an accident.
This caused an open fracture and subsequent post op infection. The standard of care was and continues to be fantastic in what are obviously challenging and difficult working conditions.

I am and will continue to be in awe of the work done by all health care professionals but in particular nurses Thank You.

I do have a question:

How difficult is triage? What are the challenges in getting a sick and worried person to articulate their problem in a way that makes sense to a nurse/doctor?

Thank for taking the time to do the AMA

devnull

The standard of care for me really depends on the doctor, over the last 10 years I've been in A&E a few times and over that time I've seen a whole spectrum of standards and attitudes.

EG: Once I was in the Mater a couple of years ago, and had an issue for which I was refereed to them by my GP. After waiting ages the first doctor, a registrar was very rude, smirking and laughing and did not take the situation seriously and even wrote some things in my notes that were not true since he couldn't be bothered to do some of the things he should have and clearly was arrogant and thought he could guess at the diagnosis without needing to do any tests.

A few days later my symptoms got worse and my GP told me to go back and make sure they did the relevant tests. That day I got an intern, who was the complete opposite of the rude doctor who would not allow me to speak. She listened, didn't interrupt, organised the relevant exams with minimal fuss and showed an interest and she asked me was x&y already done and examined and was I asked about it, by the previous doctor, it wasn't, but he said he had done it.

At that point I was given some drugs for my issue, the consultant came around to speak to me since the intern took my report and her findings and told him certain things were not done, who apologised to me on behalf of the other doctor, arranged an urgent appointment with a specialist and the intern then wrote me a detailed letter for my workplace (who were annoyed it cost me so many days when it should have been diagnosed first time around), and was amazing.

PS: Nurses in Beaumont can certainly take blood, I saw it happen there, I once was rushed there with a possible blled on the brain and when I was laying in the ED for a little while I saw nurses taking lots of bloods.

My experience in Beaumont is if you are having possibly a serious or life threatening condition, the care is top notch, can't speak for more minor things, but the care I got from the Lead Consultant was great, she took full ownership of my issue and was very respectful. Thankfully it was a false alarm, but for a while it looked grim.

I'm an Emergency Dept nurse, AMA

diomed wrote: »

I was released from hospital a few days ago. When I reached A&E a week earlier I waited my turn, but as I got to the top of the queue my arms and legs started shaking. A quick triage and I was getting drips, antibiotics, blood taken. After a night in A&E I was upstairs in a bed. It was blood tests, drugs to suit, and in a day or two I was recovering.

They are dealing with many medical situations and different patient personalities yet they keep going.

One patient beside me wanted to leave although there was a high probability of a heart attack.
Another started their story six months ago and related everything that happened to them (none of it medical) until finally in one sentence they said why they were in A&E.

A big thumbs up to A&E staff. It must be one of the most stressful jobs ever.

Hi Diomed. Its great to hear you had a positive experience. And thank you for the thumbs up

brianc123 wrote: »

Hi,

Very interesting thread,

Over the last couple of years I’ve had a couple of trips to a&e with an accident.
This caused an open fracture and subsequent post op infection. The standard of care was and continues to be fantastic in what are obviously challenging and difficult working conditions.

I am and will continue to be in awe of the work done by all health care professionals but in particular nurses Thank You.

I do have a question:

How difficult is triage? What are the challenges in getting a sick and worried person to articulate their problem in a way that makes sense to a nurse/doctor?

Thank for taking the time to do the AMA

Hi brianc123. First of all thank you Triage is really quite difficult. It is your responsibility to ensure that a patient is seen to in the appropriate order. If I triage someone wrong or miss something important that means they are put in a triage category below what they should then they may deteriorate before they are seen. It is also my responsibility to get that patient started on treatments if I think they need them or even to make sure they are put into the right area in the department.
It is very difficult sometimes to actually figure out exactly what is wrong with a patient.... Sometimes a patient is actually unable to explain what is wrong with them and this leads to tonnes of questions to try and figure out what we are even looking for. Actually one of the most difficult types of patient to figure out what is wrong is an older person. They may have had a fall 2 days earlier and have a broken arm or hip but it is as if they are unable to feel pain and they most certainly cannot describe it. Some 90+ year olds will say they have a stinging sensation to their leg whereas a 50 year old would be screaming. It is one of the most difficult scenarios we deal with as these patients just cannot articulate what is going on with them and we may miss something because of that!

devnull wrote: »

The standard of care for me really depends on the doctor, over the last 10 years I've been in A&E a few times and over that time I've seen a whole spectrum of standards and attitudes.

EG: Once I was in the Mater a couple of years ago, and had an issue for which I was refereed to them by my GP. After waiting ages the first doctor, a registrar was very rude, smirking and laughing and did not take the situation seriously and even wrote some things in my notes that were not true since he couldn't be bothered to do some of the things he should have and clearly was arrogant and thought he could guess at the diagnosis without needing to do any tests.

A few days later my symptoms got worse and my GP told me to go back and make sure they did the relevant tests. That day I got an intern, who was the complete opposite of the rude doctor who would not allow me to speak. She listened, didn't interrupt, organised the relevant exams with minimal fuss and showed an interest and she asked me was x&y already done and examined and was I asked about it, by the previous doctor, it wasn't, but he said he had done it.

At that point I was given some drugs for my issue, the consultant came around to speak to me since the intern took my report and her findings and told him certain things were not done, who apologised to me on behalf of the other doctor, arranged an urgent appointment with a specialist and the intern then wrote me a detailed letter for my workplace (who were annoyed it cost me so many days when it should have been diagnosed first time around), and was amazing.

PS: Nurses in Beaumont can certainly take blood, I saw it happen there, I once was rushed there with a possible blled on the brain and when I was laying in the ED for a little while I saw nurses taking lots of bloods.

My experience in Beaumont is if you are having possibly a serious or life threatening condition, the care is top notch, can't speak for more minor things, but the care I got from the Lead Consultant was great, she took full ownership of my issue and was very respectful. Thankfully it was a false alarm, but for a while it looked grim.

Hi devnull, You are correct. Standards differ between hospitals, doctors and nurses.... It is just how patients completely differ too. Not everyone can be the same and unfortunately people don't sometimes get that this is just a way of life.... Its a pain in the arse for us too :P

JellieBabie

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

Hi Brussels Sprout. I can't speak for everyone but I know this does pi$s me off to some extent. I would love the holidays teachers get for starters. I do think that teachers do an incredibly important job but I am honestly jealous of all my teacher friends. Yes they have stressful jobs but I honestly don't think they are anywhere near one another in terms of stress but that is my own opinion. I also get jealous when I see the gifts they get at Christmas or at the end of the year and nurses struggle to just get a thank you even after saving someones life.

To be fair, unless you've worked as a teacher I think it a bit unfair to state their jobs are nowhere near as stressful. I often hear of people complaining about teachers' cushy holidays and lifestyle but if push came to shove the same people would quake in their boots at the thought of standing up in front of thirty teenagers and not only managing their behaviour but also trying to get them to learn. Anyway I digress!

Regarding your ideas on private vs public healthcare I have to agree that the standard seems better in the public hospitals, but I once needed very serious surgery and was put on a waiting list. I managed to get it done much faster by going privately (to the same surgeon I might add - he worked in both a private and public capacity) and would have been waiting a ridiculous amount of time for what was actually classified as emergency surgery had I stayed public.

I've had lots of experience in hospitals and what always frustrates me is that some nurses are extremely thorough in hand hygiene when going at my line but then others will bandage a wound on another patient, won't bother washing their hands or putting on gloves and will go at my line. I am always too intimidated to say anything though and I suppose I'd be concerned the nurse would dislike me then and I'd receive inferior care as a result. What do you make of this?

I'm a very quiet and cooperative patient and I actually feel sometimes I'm neglected or forgotten about to an extent as a result. I was very seriously ill once and because I was quiet I was ignored in my ward for a long time while the ward nurse sat comforting a girl who was crying and sobbing but had much less wrong with her than me. Have you ever noticed this pattern, whereby he who shouts loudest gets better or more efficient care than the quieter person in the corner?

Would you ever postpone giving life saving medicine in order to make it fit in with the schedule of the ward nurses' medicine rounds? Again another time I was in hospital and almost died, a doctor prescribed me emergency medicine at eleven o' clock. I hadn't received it by five and the doctor was utterly shocked on his return. The nurse hadn't given it to me because it didn't fit the schedule or something along those lines.

All in all, I think nurses are great and do an amazing job.

Regarding newly qualified nurses and their pay, would you support them with a restoration to the old pay scale if it meant a reduction in your own allowances?

Neverforgotten

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

Hi Neverforgotten. I am glad to hear you are still here with us thanks you some good people and well done to you too I think every one receives some amount of training but I think a lot of it is learning on the job and even then I think some people are suited to dealing with a mental health crises more than others which training unfortunately wouldn't help

I lucky to be alive over my impulsivity

I agree. Thing is, if you are treated a certain way in a crisis, it can make things worse. I agree with separate mental health urgent care centres being introduced..

I'm an Emergency Dept nurse, AMA

JellieBabie wrote: »

To be fair, unless you've worked as a teacher I think it a bit unfair to state their jobs are nowhere near as stressful. I often hear of people complaining about teachers' cushy holidays and lifestyle but if push came to shove the same people would quake in their boots at the thought of standing up in front of thirty teenagers and not only managing their behaviour but also trying to get them to learn. Anyway I digress!

Regarding your ideas on private vs public healthcare I have to agree that the standard seems better in the public hospitals, but I once needed very serious surgery and was put on a waiting list. I managed to get it done much faster by going privately (to the same surgeon I might add - he worked in both a private and public capacity) and would have been waiting a ridiculous amount of time for what was actually classified as emergency surgery had I stayed public.

I've had lots of experience in hospitals and what always frustrates me is that some nurses are extremely thorough in hand hygiene when going at my line but then others will bandage a wound on another patient, won't bother washing their hands or putting on gloves and will go at my line. I am always too intimidated to say anything though and I suppose I'd be concerned the nurse would dislike me then and I'd receive inferior care as a result. What do you make of this?

I'm a very quiet and cooperative patient and I actually feel sometimes I'm neglected or forgotten about to an extent as a result. I was very seriously ill once and because I was quiet I was ignored in my ward for a long time while the ward nurse sat comforting a girl who was crying and sobbing but had much less wrong with her than me. Have you ever noticed this pattern, whereby he who shouts loudest gets better or more efficient care than the quieter person in the corner?

Would you ever postpone giving life saving medicine in order to make it fit in with the schedule of the ward nurses' medicine rounds? Again another time I was in hospital and almost died, a doctor prescribed me emergency medicine at eleven o' clock. I hadn't received it by five and the doctor was utterly shocked on his return. The nurse hadn't given it to me because it didn't fit the schedule or something along those lines.

All in all, I think nurses are great and do an amazing job.

Regarding newly qualified nurses and their pay, would you support them with a restoration to the old pay scale if it meant a reduction in your own allowances?

Hi JellieBabie, I do totally agree with you that unless someone has done teaching that they cannot compare but from speaking to friends and family who teach between primary, secondary and universities I still think that the stress is completely different and that having someones life in your hands and dealing with sick and dying people in my opinion is much more stressful no matter what way you look at it. 2 of my best friends are teachers and they both agree with this. I do have great respect for teachers as they are the ones we task with teaching our children and I really do not deny for a minute that it is stressful... just not the same.

I also agree with you about getting procedures done quicker. It is beneficial having private insurance in this instance.

Hand washing is something you should never feel bad about bringing up. If a nurse treats you differently after then it is probably embarrassment on their behalf. I have been asked to wash my hands before between doing obs even though I had used alcohol hand gel... I put this down to that patient simply not being aware that alcohol hand gel is another means of cleaning hands but on that occasion I decided it wasn't worth an argument so just went and washed my hands. It left me feeling a little embarrassed even though I was not in the wrong at all and I had cleaned my hands.

Unfortunately JellieBabie I do agree re those that shout the loudest and to be honest it is something that I do not agree with. I try and have great time for all my patients and sometimes I do think people need to be a little more vocal to get what they need but only when done in the right context. If someone starts screaming and shouting that they need to be seen for their sprained ankle but I have a cardiac arrest on its way in or a septic patient then I am more than happy to tell that patient they need to wait. One thing I have noticed is it is always the sickest people who don't complain especially when they need to whereas I do notice a lot of people who complain about waiting 2 hours are the people who could have easily gone to their GP.

In an emergency department there is no set medication schedule really. All life saving medications are given when they are charted generally. Sometimes something may be delayed but usually due to time constraints and priorities for other patients.

I do think newly qualified nurses deserve more pay. As far as I my pay is concerned if i knew a deduction was to be taken to go solely towards their pay then yes I think I would happily do this. I do think their pay could be restored by other means but I would accept it if some of my wages were taken towards their pay.

Neverforgotten wrote: »

I lucky to be alive over my impulsivity

I agree. Thing is, if you are treated a certain way in a crisis, it can make things worse. I agree with separate mental health urgent care centres being introduced..

You are right Neverforgotten, It can make things worse for sure! Hopefully someone in those high up places will get around to opening these types of centers sometime eh?!!

JellieBabie

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

Hi JellieBabie, I do totally agree with you that unless someone has done teaching that they cannot compare but from speaking to friends and family who teach between primary, secondary and universities I still think that the stress is completely different and that having someones life in your hands and dealing with sick and dying people in my opinion is much more stressful no matter what way you look at it. 2 of my best friends are teachers and they both agree with this. I do have great respect for teachers as they are the ones we task with teaching our children and I really do not deny for a minute that it is stressful... just not the same.

I also agree with you about getting procedures done quicker. It is beneficial having private insurance in this instance.

Hand washing is something you should never feel bad about bringing up. If a nurse treats you differently after then it is probably embarrassment on their behalf. I have been asked to wash my hands before between doing obs even though I had used alcohol hand gel... I put this down to that patient simply not being aware that alcohol hand gel is another means of cleaning hands but on that occasion I decided it wasn't worth an argument so just went and washed my hands. It left me feeling a little embarrassed even though I was not in the wrong at all and I had cleaned my hands.

Unfortunately JellieBabie I do agree re those that shout the loudest and to be honest it is something that I do not agree with. I try and have great time for all my patients and sometimes I do think people need to be a little more vocal to get what they need but only when done in the right context. If someone starts screaming and shouting that they need to be seen for their sprained ankle but I have a cardiac arrest on its way in or a septic patient then I am more than happy to tell that patient they need to wait. One thing I have noticed is it is always the sickest people who don't complain especially when they need to whereas I do notice a lot of people who complain about waiting 2 hours are the people who could have easily gone to their GP.

In an emergency department there is no set medication schedule really. All life saving medications are given when they are charted generally. Sometimes something may be delayed but usually due to time constraints and priorities for other patients.

I do think newly qualified nurses deserve more pay. As far as I my pay is concerned if i knew a deduction was to be taken to go solely towards their pay then yes I think I would happily do this. I do think their pay could be restored by other means but I would accept it if some of my wages were taken towards their pay.



You are right Neverforgotten, It can make things worse for sure! Hopefully someone in those high up places will get around to opening these types of centers sometime eh?!!

Really appreciate you taking the time to answer my rather long post! Very informative answers! Just would like to say that I appreciate the tough job you have and I feel nurses are totally underestimated and underappreciated in general.

Redser87

Thanks for the thread so far. The work you do is so important, so thank you.
I'm surprised to read that you don't get thank yous and gifts from patients as a friend of mine is a nurse and she is always complaining that she can't stay away from the chocolates they are given in work! If a box of chocolates or biscuits arrived as a thank you to the nurses' station in your hospital, would they be enjoyed or are you just too busy for that?

I'm an Emergency Dept nurse, AMA

Redser87 wrote: »

Thanks for the thread so far. The work you do is so important, so thank you.
I'm surprised to read that you don't get thank yous and gifts from patients as a friend of mine is a nurse and she is always complaining that she can't stay away from the chocolates they are given in work! If a box of chocolates or biscuits arrived as a thank you to the nurses' station in your hospital, would they be enjoyed or are you just too busy for that?

We do get chocolates the odd time and it is actually funny how excited we get when a box is opened at the nursing station. They are gone in minutes as we tend to grab and go!!! Years ago when I worked on the wards we always had chocolates. I think when a patient gets admitted they go to the ward and tend to buy the wards a box of chocolates or biscuits as a thank you! :P Its amazing when someone comes back with a card or even writes in a letter to say thank you.... its amazing how much it means to us and in particular myself as I am a little bit of a sap like that

doireannod

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

Hi Newwan. The patient has bloods done by the doctor when they are seen to. It is generally up to the nurses to do bloods if they can. If they can't then unfortunately that patient has to wait until they are seen.



Hi CameraBag. I think emergency departments can be an excellent place to learn but I think you hit the nail on the head by asking if it is just too hectic an environment. I love teaching students but sometimes you are just too busy ensuring your patient is well looked after and this sometimes means that unfortunately your teaching slacks. I feel sorry for some students who genuinely appear lost when they have no-one showing them or telling them what to do as sometimes you are involved in an emergency and they are left standing.



Hi Stheno, I do not understand why you are so bemused. Every hospital is different. I don't know why it would be difficult to understand that every emergency department is different too. I am sorry that you would have had to wait for these bloods to be done. Did you ask why you had to wait? This nurse may not have had her venepunture course done. She may have been too busy trying to get other patients triaged and may not have had time to do your bloods. I know nurses in Beaumont can take and order bloods but maybe there were other factors behind why they couldn't do yours.
No chest pain patients would ever go to a minors clinic. That completely undermines what a minors department is for. Chest pain is not a minor condition.
Many hospitals do have a minors clinic but this is for minor injuries only.
Hopefully all emergency departments will become standardised at some stage. I cannot see this happening anytime soon though.

I don't understand how nurses can say that they are too busy to take bloods from a patient. What if the doctor then says that they are too busy to take bloods? The doctors don't seem to have this luxury.

Dozen Wicked Words

doireannod wrote: »

I don't understand how nurses can say that they are too busy to take bloods from a patient. What if the doctor then says that they are too busy to take bloods? The doctors don't seem to have this luxury.

Some nurses can't take bloods, nothing to do with being too busy or choosing not to take them.


Anyway my questions. What is the ratio of CNM to staff nurse in your department? Do you think you have adequate staffing?

I'm an Emergency Dept nurse, AMA

doireannod wrote: »

I don't understand how nurses can say that they are too busy to take bloods from a patient. What if the doctor then says that they are too busy to take bloods? The doctors don't seem to have this luxury.

Hi doireannod, Well nurses taking bloods for starters is down to nurses upskilling and taking on the responsibility. Taking bloods and ordering of them is the doctors responsibility. Nurses are courteous enough to help the doctors out. I would rather have a nurse looking after me that is making sure that their nursing care is their priority over taking bloods. Once I have my patients nursing care and all my nursing responsibilities taken care of then I will go and take bloods happily. An emergency doctor may need blood results for their diagnosis and if they are not done already then they will happily do them without complaint as we work as a team and they are aware of the pressure a nurse is under. Many doctors (not emergency doctors) request that we do their bloods and many doctors state they are too busy to do them too. It is not just nurses.

Dozen Wicked Words wrote: »

Some nurses can't take bloods, nothing to do with being too busy or choosing not to take them.


Anyway my questions. What is the ratio of CNM to staff nurse in your department? Do you think you have adequate staffing?

Hi Dozen Wicked Words, Thanks for having our backs there! Unfortunately sometimes we are just too busy but as you said it is definitely not a case of us choosing not to do them... to be fair really I do love taking bloods
As for your question... Emergency Departments have a lot of CNM staff as we have 24 hour cover so there are a good lot in my department too thankfully! Not going to give away our ratio if you don't mind as it could identify where I work I don't think my department has adequate staffing but I don't believe that any Emergency Departments are fully staffed but I am happy to be corrected on that.... and jealous if any of them are :P