New Year’s Eve in A&E: Belonging in action

I spent much of New Year’s Eve in A&E. Not for drunken behaviour.

For my Mum who needed urgent care.

Few work environments have demands as intense, or camaraderie as close, as an Accident & Emergency unit in any town’s main hospital. Success or failure of the staff rests heavily on a tight sense of belonging and easy professional exchange between them.

There’s nothing much you can do as the supportive relative, the impotence can be frustrating. As my mother dozed my attention was distracted by watching Belonging in action around me.

The experience is alien, but the scene is familiar from all the telly shows: the cast of characters moving in and out of the central square, Command HQ; the bays around the side, the blue curtains; a couple of policemen chatting with nurses, hands in pockets of their protective vests, looking casual but a clear eye on whoever was being sewn-up behind them.

Camaraderie is high and, as in other critical work environments observed in this research on belonging, here it is much more than just ‘nice’ – it is essential to doing the job well.

Interdependency is visible. Each person moving quickly with purpose – but not racing, no panic.

Communication is clear and direct. The handover from ambulance team in two minutes. Scale and urgency of need assessed quickly. Priorities constantly rebalanced. Shared understanding of what’s happening, why, who needs to do what.

A great example of active internal communication: in this setting of electronics, bleepers and gadgets, the old-fashioned Whiteboard is still King. Clear basic information, simple code of symbols. Immediate, responsive. Hand written, reassuringly human.

Community is strong too. A sense of belonging to the hospital, and of belonging to Middlesbrough. But overriding all that, this team belongs to A&E: a specific world with a distinct code.

It’s transient for patients but absolute for staff. They go to the edges of A&E to handover, but don’t really leave. Other figures come in and out briefly.

“You see that lady in the suit, she’s Hospital Management. She’s sorting out the beds. Your Mam has a priority symbol, she’ll get a bed.”

Status is interesting. Though medicine is a notoriously status-driven profession, other than the-lady-in-the-suit-who-came-from-upstairs, in the A&E team it was hard to see status. The focus was more on each person doing their part with a clear definition, the tasks and team members interconnecting smoothly. There was a guide to the different coloured tunics, but there was no overbearing body language or tone of voice that said
“I’m frightfully important” or “I’m lowly and humble”.

Team members showed clear respect for each other, their roles all important and well-defined.

The nurses express this politely to families, in the positive and with specifics:

“I’m helping with [specific task], I’ll be in and out, ask for whatever you need. The doctor [points to specific person and names them] will be round in about fifteen minutes to assess the next steps. It looks like we’ll need [specifics]. You’ll be here three of four hours”

This is so much more useful than the negative and generalised comments you often get “That’s not my job” or “I don’t do that” or “We don’t know how long you’ll be.”

By late afternoon the team was busy bolstering forces and kit, with all the precision of a military briefing, ready for the New Year’s Eve onslaught. Assigning areas for later

“That’s for trauma.”

“Keep that section round there clear for paediatrics and geriatrics.”

“Up here round the back for the Drunk Tank.”

(Later in the evening that last phrase inspired a singalong with my sister and brother of ‘Fairytale in New York’ by the Pogues)

It all felt a bit like M*A*S*H, waiting for Radar O’Reilly to say the helicopters are coming in. And suddenly a tannoy message did indeed say

“Trauma in five minutes.”

It meant arrival of patient rather than cueing an incident in five minutes, but the non-bodied voiceover had a surreal sense of a flight-control centre for mortals.

The doctor pre-empted any concern that we risked being stuck in A&E in all the lairiness of New Year’s Eve.

“I’ve already ordered a bed, you’re on to XRay soon, we’ll have it done before the shift change.”

We’ve learned a lot about hospitals this year, and how to be a good advocate for our parents: shift change is an important rhythm.

Time to move to XRay. I picked up our bags, reassured Mum, thanked Laura our nurse, and thanked Rich our porter for pushing her as gently as possible and watching out for bumps.

We moved down the corridor, left then right. 20, 30 yards.

And what a different world. No-one to explain. Mum left on a trolley in the corridor. Rich hung around, a little uncomfortable.

“I’ll just mind here awhile, make sure you’re all OK.”

Sure enough, we weren’t.

The radiographer couldn’t find details or request form, then found documents from a previous visit

“Aw you’re alright, it says here no more X-rays.”

I pointed to the sheet.

“That was 10th December. Back in today, new thing to deal with.”

And the killer phrase of Unbelonging:

“Well I can’t tell you about that. We don’t assess patients. We just do the X-rays. I’m not part of all that. We’re separate.”

20, 30 yards. A separate world.

The strong sense of belonging in the A&E team had embraced us also: we felt safe. Now we felt disconnected, insecure.

Mum: “Are you causing trouble Isabel?”

No, just my best efforts at empathetic, diplomatic, stalwart lobbying.

Radiographer reconnected with A&E, came back with Rich and a smile. We got the XRay and the bed. And compassionate care from the nurses.

But what if one of us wasn’t up in our hometown at that point?

This is why patients need advocates.

For all the elderly who do not have family immediately with them we need to provide a network of well-trained professionals. So that patients can belong and get the care they need.

My sister and brother joined us, after a long car journey. The best tonic for all of us after a tough day as Mum settled on the ward.

And so we three spent our first New Year’s Eve together in our hometown for 30 years. Enjoyed a fine Northern tradition: out for a curry and people-watching:

“Oooh, he’s heading to A&E before the night’s out.”

We saw in the New Year together, first-footing by telephone with our respective families, exchanging greetings with neighbours.

It’s been a year of debelonging and rebelonging.

Wishing you all joy in 2015.

May it bring you life, love and laughter.

Do your teams have a shared sense of belonging and accountability? 

Talk to us about how to create effectiveness from Belonging.