Doctors doubled up as nurses and with advance planning the impact onpatients of yesterday's stoppage was minimised, reports Dr MuirisHouston, Medical Correspondent.
The two-hour stoppage by A&E nurses passed off without any danger to patient care, according to hospital consultants. Most hospitals had cleared their casualty departments of patients by the time the industrial action began at noon. This was achieved by freeing elective beds for emergency admissions in the run-up to the strike.
One Dublin A&E department had only four patients left by noon; all had been treated and beds were quickly found for them shortly after the stoppage was over.Cork University Hospital had a quiet two hours with no problems reported; it did not need to call in the emergency nursing cover during the stoppage.
A&E consultants functioned as triage nurses during the strike, but with so few patients coming for treatment they were hardly required to exercise this function.
Another Dublin hospital saw 10 to 12 patients between noon and 2 p.m., one a major trauma case. This patient was managed by a consultant and a junior doctor, and nurses on stand-by responded to the emergency.
The strong message from all hospitals was that no patient was put at risk by the stoppage.
Consultants are more concerned about the effects of the nurses' ongoing work-to-rule. Dealing with the stoppage was always going to be straightforward because of its short duration and the public warning to stay away from A&E.
The work-to-rule has the potential to cause major disruption not just to accident and emergency departments but to overall hospital activity. According to several hospital consultants contacted by The Irish Times, the ongoing non-performance of duties by nurses is likely to add significantly to the usual backlog of casualty cases. As the system backs up even more, hospitals will be faced with a stark choice: close the A&E department to further emergencies or cancel all planned admissions.
Ironically, the cancellation of all non-emergency admissions could make the A&E departments function more efficiently than they do normally. By ensuring a smooth availability of beds "in-house", patient flow will be quicker, with no reason for the routine 36- to 72-hour delay lying on a trolley in casualty.
It is likely that with a long- weekend coming up the work-to-rule will hit especially hard. A&E departments are busy places over bank holidays; with nurses slowing down their usual work practices, the picture that will greet us by Tuesday morning may not be pretty. Only on-call medical staff will be on duty for three days; with no nursing co-operation with the setting up of intravenous fluids or the giving of drugs, it is hard to see patients not suffering to some extent.
Doctors are largely sympathetic to the cause being fought for by their nursing colleagues. The industrial action is clearly for the benefit of patients; doctors too are appalled at the standard of care people are routinely receiving within units. One A&E consultant said: "We cannot professionally stand over the care which people get in accident and emergency."
Emergency departments don't just function as casualty units; they have also become admission wards and an extension of the out patient department. With waiting lists of two years for some specialist outpatient clinics, patients regularly appear in A&E either as avoidable emergencies, or in a desperate attempt to move up the list. All of these "inappropriate" attendances add to the workload of departments designed to deal with emergencies.
One A&E consultant at Cork University Hospital, Dr Stephen Cusack, expressed concern about the industrial action. "While nurses have my sympathy I am concerned that I don't see an end point for their action. What is the demand? It is a badly conceived strike, and with no resolution patients will suffer."