Nurses in the consistently clogged emergency department (ED) of University Hospital Limerick (UHL) are concerned they will not be able to safely and adequately evacuate patients in the event of a major emergency situation, according to a staff nurse with over 30 years’ experience.
Staff “cannot cope” with the stress of working in constantly overcrowded conditions in the hospital and are “leaving in droves”, according to Ann Noonan, a staff threat nurse at UHL.
Ms Noonan, who lifts the lid on the “inadequacies” in the system, believes fire training procedures for staff working in emergency departments is “pie in the sky” as it cannot possibly adequately prepare staff to evacuate the numbers of patients coming through the ED doors.
Ms Noonan (52) who is an executive council member of the Irish Nurses and Midwives Organisation (INMO) said there is a current nursing deficit of “16 deficits alone in the ED” and a deficit of 79 in total at in the hospital.
These figures are the nursing deficits for the UHL’s current bed capacity of 450: “If you never had one extra patient inside in (UHL), if that hospital was at capacity with no trolleys and no extra beds, you have 79 nursing deficits. That is to fill what nursing compliment should be in the hospital if you had no trolley.”
Overcrowding has got progressively worse in the past 10 years after 24-hour ED services were centralised to Limerick from Clare, Tipperary, parts of Kerry and north Cork.
“It’s quiet astounding in the last 10 years how much worse it has got to be honest. If you walk onto a ward now and there isn’t a trolley, its nearly unusual,” says Ms Noonan.
“I’ll be honest – there is no dignity for patients on trolleys. They are in full view of everybody. Screens are obviously lacking. A lot of the patients are elderly, where do they brush their teeth, where do they even put their belongings, there are no lockers, there is nothing; It’s actually third world.
“We are in a (rich) country and we have people on wards, on trolleys, without a place to even put their teeth or their handbag, it’s terrible.”
Emergency departments are designed to “care for people in an emergency situation” she says, “not to acre for people for seventy-two people or more hours on a trolley”.
“There is no night and day in the ED” in the hustle and bustle of an emergency unit.
“If you’re a patient on a ward, the lights are dimmed at night and there’s an air of calm. There is no calm and there is no dimming of lights (in the ED). It is like being in a constant supermarket.”
Stress levels
Staff in emergency departments are “leaving in their droves because of the stress levels, they cannot cope with it”, she says.
“That is not what doctors, nurses, porters, attendants, sign up for. You sign up to work in an environment where you have a caseload, but when your caseload doubles or trebles you cannot constantly work in that environment.”
Staff are “afraid” of making mistakes due to the stress.
“As a nurse, your registration is your responsibility. People are afraid because its so busy and you’re trying to do everything you’re supposed to do.”
Ms Noonan “is at the end” of her career and what “frightens” her is “who is going to mind me? Because there are not going to be nurses there to mind us unless we do something about this.”
She welcomed the inspection by the fire authority of the Limerick emergency department last Tuesday night after 85 patients languished on trolleys in the emergency departments (55) and wards (30).
“Sure, can’t you understand yourself the fire officer going in. If there was a fire (in the ED) can you imagine trying to evacuate all those patients.
“You would wonder about the ability of these fire safety measures being able to work with the level of overcrowding that there is. You can hardly walk between the trolleys as it is, and, trying to evacuate (extra patients), actually, it’s something I wouldn’t even like to comprehend to be honest with you.
“I’m sure there is no fire safety training that we all go to that actually prepares you for a fire evacuation with 50 (patients in the ED). If you actually think about it in that capacity – when you do fire safety training sure isn’t that a bit like the manual handling – it’s all pie in the sky, and its all a utopia situation, and we’re all going to walk very gently and we’re all going to be very calm and cool.
“So if you’ve 55 patients on top of your full compliment how are you going to think of evacuating all that in a fire? I think it’s great the fire safety officer came in and saw what is going on.”
Ms Noonan says she does not blame UHL management who are “doing their best” to put out the fires within the system.
Routine diagnostics, such as Cat scan and MRIs are not available at the UHL outside of 8am-5pm Monday to Friday, and these should be extended to weekends and 24-hour opening times, she says.
More beds, more staff, better access to diagnostics, and more funding homecare packages and primary care are all needed before the “pressure valve can be released”.