Conditions at the emergency department of University Hospital Galway are chaotic and “nothing short of scandalous”, according to an official report.
Nursing staff feel disempowered and frustrated, patients are at risk and “nobody is in charge” at a departmental or corporate level, the review by senior representatives of the Royal College of Nursing in Northern Ireland says.
The report describes the physical environment of the department as “shocking and disturbing”. “The reviewers found the sight of numerous sick and vulnerable patients lying on trolleys in full view of the public as nothing short of scandalous. The overcrowding and congestion make the environment completely unfit for purpose.
“Patients are crammed together within touching distance of each other for the most part, with little or no privacy,” it says. There is just one toilet and patients, especially older ones, find themselves in an environment that is “dehumanising and degrading”. The infection risk is also increased.
The review was commissioned by Saolta University Health Care Group, which includes UHG, and followed a series of conciliation conferences at the Labour Relations Commission involving hospital representatives and staff unions. Overcrowding in the hospital’s emergency department is among the worst in the country and even Taoiseach Enda Kenny admitted in 2015 it was not “fit for purpose”.
The biggest problem identified by many staff in the report is the lack of senior doctors on the “shop floor”, leading to delays in the assessment and treatment of patients, it says.
“Nursing staff claim there is a hierarchical model of working where consultant colleagues dictate the clinical running of the department but fail to take responsibility when things go wrong. They are perceived as being opposed to change and reluctant to engage.”
Staff interviewed for the report say management had not addressed the problem and a “culture of acceptance” is putting patients at risk.
The report says there needs to be an immediate improvement in the level of consultant presence in the emergency department and this alone would have a significant impact.
Extremely damaging
It says relationships between senior medical staff and the nursing team appear broken and the resulting lack of trust is extremely damaging.
It says nursing staff expressed a deep sense of frustration and anger at being unable to care for patients in the way they would wish and were trained to do.
Even very urgent cases have had to wait more than 12 hours to be assessed by a doctor, while elective work is cancelled regularly. One heart patient urgently requiring angioplasty had been cancelled three times.
The report says it is unacceptable that staff have not had an appraisal for long periods, ranging up to 13 years.
A number of staff became visibly upset describing their experiences of working in such a stressful environment during interviews, it says. Seven experienced nurses have left the emergency department in recent months. Nurses say nothing is being done to address the departure of senior staff due to work-related stress.
Staff feel deskilled and disempowered because they are not allowed to use their expertise. The scope of their practice does not extend beyond the recording of patients’ clinical observations when they have “much more to offer”.
Blood tests
For example, nurses don’t have access to lab results and doctors have to sign off requests for blood tests. Neither are nurses permitted to refer patients directly to occupational therapy or physiotherapy, a restriction the report describes as outdated.
Staff feel they are not fully supported and don’t feel “in control” when on duty. Decisions about the transfer of patients are often made without them being consulted. “There appears to be a problem in UHG about the voice of professional nursing staff not being heard when concerns have been raised about patient care.”
Nurses feel the organisation would not support them if something went wrong and they would be “hung out to dry” as “theirs is the only name on the chart”.
“It is completely unacceptable for professional nursing staff to be made feel that they are alone in dealing with the consequences of systemic failures in the health service,” the unpublished report says.
There is little evidence of support in UHG for supporting staff who blow the whistle on safety concerns and this needs to change, it adds.
