If you’ve ever watched any TV medical dramas you’ll know for a fact that all the nurses are in clinches with hot doctors in linen cupboards, the registrars are totally being sassy with their clever diagnoses of rare autoimmune syndromes or they’re pretending not to be googling that weird skin condition you said you had in triage. But here’s what’s actually going on.
1: You’re just not that sick! I know that your health is important to you and I’m sure you’re not one of the thousands of people that turn up to the emergency department when you should be seeing your GP or pharmacist but if you’re walking and talking then the staff probably have higher priority patients to see to first. If you’re coming in with something you should see your GP for then you can expect to wait a while. Bring a book but don’t get too engrossed, if we call your name and you miss your slot because you’ve got your earphones in then it’s not our fault.
2: The department is full. Yep, we sometimes can’t start your treatment until we have space in the department. This could be caused by a number of different things. If the rest of the hospital is full then we physically can’t move patients out of the department. Even if the adult waiting room is empty that doesn’t mean there aren’t seven ambulances outside and a list of 20 sick kids to be seen. Also there might be several emergencies happening at once: a resuscitation attempt in one bay, a traumatic hip fracture in the next bay, and the majors department full of sepsis and dementia patients all needing attention. Your broken toe can wait.
3: We’re waiting for your results. Chill out! The lab can take a couple of hours to get all your blood tests back. They can’t go any quicker and we don’t have time to keep calling them for each individual patient. The same goes for X-ray results, MRI & CT scan reports and anything else you care to think of. X-rays are easy -we just need to find a doctor to confirm your broken bone, but other imaging reports take a lot longer because they have an awful lot of slides of your brain to look at and I doubt you’d want them to miss your small but significant subdural haemorrhage.
4: We simply do not have the resources. Read all about the hospital closures, nursing recruitment crisis, junior doctor contracts and midwife shortages in any newspaper you like. We’re trying our best, but without the money the National Health Service needs, the waits will only get longer. As the nurse in charge of a number of staff, I need them to get their breaks too. Its 3am, this is their third night shift -they do need that 30 minute break; tired doctors and nurses make mistakes. You don’t want to be dealt with by a hangry nurse deprived of her caffeine or nicotine do you?
5: Outside agencies. The team in the emergency department aren’t the only people working to look after you and your relatives. They have to liaise with social services, transport, pharmacy, mental health crisis teams, other speciality hospitals, transplant services, the police, care agencies, you get the idea. We have zero control over the other people involved in your care.
6: Unpredictability. No two days or even two hours are the same for an Accident and Emergency department. From the Ebola crisis to terrorist attacks, your lovely emergency department staff are on the front line for all of it. They arrive each shift to any situation imaginable. Not just acute emergencies, but a lot of emotional rollercoasters too; it’s important for clinical staff to be thorough when filing reports about abuse and neglect to the people best equipped to help with non-medical crises. It’s very important for your nurse to spend the time comforting and supporting the lady who just lost her baby after 2 cycles of IVF, you don’t want to be the person butting in on that conversation. No one wants to be that guy.
7: You’ve been referred to a specialism! Lucky you, your specialist team have accepted you under their care and they want to look after you. Unfortunately the renal team are currently performing a lifesaving kidney transplant or the plastic surgeons are saving a guy’s hand that got caught by a chainsaw, but you can be sure they’re deffo gonna see you next.
8: We like you, we’re going to keep you. Well actually we’re obliged to keep you with us for a few hours. There are all sorts of guidelines applicable to multitudes of situations so sometimes you’ll need to hang around the department without actually being admitted to the hospital proper. These can be things like monitoring for head injury symptoms or after certain medications we may need to make sure your vitals are hunky dory before we release you back into the wild.
9: These things happen. Although your emergency department team are more superhuman than anything in a Marvel Comic, sometimes shit happens. We’re sorry. Perhaps some paperwork got mislaid, a specimen bottle was mislabelled and we need to send another, a student nurse wasn’t quite sure what was being asked of him or a nurse ending her shift forgot to hand something over. Sometimes there’s no excuse other than we’re doing 20 things at once but as long as we didn’t amputate the wrong leg we’ll get it sorted if you can give us a couple of extra minutes.
10: I’m waiting too! I really want to start your treatment, get your physio referral done and check your hourly observations again but unfortunately I’m also waiting for pharmacy to prepare your meds, the physiotherapist to call me back after she’s finished in the intensive care unit and for the porter to stop using the dynamap as a leaning post. You’re frustrated? I’ve got a million other things to do and I wanted to check your temperature first so I could put off administering that phosphate enema for as long as possible!