ED staff must feel safe and supported to deliver dignified care
Progressive nurse leaders can ensure decreasing morale and increasing turnover aren't inevitable
Progressive nurse leaders can ensure decreasing morale and increasing turnover aren't inevitable, writes Cliff Evans
I recently presented at The Next Steps in Transforming Urgent and Emergency Care Services conference in London. My presentation focused on highlighting sustainable solutions to the workforce challenges facing many emergency departments (EDs).
Nursing and medical leads from around the UK expressed concern that inadequate staffing was negatively affecting their working experience.
Although recruiting and retaining emergency nurses is an international problem, addressing some fundamental issues can create a positive environment where nurses will want to work and develop their careers.
The pressures nurses face can result in an ethical dilemma between achieving their aspirations to deliver the best care possible and the reality of frequently delivering undignified and potentially suboptimal care.
Nurses frequently leave emergency nursing disillusioned, with moral distress and accelerated burnout, before gaining fundamental knowledge of the specialty.
Winter crisis effect
Each year, the winter crisis has a profound and disproportionate effect on emergency nurses.
Assessment areas and wards become blocked and closed to new arrivals once cubicles are full. As a result, people who have been seen and treated by ED staff and are awaiting specialist input from admitting teams, as well as those referred directly by their GP, remain in the ED for protracted periods to compete with emergency arrivals for nursing care.
Progressive organisations use escalation areas as part of an orchestrated strategy to alleviate pressure in the ED, minimising risk in any one area. Others fail to provide a trust-wide response, resulting in delayed ambulance handovers and implementation of the immediate handover protocol.
The potential for unsafe nurse to patient ratios intensifies as EDs become increasingly overcrowded. This leads to the potential for patients to be left unsupervised in corridors, which can then become accepted areas to care for the frail and vulnerable.
In a high-pressure system, emergency nurses routinely encounter verbal and physical abuse. In 2016-17, assaults on NHS staff in England increased by 10% on the previous year, the equivalent of an additional 13 physical attacks a day.
I can’t imagine anything more demoralising at the start of a shift than being confronted by aggressive behaviour or being expected to nurse in a corridor.
The resulting cycle of decreasing morale and increasing turnover isn’t inevitable. Robust and supportive leadership can provide representation at a senior level, ensuring nurses don’t feel expendable and their experiences, and those of the patient, are not forgotten.
Zero-tolerance of aggressive behaviour and early intervention to establish predetermined boundaries harvest a safer environment.
Devising a multidisciplinary workforce strategy that invests in experienced nurses and support workers to maximise their career potential, would aid the sustainable delivery of evidence-based practice and innovation.
'The priority for nursing leaders is to create an environment where nurses feel safe and supported to deliver dignified care'
Having a structured career advancement framework with a commitment to professional development would also create an environment where nurses want to work and progress.
Newer roles, such as advanced clinical practitioners and nurse associates, help address the healthcare requirements of tomorrow through complementing the historic doctor and nurse dominated model.
This year is an exciting time for nursing development, nevertheless, the priority for nursing leaders is to create an environment where nurses feel safe and supported to deliver dignified care.
- Royal College of Nursing (2018) Violence and Aggression in the NHS: Estimating the Size and Impact of the Problem – Interim Report
About the author
Cliff Evans is a consultant nurse at Medway NHS Foundation Trust emergency department