Comment

Corridor nursing is sadly not a new phenomenon

Even under extreme pressure, ‘trolley waits’ should be resisted
Corridor nursing

Even under extreme pressure, trolley waits should be resisted

Imagine, just for a moment, emergency care without national resuscitation guidelines. Or how about trauma care without trauma training, or patient assessment without triage?

Emergency care has evolved beyond recognition

Can you picture pre-hospital care without paramedics, or minor injury care without nurse practitioners? What about if nurses were not able to cannulate and send bloods for testing? Oh, and no specialist emergency care areas for children in a general emergency department (ED). And, of course, the department would have no computers

I could go on, but I think youll agree its a struggle to imagine providing an emergency service under such conditions. Yet most of these innovations were only introduced in 19822007.

'Trolley waits' should be consigned to the past

I look back at how things

...

Even under extreme pressure, ‘trolley waits’ should be resisted


Picture: Alamy

Imagine, just for a moment, emergency care without national resuscitation guidelines. Or how about trauma care without trauma training, or patient assessment without triage?

Emergency care has evolved beyond recognition

Can you picture pre-hospital care without paramedics, or minor injury care without nurse practitioners? What about if nurses were not able to cannulate and send bloods for testing? Oh, and no specialist emergency care areas for children in a general emergency department (ED). And, of course, the department would have no computers…

I could go on, but I think you’ll agree it’s a struggle to imagine providing an emergency service under such conditions. Yet most of these innovations were only introduced in 1982–2007.

'Trolley waits' should be consigned to the past

I look back at how things used to be in my memoire It’s Not All Blood and Guts: My Amazing Life as an A&E Nurse. And despite what you might think, we managed, in the main, to provide excellent care. But looking at emergency services today I see a return to staff struggling with challenges such as ‘trolley waits’ or what is now called ‘corridor care’.

Back in 1980 this was something totally alien to me. Then, on a four-month travel scholarship studying emergency care in Canada and the US, I was privileged to witness some amazing practices; but I also saw ‘corridor care’ in action.

I was appalled, yet a few years later ward admissions at Orsett and Basildon in Essex started to become delayed. In my book I describe my battle in the late 1980s to resist any suggestion of patients staying overnight in the department:

‘A&E was not, and must never become, a holding area for patients who should be on a ward’

‘With the reduced bed numbers at Orsett, and the government pushing for a general reduction in beds across the NHS, ward occupancy was hitting 100%. When the hospital manager suggested that some patients could stay overnight in A&E or in the fracture clinic, I immediately dismissed the suggestion. I pointed out that A&E was not, and must never become, a holding area for patients who should be on a ward. I had seen so much of that in the US and Canada during my tour in 1980 and I was determined never to see it at Orsett or Basildon.’

Trust status became prioritised over people

As time progressed, we found we were losing the battle and in the 1990s, as today, the combination of reduced bed capacity, inadequate social care and increased numbers of acute medical and older people made it impossible to resist ‘trolley waits’. In my opinion it was also due to the way the service became more of a ‘business’. So much emphasis was placed on hospitals gaining trust status nothing else seemed to matter. As our director of finance once said: ‘No one is as important as the trust’.

Throughout the early 2000s improvements at all levels of the NHS eventually paid off. So, it is sad to see the quote from the RCN Corridor Care Survey in February 2020: ‘It’s only a matter of time before an innocent life is lost or a nurse is taken to court for failing to provide (impossible) care.’ 

Staying positive and maintaining standards

This echoed a comment by the RCN A&E Association’s newsletter's editor in August 1995: ‘A&E staff have been saddened to hear of another patient dying while waiting in a corridor to be admitted to a ward. How many more incidents like this has there got to be before the problem is addressed?’ 

Despite the current challenges facing emergency nursing, including the challenge of COVID–19, I believe we need to stay positive. The initiatives I saw during my 1980 tour are so well ingrained in our service today it must be difficult for younger nurses to believe they were never part of emergency care.


Gary Jones is a former emergency nurse and author of It’s Not All Blood and Guts: My Amazing Life as an A&E Nurse

Want to read more?

Subscribe for unlimited access

Enjoy 1 month's access for £1 and get:

  • Full access to emergencynurse.com
  • Bi-monthly digital edition
  • RCNi Portfolio and interactive CPD quizzes
  • RCNi Learning with 200+ evidence-based modules
  • 10 articles a month from any other RCNi journal

This article is not available as part of an institutional subscription. Why is this?

Jobs