A letter to the ED nurses from an Aged Care nurse.

Here is an open letter to emergency department nurses written by an aged care nurse:

Dear ED nurses.
Firstly a shout out to all the nurses in EDs across Australia. I have worked in ED and I know the high level skills needed to work in fastpaced, complex and often emotionally charged situations.

Hats off to you all.

HOWEVER we need to talk about the elderly nursing home residents in EDs because frankly it just not working.
Elderly people who come into ED are there for the same reason as everyone else.

To be assessed and treated for an acute episode.
Agree? Yes? Great!

Aged and frail people have an additional care overlay though. If the mechanism of injury is traumatic (ie a fall) or infectious the aged are likely to develop delerium especially with a background of dementia.

This makes these people quite hard to manage in a busy ED… but here is the kicker THEY ARE STILL ENTITLED TO CARE.

We are all nurses. Basic nursing care is the foundation of what we do regardless of specialty.

So all you fabulous ED nurses out there. With the greatest of respect please, I beg of you, remember to treat their pain (even if they can’t express it – especially then), remember basic hygiene – contince aids, mouth care, skin care etc, feed them for heavens sake, and please please please dont send them back in the small hours of the night – most nursing homes have no access to medicos outside of business hours and no one wants to think of their elderly family member having to suffer through severe pain until the gp comes in to write up something stronger then paracetamol and the pharmacy is able to deliver it.

Thank you again for your hard work.
A dedicated aged care RN

13 thoughts on “A letter to the ED nurses from an Aged Care nurse.

  1. There are problems in every part of health care. I’ve never worked in a nursing home, rehab, or SNF. I’ve worked in almost every part of the hospital however and I’ve NEVER had a patient from a nursing home who was in good shape. Not once. They are all lacking basic hygiene care, malnourished, and in pain. That says something. It tells me that nursing homes and their affiliate programs are incredibly understaffed and underfunded. It also tells me that my parents will never be placed in one. Basic hygiene. That’s all I ask. For just one of my overweight patients to come in without fungus growing in their peri-area. For their teeth to have been brushed in the last week. That’s all I ask. Because it hurts to send them back to a facility in which I know they won’t get good care. It hurts to look at their children and NOT tell them, “get your loved one out. Now. They deserve better.”


  2. Totally agree with all that has been posted as I lost my husband in October at a nursng home and felt that the hospital staff when he had been admitted for a fracture of the shoulder had been issued with instructions not to do anything heroic and he lingered on unable to walk after that fracture for another 10 months in the nursing home in a very depleted state. I sincerely hope that his suffering was not too great as panadol was the painkiller of choice. The nursing home do not have trained nursing staff just one nurse to 120 patients and they are not able to administer the care required. I suggest that nursing homes set aside 3 beds at least for palliative care purposes as end of life care is not good at all.


  3. With respect to the ‘aged care nurse’ I too have worked in both! I treasure aged frail pts all of which are treated with the dignity and respect offered to all. But please you ,of all people are aware how often a nursing home pt is sent unnecessarily into ED for a ?UTI or a fall that they had 12 hrs ago and a night duty nurse was concerned even though nil behaviour or injury noted through the day, and send into ED at 11 pm. All of these issues can be handled by their own GP. How cruel is it to send an elderly frightened person into ED when they can be kept comfortable with end of life issues in their own bed. So please have a little thought for ‘us’ , that when we call for an ambulance to return a pt to a nursing home at 2pm we have no control when it arrives at 11pm. When hospitals are stretched to the limit , limited ED beds and that little old lady who can be managed at their facility keep them in their home!! And if they are sent in for injuries or medical conditions requiring treatment please send their current ‘medication’ chart not a 3 month old one. This always occurs. So ‘Aged Care Nurse’ perhaps we can both look at each other’s side!!!!!! Do not put down your peers when the Emergency Dept is used for the wrong reasons.


  4. Plus we now have 4hr timeframe to see treat & discharge all presentations -I’m happy that I have always treated each with the same respect but we are pushed for time…having a complete history /meds included are supplied with thanks but we could do with more End of Life plans or I’d prefer AND Allow a Natural Death at home/residential care not a busy ED ..we have no choice but to send patients home once their care is completed esp to a residential facility from which they came. Otherwise we need to answer to management NEAT that is…


  5. Too many nursing home patients are sent to the ED when they can in fact be treated at the nursing home. Many times a “NFR” pt is sent in for end of life care or because they have deteriorated. We can only make them comfortable, the same as could have been done in their own environment. Most pts don’t want to die the the ED. As for sending them home during the night, it is not appropriate to keep a patient on an ED trolley until the morning when there is a waiting room full of patients needing that trolley. Patients can be discharged with medications, enough to keep them going until they can be prescribed more by their GP. I find the author of the original post to be quite ignorant of the function of the ED even though she states she worked in the area.


  6. Some of us ED nurses are the first ones to have changed a dressing for an aged care patient that the nursing home staff has not. Or give them their first bed bath in who knows how long. Or snuck them extra skin care supplies when they get discharged back…

    Some of us do it because we know they are neglected there, whether intentionally or unintentionally, because we know aged care nurses are over whelmed, understaffed, and undersupplied and the patients suffer.

    The kicker here is I’ve rarely heard other nurses blame aged care nurses on the lack of care these patient’s recieve when we get them riddled with pressure ulcers – we blame the organization you work for because we KNOW you don’t intentionally let that happen. So knowing that we, too, are at times over worked and unable to give the one to one care ALL patients deserve, why is there so much condescension in your plea?

    Liked by 1 person

  7. Why do I think this nurse would be less sanctimonious after working say 15 ER shifts?

    If you don’t want your patients to get delirious in the ER: don’t send them to the ER. There’s not much we can do about it if you send a 98 year old to the ER at 3am. We are going to have to wake her up.

    I have zero patience for nurses criticizing ER practice who have no idea how the ER works in the first place.


  8. Found this rather condescending and insulting. Actually. Working across all fields of Nursing for the last 20 years ED nurses can be judgemental, can be stressed, despite this, I have in the last 7 years in particular, worked with the most dedicated and caring ED nurses I have come across yet, who would never treat a resident so poorly. yet, so have I seen carers not be bothered to take the time to feed residents, RNs in charge bullying not only residents, but the carers as well, with no care at all for the resident. My point is, there are some brilliant nurses in all fields and there are bad ones. We all need to be mindful of each field and how diverse it is, and that the person we are there advocating for, is the patient, the resident, the child who fell off a swing, the overdose or the person who is ready to leave this life needing End of Life Care. Be mindful of Each other and know that the good ones are striving for the same goals in every field: to be the best nurse they possibly can in amongst all the paperwork for the sake of their charges.

    Liked by 1 person

  9. I’ve also seen the opposite. One lady had begged the care staff to change her “dressings” just soggy pull ups held on with tape, concealing a raging infection. Until she paid to see us. Or hungry elders who nurses sneak extra food to during outpatient visits. It goes both ways.

    Liked by 1 person

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