Day-to-day compassion in the emergency department

​Despite its representation in the media as a place of unremitting tribulation, the ED is brimming with compassion

​Despite its representation in the media as a place of unremitting tribulation, the emergency department is brimming with compassion

Care and compassion are not synonymous with emergency department (ED) care in the national press. EDs are portrayed as places of suffering or arduous waits and staff are frequently criticised for the number of people waiting more than four hours to be seen. It feels like the only service that matters is a quick service.

But recently I cared for a patient who was picked up by the ambulance service as a ‘cause for concern’. He was unkempt, brought from his squalid home and covered in excrement that was days old. Because of his alcoholism, he wanted to leave to have another drink but authorisation to keep him in was granted under the Mental Capacity Act. He had sustained a head injury and because he was confused he was given a computer tomography scan.


Care and compassion are evident in the emergency department every day.

I was pleased to finish my shift, but in the morning I found him still in the department with a nurse ‘specialing’ him to prevent him from falling. Overnight, a colleague drew the picture used to illustrate this article of the nurse sitting with him. For me it highlights the care and compassion that occur every day in the ED, but which arefrequently overlooked. I then took some time to think about how NHS England’s 6Cs underpinning compassion in practice affect nursing in an ED.


We care in countless ways. We care for patients daily, we take care not to make mistakes, we ensure our patients receive the highest standard of care possible. I have always held palliative care as the epitome of caring, but my colleague’s drawing gave me a snapshot of how caring the staff in the ED are too, not just nursing and medical staff, but volunteers, reception staff and all the other services that visit us. It allowed me to see that a momentary touch or look that conveys the empathy we feel can mean as much as it does in any other area.


Compassion is arguably squeezed out of you as you progress through your career in emergency nursing. However, it is essential that we retain it to deliver care at times of extreme crisis.


Competency is something we have to think about constantly: are we competent to do that task? How frequently do we need to do the task to retain our competency?


Communication is one of the emergency nurse’s greatest skills. This is the only job I know where you can have a baby being born in the same room where someone else is dying. And we often see patients who do not speak much English and yet we must still be able to communicate with them.


Courage is rarely talked about in this context but it is evident daily: caring for patients under unprecedented strain; continuing a shift after a traumatic event; or nursing a patient who is rude and abusive.


Nurses everywhere are committed. They take pride in their work and will study in their own time to extend their skill-set knowing it might not bring them financial benefit but it is in patients’ best interests.

On reflection, the 6Cs are used every day in the ED but are overlooked amid the escalating numbers of audits and the pressures that are ever present. Sometimes the simple act of finding a pillow or a bed for a patient may be the thing they remember the most. Heaven knows, that’s frequently the hardest thing to find in an ED.


About the author

Justin Walford is charge nurse, Royal Sussex County Hospital, Brighton



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