'The good, the bad, and the ugly' of my emergency nursing career.
Subject: Nurses (Beliefs, opinions and attitudes)
Nurses (Practice)
Author: Hailstone, Debbie
Pub Date: 08/01/2010
Publication: Name: Kai Tiaki: Nursing New Zealand Publisher: New Zealand Nurses' Organisation Audience: Trade Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2010 New Zealand Nurses' Organisation ISSN: 1173-2032
Issue: Date: August, 2010 Source Volume: 16 Source Issue: 7
Topic: Event Code: 200 Management dynamics
Product: Product Code: 8043100 Nurses NAICS Code: 621399 Offices of All Other Miscellaneous Health Practitioners
Geographic: Geographic Scope: New Zealand Geographic Code: 8NEWZ New Zealand
Accession Number: 236247960
Full Text: There must be something special about Middlemore Hospital Emergency Department (ED) that has kept me here for over 20 years. Maybe it is because Middlemore is continually evolving, and I have stayed because I wanted to be part of the change. Although not always easy, I feel we are now getting it right for the patients and the staff. The journey has definitely exposed me to 'the good, the bad, and the ugly' of emergency nursing.

When I started my emergency nursing career at Middlemore ED, it was in a 20 bed unit. The department was run by hardcore nursing staff, experienced, independent and a little scary. I was taught by the "watch me then do it" method. A rough introduction to acute nursing, but the lessons will never be forgotten. It was fun and new, and think of these days as the 'good' times.

In 1992 the first of the redevelopments occurred increasing the department to 36 beds. The need for expansion reflected the growth in the South Auckland population. The diverse community supplied us with all kinds of raw emergency situations. Complex medical conditions and high trauma presentations related to the low socio-economic community we served. I learnt so much during the 1990's, and although I thought the situation was "bad" with issues of understaffing and overcrowding, it was nothing compared to what came in the new millennium.

In 2000 we became the biggest ED in the Southern Hemisphere--with 96 beds. The 2nd redevelopment was designed to meet the population, but within the first month we had already outgrown the new department. We cared for patients in corridors and other non-clinical areas, and the team work that had worked in the old department, was lost in this extensive environment. It felt like we spiralled down into the darkest times. Staff worked from one day of crisis to another, not only managing acute emergencies, but also patients waiting for a ward bed. It was important to eliminate overcrowding, long waits for treatment and delays in the ED, and restore public confidence and staff trust in the emergency service.

The 'ugly times' began to end when CMDHB decided that patient and staff care in the ED had to improve. The CEO saw clearly the relationship between the community and the organisation, and how the organisation could be judged by the performance of the Emergency Department. At the same time the MOH set a national health target; 95% of patients presenting to ED would be admitted, discharged or transferred within 6 hours. Emergency Care was provided with a new Nurse Manager, Nursing Director, followed by a new 'Head of Department' and a new Service Manager. The vision of these leaders created a robust and safe environment, stabilising the work force and generating career pathways. There is now structure to our professional development, an exceptional education programme, and support from the clinical coaching team.

As an innovative organisation, the leaders have listened and empowered the staff to make changes they felt necessary. The trials and tribulations are over for now, making it right for the next generation of emergency nurses. The 'good, the bad, and the ugly' are truly behind us now, but I can see these were steps that we had to experience to get to the 'best of times' which is what I have now.

Debbie Hailstone

RN and Facilitator

Quality Improvement
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