It always takes me a bit of time to get used to a new placement. That awkward settling in period, trying to learn the ropes and get to grips with ‘how things are done’, is never easy. Plus, A&E was bound to be a difficult transition: high turnover and volume of sick patients, coupled with low numbers of staff. I knew that it would be very very different from GP.
For some reason, I had this idea in my head that A&E would run like a well-oiled machine, that it would be efficient. I don’t know why I thought that, because the reality is often very different.
The department is small which means it overruns with patients very quickly. All of a sudden there’s no where for us to see anyone. We have to squeeze people into every nook and cranny for a quick examination and then send them back to the waiting area until a bed becomes free. Then it all becomes disjointed. You can’t start treatment and you can’t really observe the patient because they’re back in the waiting area. The nurses won’t take responsibility for the patients in the waiting area which is understandable, because they have their patients that they’re already looking after. The most I can do is take bloods and beg the co-ordinator to find them a bed.
For the ones that do have a bed, I have to run around and look for the nurse responsible for them which is hard. I have to look high and low, far and wide. There are times when the response I get is: ‘you can do that yourself’. Yeah, I could do it myself. I could do it all myself, but then that takes away from me doing what I’m actually supposed to be doing. It feels like a tug of war sometimes, and I do end up doing things that other healthcare professionals could do. And when there’s a growing pile of patients to be seen, I can only hope that I’m not scrutinised for being slow, but what can I do?
My third eye is on the clock because of the four hour targets. A&E departments are supposed to see and treat patients within 4 hours or else they’re penalised. It’s something I’ve not really looked into, so I have a very blasé understanding of its incriminations. On the first day, after the consultant gave us a mini tour she pointed me towards the list of folders each representing a different patient and told me to start seeing people. I asked her whether I needed to be wary about the times. And she looked at me and asked pointedly, ‘what do you mean?’. I remember thinking I should chose my next words very carefully. ‘I mean the four hour targets.’ Her reply was, and please imagine the icy cold stare she gave me whilst she said this, ‘your concern should be patient safety’.
Maybe I was wrong, maybe the four hour wait thing wasn’t a big deal. Until I realised that every time a patient passed the three-hour mark, nurses, consultants and registrars would descend upon me and want to know my plan for said patient.
But… it’s still early days, and I’m still adjusting. I’ll just have to see what the next few months will bring.