Comment

ED pressures force nurses to compromise clinical decision-making

Understaffing and overcrowding make it difficult for emergency department nurses to care for their patients in the way they would like to
Image shows ambulance outside hospital emergency department in winter in the snow

Understaffing and overcrowding make it difficult for emergency department nurses to care for their patients in the way they would like to

Winter is upon us and once again emergency nurses and patients are facing a perfect storm in emergency departments (EDs) up and down the UK.

Reduced nursing numbers, increasing demand, immediate handover by the ambulance service, and a lack of social care make the process of getting patients to the right or any bed difficult.

Such understaffing and overcrowding make it difficult for us to care for our patients in the manner we would like to.

Understaffing and overcrowding make it difficult for emergency department nurses to care for their patients in the way they would like to


Picture: Neil O’Connor

Winter is upon us and once again emergency nurses and patients are facing a perfect storm in emergency departments (EDs) up and down the UK.

Reduced nursing numbers, increasing demand, immediate handover by the ambulance service, and a lack of social care make the process of getting patients to the right – or any – bed difficult.

Such understaffing and overcrowding make it difficult for us to care for our patients in the manner we would like to.

We are relentlessly told by management and government to do the best for our patients – something I strive to do every day of my working life.

Moral support or tips for coping 

But practising in these conditions and under such pressures often makes me feel I am compromising my clinical decision-making. Rather than choosing what is best for my patients, I am making my decisions based on the least inappropriate options available to me.

Conversations with my peers reveal that they feel the same.

‘Rather than choosing what is best for my patients, I am making my decisions based on the least inappropriate options available to me’

My advice to emergency nurses is to know that you are not alone in these thoughts and emotions, and to discuss them with your peers and your line manager, who may be able to offer moral support or tips for coping.

The RCN Emergency Care Association (ECA) is working with the Royal College of Emergency Medicine on systems to prevent overcrowding, to ensure that there is a measurable method of flow in EDs, and that nurses have the correct skills for working in the ED.

The ECA is about to review the national competencies for emergency nursing. These were first published in 2017 and link up with the national major trauma nursing competencies, with the aim of ensuring that nurses are taught every aspect of emergency care.

Suggestions on improving ED nursing standards welcomed

If you have any suggestions on how these can be improved, my fellow RCN ECA steering committee members and I would love to hear from you.

It is important these competencies are reviewed regularly to reflect current practices, and that emergency nurses feed into this process.

I look forward to hearing from you, so please contact me at justin.walford@nhs.net

Meanwhile look after each other and have a happy and healthy festive season as well as a great start to 2020 – the International Year of the Nurse and Midwife.


Find out more


Justin Walford,  @Justin_Walfordis senior practice development nurse in the emergency department of the Royal Sussex County Hospital, Brighton, and is a member of the RCN Emergency Care Association steering committee 

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