Watching the news, we see the reports about ambulances ramping at the doors of hospitals emergency departments, with the immense workloads of paramedics being seen too. I can’t help wondering how did we get to a place where there is so much pressure on the emergency system?
This seems to be a long standing issue within our system and it is only just presenting itself. Seeing that paramedics and the emergency departments are meeting their limits regularly, the effects is being felt by the people waiting to receive care.
In this blog piece I’ve tried to explore a little bit more about our current work conditions from a ward nurse perspective as these pressures placed on the emergency services has a ripple effect throughout many parts of the health system.
In general conversations it is regularly expressed that emergency nurses are angry with ward nurses, I actually see the emergency nurses viewpoints as there is so much low morale there, maybe this is only one of the side effects of being strained at work for them at the moment.
Some people will make general statements about nurses pay or remuneration, thats definitely true in areas like aged care settings where the pay levels are not fair. But what’s happening in the emergency services feels as though it involves our whole health system and is more about how we are working with the structure of it. It seems people are arriving to emergency departments needing medical attention but are not actually sick or injured enough to need emergency care.
To explore why there are these pressures being placed on the emergency services, I’ve been led to primary healthcare and found some gaps. In the community there are Gp’s (general practitioners), pharmacists and in some states in Australia we have nurse led telephone helplines. But nationally there doesn’t seem to be many other options for people seeking services for minor injuries, illnesses or non-urgent care apart from the emergency departments and in turn these services have become stretched.
Exploring Nurse Led Clinics To Help With The Overwhelmed Emergency Services
In my research I found in the UK in January 2000 they first opened a NHS walk-in centre with the aim to improve access to health care. It allows people to walk in without an appointment, usually conveniently located, linked to other health services and provide treatments for minor conditions, also it is nurse led.
I then brought the lens back on primary healthcare in Australia and I found that only the ACT (Australian Capital Territory) or Canberra has Nurse Led Clinics with both nurses and allied health workers based at the clinics. The benefits of this service is to provide non-urgent care and treat non-life threatening injuries and illnesses- 7 days a week.
For nurses working in the clinics it maximises their roles by tapping into nurses skills and there are nurse practitioners on duty as well, they are able to work with a scope of practice at a level that is independent and more advanced than registered nurses.
‘It is within a nurse practitioner’s ability to assess and diagnose health problems, order and interpret diagnostic investigations, formulate and assess response to treatment plans, prescribe medicines and refer to other health professionals within their individual areas of competence’ (https://www.acnp.org.au/np-fact-sheets 2022).
The ACT is the only state with the walk in clinics, its not found anywhere else in Australia. Why is this?
So far it seems that nurse led clinics have been controversial with doctors, they question the public health benefits and costs too. I don’t know if there are any statistics that shows if there is any value for the population in an area of having nurse led clinics or even if there are any improvements with reducing the amount of people presenting to emergency departments.
Also, I can’t help wondering if there are any other ways if both nurses and doctors can complement each others work?
I don’t think nurse led clinics will ever fill in the job role of a doctor or even cause duplication of GP services as they have an ongoing relationship with a person and their health needs. I feel that the impacts being felt in emergency departments can be improved with better access to care in the primary care setting and nurse led clinics may be an option where nurses are involved.
The main thing I’ve learnt from seeing the pressures on the paramedics and emergency nurses is that if one part of the health system is struggling with issues of workloads, resources or workforce issues- it passes through the different disciplines in healthcare. When the workforce is tired the main impact and biggest disappointment with all the pressures is the amount of people reaching breaking point, it’s hard to stay optimistic.
For this blog post I’ve had to step outside my own role of a hospital based ward nurse and I wonder if I’m naive or have any blind spots, if you work in primary care or the emergency services do you share this viewpoint or do have different suggestions or solutions for how we can return to serving the community like we used to?
- Beyond Blue – 1300 22 4636 https://www.beyondblue.org.au
- Nurse & Midwifery Support – 1800 667 877 https://www.nmsupport.org.au
- Canberra Walk-in Centres (WiC) – https://www.canberrahealthservices.act.gov.au/services-and-clinics/services/walk-in-centres-wic
- ACNP – Australian College Of Nurse Practitioners – https://www.acnp.org.au