Simulation Today Autumn 2021

FEATURE
England since 2010. Coupled with an increase in number of attendances
for ED’s (in England). 2018-19 there were 24.8 million attendances up 4%
on the previous year and 21% since 2009-10 (NHS Digital 2019). These
two factors among others have created a situation of overcrowding in the
ED. Overcrowding or crowding is defined by Royal College of Emergency
Medicine as the inability to offload patients from ambulances, or long
delays for high acuity patients to see a doctor. Furthermore, excessive
numbers of patients on trolley or beds in the ED more awaiting cubicle
spaces, or patients waiting more than two hours for an inpatient bed after
a decision to admit has been made (RCEM 2014). These factors coupled
with the nursing shortages mean that the ED is always busy. Traditionally
mornings were quieter in ED however recent data show’s that the highest
number of attendances occur between 10 am to 6pm every day (NHS
digital 2019). Furthermore, the length of stay for patients has increased
(NHS digital 2019). When combining the increased attendances and
length of stay with the reduced number of beds and staff, it is easy to see
why the ED’s have got busier. This has resulted in increasing difficulties
in withdrawing nursing staff from the shop floor to participate in teaching
including SBLE.
These factors that have just been described combine again to result
in a nursing workforce that is fatigued and potentially not wishing to
participate in educational sessions (including SBLE) in their days off.
However, on the survey only one nurse stated that tiredness was a factor
that inhibited them from attending SBLE. This links with another factor
that a single nurse highlighted which was family commitments, while not
‘every’ emergency nurse will have family commitments ‘every’ nurse will
have some commitments outside of work. This results in an inability to
attend every SBLE opportunity.
One nurse stated that shift work inhibited them from attending SBLE,
nurses work a variety of shifts patterns in the ED, not just day and night
shift but shifts with variable starting times to best meet the needs of
the service. This in turn means that nurses have a higher probability of
missing SBLE sessions than those that work traditional working hours.
Emergency nurses highlighted that some departments do not have the
right resources to be able to access SBLE while working in the ED. Four
percent of respondents stated that there was a lack of senior nurses
to provide SBLE in their department. Furthermore, not all ED with have
a simulation lab located near to their department. This means if in-situ
simulations are not performed it can result in difficulties getting nurses
away from the department and potentially this could be quite difficult if
the simulation lab is on another site.
Conclusion
By understanding the barriers that inhibit nurses accessing SBLE in the
ED it means that the risks can be mitigate and some of these factors
can be improved in the future, to improve the uptake of SBLE by nurses
in the ED.
This piece of work has highlighted the paucity in the literature of factors
which inhibit nurses from undertaking simulation generally and in the
ED. Due to the lack of literature a small-scale questionnaire was devised
to explore this subject. This survey has highlighted several barriers
these are, nurse’s individual anxiety although the research is conflicting
about this. The author believes that some nurses feel under greater
pressure when undertaking SBLE, and while the long-term stress maybe
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