Emergency Departments delivering quality care, and ready to manage any emergency?
No-dice.
Read some stories explaining: why we all get so pissed off …
Emergency Departments delivering quality care, and ready to manage any emergency?
No-dice.
Read some stories explaining: why we all get so pissed off …
ImpactEDnurse, your Department is not alone. Your brief description of the Access block issue reads exactly as if it were my own ED and by all accounts, many others. The strength and quality of the Department is dependent on people such as you who are confident in the knowledge that you do good work, regardless of the whole hospital problem of access block. Resources in nurse ‘bodies’ and Care awaiting Placement ‘Beds is the common theme. We need more people to stay and say ‘I can do good things for my patients regardless of the hand I’ve been dealt.’ The quality will vary with the workload.
Although I’m not particularly religeous I have more recently found strength in the statement or prayer.” Grant me the serenity to accept the things I cannot change, The courage to change the things I can and the Wisdom to know the difference.”
Regardless of the Frequent Dramas…ED Rocks!
Wouldn’t work anywhere else.
Thanks for the opportunity…Great site
Dear “what to do”:
I’m 44 years old now, and I have been working in the ED for a long long time.
I have wrestled through the symptoms of stress and burn-out on more than one occasion. I have been fighting the problems that our department faces since 2001 and have put my butt on the chopping line on more than one occasion.
Point one: If you find my stories of “mystery animals, fluffy puppies and how to be a nurse” distracting you from the crusade… then fuck off and don’t visit the site. Simple.
Point two: If you want to talk about the problems we experience in our department..hell, you can write a piece as a guest blogger, and I will give it its own page. But if you want to make it personal and identify individual people to attack you had better a) start up your own site or b) follow instructions under Point one.
I have watched this department slowly become smothered with access block and overcrowding as the hospital fails to meet our demand for beds. I have seen more patients receive sub-optimal care due to the high workloads than I care to imagine. I have surely seen a lot more good staff (and good friends) crumple under the weight and leave than you have.
And after all this time, we still have to battle tooth and claw, every day, every shift, just to maintain some form of basic service delivery to the community in our role as an emergency department.
Despite this, I do not think impactednurse.com is the forum to attack individuals who may or may not be part of the problem.
I’m getting way too tired of all this. That is all.
i rememeber when i first moved to canberra and had not as yet started my job in the ED, i would drive past and feel proud that i was soon to start work there. how naive.i guess that is why i feel so let down, and deflated.
what a horrible place to work, don’t let all of this talk of mystery animals, fluffy puppies and how to be a nurse distract you from the reality, the emergency department is going quickly and messily down the toilet. there are a few trying desperatley to get there fingernails into the porcelain, but its a slippery watery stinky descent into the sewer.
i would love to say that we are all going to some how “save” it from happening but succumbing to pressures has now seen the vocal disband. those capable of change are destroyed despite obvoiusly dong a great job, the rest leave.
and who can blame them.
top order bullying is rife, it may be subtle, and just managing to be above board, but bullying none the less. people are told via the allocation book that they are no longer capable of anything other than basic nurisng care. other less experienced staff are rewarded for agreement.
with the latest staff meeting came the revelation that our manager could do what they wanted with our roster. the successful roster rotation that we have had for months initiated by another manager would be scrapped, and no, we can’t discuss it!
So that sees some people with 75% of their roster in night duty, and i’m guessing that this is only the people that they want to push out the door!!
and when those people do leave they openly exclaim “good ridance”
It’s an unfortunate reflection of the current state of the public health care system, and the emergency department in particular, that any sensible observer can’t help but agree with “smooth”‘s assessment of the situation and recent attempts to improve it. It would be nice to be able, with some degree of honesty, to accuse him/her of being a little pessimistic, however it just is not possible to do so without being guilty of lying to oneself to make it seem like good things might, in fact, be happening. They just aren’t.
The fundamental difficulty with the all-singing all-dancing “Access Improvement” program is the seeming inability of those in power and holding the purse-strings to appreciate the rather simple fact that making efforts to streamline the processes of triage, initial diagnosis and treatment, and appropriate disposition (in short, the provision of Emergency Medicine services) in order to optimise access to hospital and community-based medical services just plain will not help, if the resources to which we are providing better “access” are still too few to provide an adequate level of service to the population they are intended to serve.
There are complicating factors, but the fundamental issue revolves around one simple glaring inequality…
(Inpatient beds required) > (Inpatient beds available)
This inequality continues to grow. In the past decade or so the population has continued to expand; bit of a shock that one, eh? At the same time, the number of hospital beds has _decreased_ in absolute number… not just failed to increase at the same rate as the population, but decrease. My apologies for labouring the point, but it would seem that for anyone elected, or in a job with a title that involves the terms “public service” and “executive”, that stating the obvious is often necessary. Over and over.
There are certainly improvements to be made in the micro-management of the emergency department, both individually and from a systems perspective. However, in terms of the dysfunction we so regularly hear about (and work with) these days, far greater inroads are to be made by improving aspects of hospital functionality downstream of the ED.
It’s a little like pouring large sums of money into developing a more energy efficient light bulb for car headlights, saving say 80 or 90 watts of power in the average car, when the same amount of money could be spent on designing an engine that gives you an extra 10kW of power for the same fuel expenditure. The trick is knowing where best to invest your resources. Where will you get the most bang for your buck? And the tragic thing is, it’s not even tricky. The average 6th grader could probably tell you you’d be better off building a better engine and forgetting about the light bulbs for now. The average 6th grader could probably give you just as sensible an answer if the logistics of ED patient flow, number of inpatient beds, and change in population size were outlined in simple terms.
Why can our alleged leaders not also grasp this simplest of concepts?
Their answer is probably that they _do_ understand this, but have budgetary restraints. There are two issues arising from this…
Firstly, put the money you do have into the engine and not the headlights. It may seem like a drop in the ocean, but investing resources in resolving (no matter how slowly) the underlying problem is a vastly superior strategy in the long-term than scrambling to provide band-aid solutions in the short-term to make everyone feel like things are being done.
Secondly, if the bucket of money is not big enough, make it bigger! Bugger providing $20 a week tax cuts to the majority of Australians in order to buy votes. How about making us pay the same amount of tax, and just spend it more effectively?? There will always be arguments about how to prioritise the spending of taxpayer’s money, but rocket science this is not.
A third issue arising from the first two is the transient nature of governments. Efficient and effective long-term planning is not encouraged or fostered within our system of government, as by its very nature the government is predominantly interested in still being the government in 3 or 4 years. Eliciting decent planning or policy-making on a scale beyond that is exceptionally difficult. The recent expenditure on access improvement is illustrative of such short-term planning. The numbers will look a little better, the politicians will feel warm and fuzzy about themselves for a short while, and then the system will reach a new, slightly shifted, clogging point.
The establishment of MAPU, the 3-2-1 system (ie: ward nurses having to clean and ready a bed when it becomes empty, not when it’s convenient) and other recent improvements are probably a step in the right direction, however they represent some very expensive tweaking of the headlights, while the engine is still very fucked up.
Thus endeth the rant…
Let me put it this way.
If the government actually does something to improve the service in ED’s and Public Hospitals it will mean that more patients can be treated, which then will cost them more money.
Costing them more money is the last thing governments actually want. Besides the various governments have Federal and State have better things to do with the money like ‘Pork barreling’.
Now if patients can be forced into the private sector this actually saves federal and state governments money (which is what they want) but health care then becomes a very expensive proposition for the individual. In other words, costs a hell of a lot more.
The US has gone down this path.
no longer able to muster the energy to be pissed off we are now defeated.
a report released this week stated that the emergency department where i work has the longest emergency waiting times in the country.
i can hear the excuses now, “that was before the access improvement program”, “those figures are two years old” “we have opened MAPU and aged care beds”
“we have allocated a total of 7 million dollars to improve access” blah blah blah
lets get a few things straight…
the access improvement program is bollocks, in our emergency department it has involved changes that have cost a lot but have had no real benefit to access. for example over 50,000 bucks, (kindly donated by you and me the taxpayer) was spent on the redesign of triage, including changing the desk and the laying of a really expensive bright red glittery floor, nice and calming!! the design of the desk = less room and neck ache, and the red floor hasn’t really seemed to help getting people from the waiting room to emergency beds…whoops!!
also as a part of the access improvement plan, god knows how much money is being spent on new uniforms for emergency department nurses, scrubs in red (nice, we seem to be on a theme here)call me stupid but i can’t work out how this will help access block, i think it is going to confuse patients, especially as the cleaners and the clerical staff also wear red….whoops
team nursing was introduced despite the nursing staff not wanting it and there being no evidence to its value in an emergency enviroment. but we get funding for it, and someone was planning to present it as a great success at an emergency nursing conference…whoops.
not sure how much money has been wasted here, but what it means in terms of staff can be quantified. there are fewer nurses doing hands on patient care, there are more nurses in patient free jobs. fewer nurses actually looking after patients equals extended time for patients in ED beds, simple really, the nurses can only look after and move patients as quickly as one person is able. and i mean one person because you guessed it, team nursing has gone out the window too. we have all been recently told that we need to be individually accountable for patients in our care, why does that ring a bell? oh yes i remember, its because that is what nurses were saying all along!!
there are plenty more examples, loads of them, escalation plans, 321 plans, new jobs (higher grade) for bed allocations.
it’s all fucked up.
the introduction of the first phase of the access improvement program has made no difference (this is a fact, waiting times are worse now than the recent report)
according to executive access improvement programs work in other states and in other countries, it is not working in our hospital, and i think that the people responsible for it’s failure should be held accountable.