A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift

Summary

Corridor nursing is increasingly being used in the NHS as demand for emergency care grows and A&E departments struggle with patient numbers. In this anonymous account, a nurse shares their experience of corridor nursing, highlighting that corridor settings lack essential infrastructure and pose many safety risks for patients. They also outline the practical difficulties providing corridor care causes for staff, as well as the potential for moral injury. 

Using the System Engineering Initiative for Patient Safety (SEIPS) framework, they describe the work system, the processes and how that influences the outcomes.

Content

I have been a nurse for 25 years and have significant experience across a range of specialties including ICU and cardiology. I consider myself resilient and confident to take on most nursing roles. I work in a non-clinical role at present; however I was recently asked to support in the emergency department at my hospital in order to ease pressure. I think it’s important to work occasional shifts in different specialties as it keeps me aware of the challenges frontline staff are facing. I was looking forward to working in a clinical team again.

I am an experienced nurse and am vigilant to the needs of my patients, but yesterday I was stretched in so many directions that it was impossible to care well for anyone, even on a basic level.

When I arrived in the emergency department, I was assigned to work in the corridor. The department was over capacity. There were 70 patients in the ‘fit to sit’ area and all cubicles were full, including the resuscitation rooms. The only physical space free was the corridor.

At the start of my shift there were four patients on trollies. Corridor nursing has been around for a while, and unfortunately has become a daily occurrence when it should really only be used in exceptional circumstances.

This shift starkly demonstrated the patient safety issues associated with corridor care and the difficulties it poses for staff trying to deliver safe, compassionate care.

This practice is going on right now in the majority of all emergency departments in the UK, every day, and it has been for years. It is a silent safety scandal.

Environment

What can I say? It’s a corridor. It’s narrow, it’s long.

This particular corridor has the ambulance access door as one end, which is continually opening and closing to allow crews in and out. Every few minutes the double doors swing open to let ambulance crews in with the next patient. When the doors open, in comes a blast of cold air along with dust from the road outside. On this particular day – it was February… and it was freezing.

The layout of the department means that children coming in by ambulance have to go through the corridor and will witness scenes that no child should ever be exposed to.

The area is narrow. You are only able to fit one trolley on each side of the corridor. The path through is like a chicane, you need to weave in and out of patients, relatives, equipment to get to where you need to be. It is impossible to get from one end to the other in less than 30 minutes. You will be stopped by either a patient, a relative or staff member asking for help. Help with checking a drug, moving a patient, taking a patient to the toilet… the list goes on. So, you need to weigh up the consequences:

Do you walk past everyone in order to complete your current task, ignoring them or giving excuses as to why you can’t help? Or do you help at the detriment of your current task, causing it to be delayed? Whatever you choose will end up making you feel as if you have not done your job properly. It’s like ‘running the gauntlet’.

Yesterday, one man needed an ECG (heart tracing) but I couldn’t complete this for six hours. That’s an unacceptable length of time, and the ECG showed an irregular heartbeat which needed immediate treatment. As I couldn’t use cardiac monitoring in the corridor due to the lack of power, equipment and space, I had to place him on an oxygen probe which would at least monitor a trace of his pulse continuously. There was no capacity in the resuscitation room for this patient. I have worked in refugee camps with a better set up than this.

Task

Two of the patients in the corridor were on oxygen and as there is no piped oxygen on the corridor, they were using cylinders. I noticed that one was low and asked a porter to replace it. However, I later saw that the other patient looked very unwell and confused. Their oxygen had completely run out. To make matters worse, the same thing happened to this same patient later in the shift, as the replacement cylinder I had been given was only partially full. Fortunately, the patient was fine, but that was only by chance. The consequences could have been much worse.

Competing priorities

There is simply too much to do. The triage nurse is also expected to provide patient care, which is doing two jobs at once. One is the primary role of triaging patients and placing them in the appropriate area of the emergency department, but then they are also expected to provide care to patients in the corridor.

Our priorities are supposed to be taking observations and administering medication, but added to this are countless other tasks, like speaking to angry or anxious family members, trying to find private spaces to carry out care, and keeping track of who and where all the patients are.

This is perhaps one of the most difficult aspects of corridor care—the difficulty in identifying and tracking patients.

People are constantly being moved in and out, so the person in the third bed can become the person in the second bed by the time you have completed a task and looked up. That’s a real safety risk, and we have to be vigilant that we are giving treatment and medication to the right person. There are only two computers available, which are used by the triage nurse and the nurse working on bloods, so there is nowhere for other nurses to check a patient’s history or medications. 

Person

The lack of dignity for the patients is also difficult to deal with—practically and morally. Often, we need to perform an ECG, which involves removing clothes from the upper body. There is supposed to be a room set aside for this, but it is often occupied by someone else in need—a mental health patient, a family member or a woman who has just miscarried. This task then has to be completed in the corridor. The screens we have do not provide any privacy and this leaves patients feeling exposed, vulnerable, and cold.

One other example relating to this lack of dignity happened when a patient’s catheter overflowed because it had not been emptied. He was on a narrow trolley with a thin mattress and had become very wet. I simply couldn’t offer him the personal care he needed. There was not enough space, no privacy and no easily accessible hot water. Once I was able to gain support from staff to help me change the patient he had been laying in wet clothes and sheets for the whole morning—four hours. This is basic nursing care that I was not able to perform.

There is not enough space for proper beds in the corridor and as patients are too unwell to sit in a chair here, they are kept on trollies. They can be very uncomfortable. Patients may be lying on these trollies for more than 12 hours and the thin foam mattress is not enough to protect patients from pressure damage. Without basic nursing care such as positional changes—these patients are high risk of sustaining pressure damage, which is a preventable harm.

A mental health patient was having a breakdown, surrounded by four security guards, just by the entrance to children’s A&E. The patient was in crisis—he was swearing and shouting and had ripped the handrail off the wall. He was trying to use it as a weapon before it was removed by security.

Food and drink is another issue. A food trolley does come round, but patients on the corridor are often missed, sometimes because they are off having tests, but more often because the catering staff are not sure whether each patient can have food, and the nurses can’t be found to ask. So, from the perspective of the domestic staff, the lowest risk decision is to give the patient nothing. Yesterday there simply wasn’t enough food for all the patients as we had more than 150 in the emergency department.

What happens when the corridor is full?

We were so full yesterday that I saw a patient being treated half in the department and half in the car park. Their head and body were across the threshold of the double doors to the car park. Paramedics had to treat the patient with hospital doctors While nurses were trying to squash patients in the surrounding corridors and alcoves of the emergency department, more patients were arriving. We were fighting a losing battle.

Tools and technology

The corridor is not a clinical area. It is a corridor. It was not designed for any patient to be cared for there for any length of time. It lacks basic infrastructure such as power outlets and patients have no call bells to ask for help. There is no piped oxygen available, no suction, so cylinders of oxygen are relied upon and the emergency suction on the resuscitation trolley would be used in an emergency.

The emergency department has enough equipment for the number of patients that they have been commissioned to care for. With regard to equipment, I mean drug cabinets, observation machines, heart monitors, defibrillators, thermometers, blood sugar machines, blood taking trollies, chairs, trollies, handheld devices (point of care testing/patient information), computers to access health records, telephones, plug sockets, handwashing facilities and toilets.

The entire shift was a battle in locating and keeping hold of equipment. If you turned your back for five minutes, the observation machine was whisked away. Much time was spent either looking for equipment or moving your patient to be nearer to a plug socket so that the ECG machine could be plugged in.

Organisation

Corridor nursing shifts are often offered as bank shifts, but no one wants to do them as they are deemed risky by the nurses.

They are worried that they may make an error and lose their PIN. They know the care that patients receive is sub optimal and this in turn reduces morale—it’s best to stick to your allotted hours, why work in the corridor when you can only give minimal care?

What needs to change?

What I experienced yesterday was an unacceptable situation for patients, relatives, paramedics, doctors, allied health professionals and nurses. If corridor nursing is here to stay, we need to recognise the significant and unique challenges it poses. That involves the NHS investing in delivering it as safely as possible as a new speciality.

What we really need is investment in social care and mental health services so that people don’t end up in A&E when they don’t need to be there. There are so many issues that are much better treated in other settings. It is not good for individuals, and it is disastrous for the healthcare system.

There was one man in the corridor who had been very quiet all day. Towards the end of my shift he shouted that the place was “a living hell,” and I can’t disagree with him.

I drove home after my shift hungry, thirsty, tired and broken—this was the worst care I have given in my entire career.

About the Author

The author of this blog wishes to remain anonymous.