Working in an overcrowded accident and emergency department: Nurses' narratives

Aim: The aim of this study was to highlight nursing issues associated with overcrowding (or access block) in the Accident and Emergency (A&E) department. Design: An interpretive phenomenological approach was adopted, with the utilisation of unstructured interviews. Setting: The A&E department of a general hospital situated in the West of Ireland. Participants: Eleven nurses working in the A&E department volunteered to be interviewed. Findings: Three central themes, with inter-related sub-themes, emerged from the data. The central themes identified were: lack of space, elusive care, and powerlessness, with sub-themes being health and safety issues, infection control issues, poor service delivery, lack of respect/ dignity, nurses hovering, unmet basic human needs, not feeling valued, moral distress, and stress/burnout. Conclusions: The nurses in this study provide a distressing picture of nursing in an A&E department, as they pursue the provision of effective, holistic care of patients in overcrowded conditions.