I’ve been back at work for 2 afternoon shifts. I have just come back from 15 days of annual leave over the Christmas and New Year break. The day I started my leave, it was such sweet relief to walk out of those sliding doors and know that I had some reprieve from the emotions and fatigue of working in an emergency department during a pandemic, while also having a slither of guilt for the work mates that are still in the thick of it.
The day I went on leave was the start of the nightmare that is COVID for Qld. The boarders had just been opened and the influx of positive cases had not hit as yet. That would come with in a couple of days.
Now I am back and in the 15 days I was on leave the department has an air of anxiety, fatigue, anger, chaos not even organised chaos anymore, just chaos. To a point that it is dangerous and impacting patients and staff. A workplace where nerves are frayed, and fight or flight is the feeling of the day in wonder of what is next.
I am a health care worker – an Admin officer. Essentially a medical secretary that works a 24/7 roster in all areas of the Emergency department.
In the Ed we work in a team environment. The nurses and doctors aren’t able to do their jobs of caring for patients, if we are not there to do ours.
The admin officers are generally the first person that a patient or relative will encounter on presentation to triage. It is the admin officer in the emergency department after hours who is the voice on the end of the phone for the whole hospital and their questions, problems, queries and seeking admin support.
Admin officers are the people responsible for the identification of the patient with their correct name and date of birth, and hospital UR number. This information can come directly from the patient, a relative, an ambulance or police officer, it is not always reliable information, and we are held accountable to make sure it is correct. It is our job to make sure nursing and medical staff have the correct labels and arm bands for the delivery of drugs or the accurate results of imaging and pathology. It is the admin officer who ensures the medical records are with the patient, an important resource the nursing and medical team need so as to have all the relevant information and history for the care of the patient.
The admin officers are the people answering the phones of patient enquires. Stressed and anxious relatives who want updates on the patient. More often than not, the phone call bounces back to the admin phone with a rude, angry, or now abusive relative, when the nurse is unable to answer the transferred phone call because, they are organising ward beds, consulting with their colleagues, checking drugs, helping with a patient, on the phone or any of the other one hundred things they are responsible for.
We admit our own patients as well as patient transfers from all over the state, discharge patients to and from the hospital, we file all the medical records and paperwork for every single patient, we organise staffing and emergent leave coverage, we help and answer questions for anyone that presents to our desk. That can be anything from directions to a ward, to being abused by the patient or relatives in relation to wait times. We send details and information to hospitals where our patients are transferring to. We complete the relevant paperwork for admission and revenue raising for private patients in a public hospital.
The admin officers are the people that the nursing and medical staff come to for help, guidance, and support in countless issues during a shift.
To work in an emergency department as an admin officer is a dynamic, stressful, and ever-changing environment, working with a multi-disciplinary team. There is constant movement, sights that can be confronting, noise, smells, and at times sensory overload, alarms sounding, monitors beeping, medical emergency bells ringing, duress alarms screaming, the constant ring of the phone, people talking, patients yelling abuse. The layout and the flow of the emergency department changing with the increased number of patients presenting because of the pandemic. The Ed that I work in, the admin officers have been stable for many years. The same names on the roster year after year. The knowledge and experience of the admin officers in the department is one of those things that is drawn on and implemented seemingly effortlessly, as most of the staff can do their job quiet literally in their sleep.
The patient with abdominal pain still presents, mental health patients fill beds and waiting rooms, cardiac arrests are still rushed into a resus bay, code strokes are still called, or the broken bones, the concussions, the kidney stones or the gall stones, the neutropenic chemo patients need beds, as do the palliative patients, the kid with the piece of Lego up his nose needs to be seen. All of the usual emergency department presentations still come through the door. None of this stops because of COVID. It is now exacerbated. And beyond that triage desk the understaffed, the fatigued, angry, fed-up staff continue to be professional to do their role in the team to the best of their ability, the admin officer, the nurse, doctor, wardsman, cleaner, security, social worker, pharmacist, radiographer, and sonographer.
The conversations in the tearoom, or the walk to the carpark at the end of a shift, where faces are turned to the sky sucking in air after a whole shift in N95 masks and PPE. Are conversations of frustration, exhaustion, anger that there is no support, no plan; only band aids to fix the hole in the side of a sinking ship. There has been no forethought and two years to prepare, people that have no idea about the flow or management of an ED, are making decisions that are causing experienced, educated, passionate healthcare workers to breakdown, leave the job or career that they once enjoyed, or stay and endure and cause damage to their own health working overtime, under such pressured conditions and the flow of patients that never ebbs. Health care workers not just nursing and medical staff are working understaffed and overtime to support their team and their colleagues, to fill the hole where there is no extra staff to fill. Because in a place like an ED the numbers do not reflect the stress and emotion. It is about the people that you work with, how the team works together, and for each other that gets you through the shift.