Patient Flow in the emergency department

 Patient flow in the emergency department is a big deal. Just like if you kink the hose with the tap on full the hose will eventually burst off the tap and water flows out everywhere you dont want it to be.

But some nurses who work on quiet, in control wards, (Paediatrics wards are a prime example), don't get this concept.

At handover its hard to hear what is being said for so many reasons. There are lots of people in a small space, many talking loudly to get their voice heard over others. Its noisy. The nurse giving handover is behind a mask and a face shield. Its really difficult to hear what they say in the best of circumstances.

Handover has just finished in the Emergency department. It is overflowing. Beds with the incoming are lining the corridors. The Ambos are standing with their patients in the airlocks.

Ok, so I didn't get the full identification on the mother and child in this scenario. Handover is finished, and I am asked to take mother and child to the Paediatric ward straight away.

The mother is busy talking on the phone, ignoring her crying infant, who she continuously jiggles in her arms while she talks.

Another nurse appoaches the mother with panadol and nurofen. The nurse asks the mother to give the medication to her baby, as the mother is not letting go of the infant, and refusing to put the phone down.

Meantime I am busy putting on PPE as the mother and baby have come out of  a high risk area.

I plan to read the notes as I go along for the walk to Paediatrics ward. The mother is far from helpful on the walk. Where are we going? Why? What for? and continuing to talk on the phone in a language other than English.

I read the notes and see that there is no documentation for a Covid swab. Oh no. Paediatric nurses get upset if this information is not clear.

I get to the ward and the Paediatric nurses go into meltdown. Has the patient got COVID, why dont you know this. I explain the situation in ED is like a hose about to burst. Please lets read the notes together.

But they didn't care. They wanted to prove their point that the nurses from ED are just SLACK.

So they put in a complaint about my lack of knowledge, and poor handover to the Nav on the flight deck.

To make matters worse, the mother had not given her crying infant the medication, and instead put it in her bag, and produced it saying "I dont know what this is for!" This was an absolute nail in the coffin of an ED nurse as far as the Paediatric nurse was concerned.

Thanks to the Nav, who by the way is an amazingly calm, experienced nurse, the situation was smoothed out. The nurse who did know the full history of the patient was called to phone Paediatrics and give them a "gold standard" handover.

If it weren't for nurses like the Nav on that day, our day could have gone from bad to worse. It takes understanding and compromise, the ability to listen and be flexible about out of the ordinary situations. This is what makes a good nurse. The nurse who tries to follow all the rules, and who becomes angry with others who dont for good reason, frankly has lost the plot.