Just part of the job

Justpartofthejob Encountering people as patients in the Accident and Emergency (A & E) department has to involve extremes. Being able to move from one person to another, along a whole spectrum of feelings, is part of the everyday work. We often assessnurses’ ability to work in the department on how they tolerate this. Many of you have done it for years, many of you say it is part of the job; somehow you build into your skills the ability to tolerate these extremes. Recent pertinent research has explored the subject in more detail, and highlights issues that are a cause for major concern (Walsh et al, 1998). This study, carried out using a group of nurses attending the A & E National Conference, should alarm us. As the authors point out, an assumption we might easily make is that these nurses are an enthusiastic, well-motivated group of people or they would not be at the conference. Many expressed distress about the nature of the work and about the very core of what are everyday encounters. A major fear was that they would become emotionally detached from the patients’ distress. Presumably this would be because the nurses needed to defend themselves emotionally Yet often nurses will say glibly that they get used to it and it is part of what they do. Patient difficulties or behaviour can be explained: the explanations are based on wellfounded theory. Transference is an unconscious response in which the patient experiences feelings or attitudes towards the nurse which are

Acndenr and Emergency Nuning (I 998) 6, I25 0 Harcourt Brace & Co. Ltd I998

icant figures in earlier life, We all know about fear and panic and irrational behaviour and feelings; this is all part of being human and at times vulnerable. After all, we have been taught about this, and have probably experienced it on a personal level. If we understand this on a cognitive level, and even on a feeling level, why does this not help us to respond to it in a way that makes it all manageable? I suspect it usually does. A & E nurses become experts on humanity and on human behaviour in particular. They develop extra special skills for dealing with people. Yet as the study reveals, we should be concerned about the high risks A & E nurses take on at an emotional level. My belief is that in order to cut costs and increase productivity many nurses are being pushed beyond what is endurable. Savings on one level are resulting in increased costs on another, in this case costs to our staff as this study highlights. Our most valuable resource is at risk of becoming dysfunctional. There will be a more serious cost to our departments because of this, and on a human level, life at work will become intolerable. One of the positive responses in the study is that A & E nurses fear becoming emotionally detached. This suggests to me that insight and hope still exist. As long as we still fear detachment we still have the best interests of the patient at heart. We continue to look for ways to redress the balance, and we need all the help we can get to prevent the fear being realised. We need all the help we can get. Is anybody out there listening?

Bob Wright, Editor

REFERENCES Walsh M, D&n B, Lewis A 1998 Burnout and Stress among A 81 E nurses. Emergency Nurse 6: 6-9