How to enhance your nursing practice despite ED pressures

Winter heaps more pressure on an already overstretched workforce, but by working together emergency department nurses can provide the best possible patient care

A busy emergency department with a paramedic looking serious, a nurse looking concerned while holding paperwork, while another nurse speaks to someone on the phone
Picture: John Houlihan

The ongoing challenges facing emergency nurses are set to peak once again this winter period.

Insufficient hospital and community bed capacity results in emergency departments (EDs) being full of patients awaiting admission into the hospital.

Many EDs were already delaying ambulance handovers during summer 2023 due to overcrowding, meaning that areas undesignated for care, such as corridors, were also full.

Nurses are forced to deliver care that does not reflect their professional values

In addition to the indignity and frustration patients must face by spending hours – or even days – stranded on a trolley in a hospital corridor, they also experience the risk of unsafe care as undesignated areas for care will not have been included in the equation when nursing ratios are set each year.

The result is a cycle of intolerable working conditions, burnt out staff and increasing workforce sickness as nurses are forced to deliver care that does not reflect their professional values.

A recent article by Christopher Williams, ‘Corridor care’ in the emergency department: managing patient care in non-clinical areas safely and efficiently, discussed key safety issues facing vulnerable patients and those living with frailty who find themselves stranded in these locations. While we continue to wait for national investment and policy change to prevent such unacceptable conditions, these patients who have financially contributed all their working lives to the NHS deserve the best care we can provide.

Improving practice despite difficult conditions

One way that nurses can make a real difference is through the early identification of frailty. Our expert advice, How to spot and manage frailty in the emergency department, discusses best practice for patients experiencing frailty. With current estimates indicating a 55% increase in people aged over 85 by 2037, understanding the importance of identifying frailty and ensuring a robust pathway to specialist input should be a priority within all hospitals.

Another recent article by Kay McCallum, Overcoming the barriers to optimal end of life care in the emergency department, discusses an area where nurses only have one chance to get it right, providing expert advice on optimising end of life care in the ED, prompting nurses to think about how they can enhance their practice when caring for dying patients.

As winter pressures intensify it is paramount that we support each other, ensure civility in our working environments and work together to provide our patients with the best care possible within the constraints of this ongoing crisis.