The bigger picture: is streaming a good thing?
To reduce delays in patient care and over-crowding in emergency departments (EDs), suitable patients are often streamed away from the department or to separate areas in the department for specialist care.
Patients are streamed routinely to minors areas, for example, but also to primary care, surgical assessment units, ambulatory emergency care and in some instances frailty units.
Is streaming a good thing? For the patient, 'yes'; they arrive earlier at the right place to receive the care they need. But, if we are not careful, it could be a 'no' for emergency nurses, who need to maintain and develop their skills and knowledge in different aspects of care provision.
How are departments ensuring that emergency nurses have the skills required for working in a department? Most departments lurch from crisis to crisis, reacting to increased demand, so it can be difficult to plan our emergency nursing workforce to work in all areas. Yet, if we don’t, where will our future emergency nurses come from?
Many emergency nurses can no longer suture or plaster or carry out the tasks necessary for treating minor injuries or other aspects of specialised care because they are no longer regularly placed in minors. Instead, we often leave emergency nurse practitioners (ENPs) to run these areas. How then can we grow our own ENPs in the future? What plans do you have to do this?
Equally, we leave acute medical nurses to stream patients to ambulatory emergency care and or frailty units and yet, because so many of our patients are older and frail, we all must learn the knowledge and skills required to nurse these particular patients? Are our departments going to become places where only the really sick and those in need of resuscitation go?
Let us rethink how our nurses rotate through our EDs before we de-skill our emergency nursing workforce even further.
About the author
Mandy Rumley-Buss is a steering committee member of the RCN Emergency Care Association, intensive support team manager for the Emergency Care Improvement Programme, and associate of the Acute Frailty Network.