Nurses have been left feeling "battered, bruised and deflated" by the pressure of working in Northern Ireland hospitals.
Emergency nurses are going home hours after their shift ends, exhausted and wracked with guilt worrying that they have not been able to give proper care, Health Minister Edwin Poots was told yesterday.
A&E nurse Roisin Devlin said her colleagues remained passionate about their work and continued to go beyond the call of duty, with one even giving an elderly patient the soup she had brought to eat during her break.
As pressures of A&E services across Northern Ireland remain in the spotlight following a Major Incident declared last month at the Royal Victoria Hospital in Belfast, Mr Poots attended the Royal College of Nurse's Emergency Care summit yesterday.
The minister had originally been scheduled to make a speech at the union's conference, but also took time to listen to concerns voiced by A&E nurses.
One Ulster Hospital A&E nurse called Anne told the Belfast Telegraph that there were times when patients waiting on trolleys even have to be taken off them to make way for another.
"For example, you have a standby – where you know that a seriously ill patient is coming into the department – and you don't have a free trolley so you are having to take a patient off a trolley to get a trolley to put a sick patient on," she revealed. "It's not fair on either patient or the staff.
"There are times when there are even delays unloading ambulance patients because we are so physcially full with patients.
"It starts at the ward, then goes back to A&E and the ambulance so you can have ambulances delayed on going on calls because they can't unload their patients. And this is across all of the trusts."
Ms Devlin said A&E nurses felt broken. "We've been kicked, battered, bruised and left feeling deflated," she said.
She said A&E nurses had been left inadequately prepared for dealing with sick patients, overwhelmed and stressed.
Through her role on the RCN board she has heard concerns of her colleagues, including one nurse who described breaking down in tears one day in work because she could see all the things that needed to be done, but didn't know how to do any of them – due to the cuts in A&E training.
Another spoke about how after spending an entire shift making phone calls and pushing trolleys, she realised she had done no actual nursing.
While another spoke about being overwhelmed with the amount of work and, even though she had not stopped all day, went home wracked with guilt that she felt she could not care properly for her patients.
But despite these conditions Ms Devlin said her colleagues were still passionate about their work and gave an example of one nurse who gave up soup she had brought in for her own break for an elderly patient who wanted soup, rather than tea and toast.
Ms Devlin said that so far A&E nurses had been silent about their plight but now they intend to "roar". She urged Mr Poots to provide them with the education they need to do their jobs, involve them in decisions and to let them nurse instead of clerical duties
Speaking to the Belfast Telegraph after the meeting, RCN deputy director Garrett Martin said the tone had been respectful but that the questioning had at times been uncomfortable for the minister.
Points were made to the minister around workforce strength, pressures, moving forward in relation to Transforming Your Care.
"The minister clearly said there needs to be a focus on that (Transforming Your Care), and a commitment to deliver on some of the changes in relation to community care and some of the alternatives to patients having to end up going to A&E because that is one of the problems – there are no alternatives," he said.
"It certainly was a respectful atmosphere, the nurses who spoke clearly outlined some of the issues and certainly the minister admitted himself that some of it was uncomfortable for him to hear.
"But that's good. The fact that he has listened, and the fact that he has given a commitment to make the necessary changes."
Major Incident was a wake-up call
Janice Smyth of the Royal College of Nurses says there has been a problem in terms of the staffing of A&E units for 18 months.
This situation boiled over last month when a Major Incident was declared at the Royal Victoria Hospital (RVH) in Belfast when a backlog of patients led to lengthy waiting times in its A&E unit.
During the Major Incident, patients faced waits of more than 12 hours, extra staff had to be drafted in and some in the ward likened the scene to a war zone.
The next day, hospital workers booed Health Minister Edwin Poots during a visit to the unit.
Last week concerns about the pressure on A&E staff were raised again when the Belfast Trust admitted that delays in treatment may have been a factor in five patients' deaths at the RHV in 2013.
Chief Medical Officer Dr Michael McBride apologised to the families of those who died.
He told Stormont's health committee that three of the five "serious adverse incidents" at the Royal were being investigated, and one was subject to independent review.
Summit with under-pressure staff wasn't a showdown, says minister
Health Minister Edwin Poots denied his meeting with dozens of under-pressure emergency nurses yesterday was a showdown.
Last month a Major Incident was declared at the Royal Victoria Hospital's A&E.
A subsequent report found serious failings – including "intolerable pressure" on staff.
Yesterday, nurses from A&E departments right across Northern Ireland told Mr Poots in a private meeting about the continual pressure they work under, lack of training and feeling "broken".
Mr Poots said their voices were not being heard and that he was there to listen to all they had to say.
He paid tribute to the work of emergency department nurses and said he believed some of the proposals contained within the Transforming Your Care policy document should address concerns.
"I have the greatest admiration for the way in which emergency department nurses deal with a wide range of medical and surgical emergencies, and trauma situations where you are required to draw upon a wide range of skills, knowledge and expertise to deal with both the expected and the unexpected," he said.
"I know the chief nursing officer has been meeting a number of emergency department nurses and through that process, it has been agreed that important work will be taken forward which clearly sets out key professional standards for emergency department nursing.
"This will also include work to develop a career pathway for emergency department nurses.
"I look therefore forward to seeing the outcome of this work which will be led by the emergency department nurses forum."