By Shahina Braganza
Emergency Departments are typically known for their team ethos, the camaraderie between staff, and the attitude of “any patient, any time, any circumstance” – even when the circumstance might be acute under-staffing due to illness, heavy patient load, and of course the ever present access block. We pride ourselves on being able to manage (almost) any situation with (almost) any resource constraint.
However, every now and again, a department can run into trouble with its morale its vibe – its Mabo*. The shift can be imperceptible. A curt word here. A dismissive tone there. Gradually, it becomes discernible that people appear to be under strain. Sometimes the fall-out can be maximal for the most junior members of our team – the trainees and the junior doctors.
They might feel that we, consultants, are abrupt when we speak with them. Or we might be impatient as we listen to a case presentation. Or we may become interrogative and aggressive in our questioning as they hand over patients after night shift. Or we may find ourselves inadvertently undermining their judgement and care of a patient as we then have a dialogue with the inpatient team – whether they are within earshot or not.
So, you may be reading this and thinking now as I may have thought then:
I don’t think I do this.
So, I don’t think I do this. But how can I be sure? I recognise that I’m pretty even-tempered at work, but my family knows that I am wholly capable of behaving like a narky psychopath, sometimes with little warning. And maybe I don’t do these specific things, but perhaps I do other stuff that has a similar detrimental effect. I’m definitely going to pay more attention to what I say and do, and how I say and do it.
We are short-staffed at the moment and we all need to wear some rough edges.
Sure, there is stuff we can’t control and it’s understandable that we’re all going to be feeling a little tetchy about it. NEAT and other targets stay static regardless of our circumstances or workload (sick calls, record-breaking numbers, etc). But amongst this, there is stuff we can control – and setting the tone for our teams is one of these things. See below.
Our staff should harden up if they want to work here.
EM is a tough gig and it takes resilience and fortitude. But we are human. In fact, it’s our human-ness that makes us whole, effective clinicians. My late colleague, friend and mentor always said “People don’t remember what you said, but they remember how you made them feel” (T Roosevelt). How we make them feel – whether they are patients or colleagues – comes from that human part of us. To deny or ignore it is not only pointless, but it detracts from the positive impact we can have on people around us.
Our EDs are invariably busy and messy, sometime frighteningly so. Our saving grace is our solid pyramid of amazing staff, including medical, nursing, allied health, admin, wardies and all the rest.
The base of this pyramid is formed by a robust, resilient, well-intentioned, crazy-hard-working group of junior doctors and trainees – and they are our life-blood as a consultant group and a department.
They are the reason we can get by on shift, get the work done, and ensure nothing bad happens (to the patients or to us). They are the reason we never need to worry about a difficult ultrasound-guided cannulation because, between them, they are spectacular at this – and a whole array of our other decaying skills. They are reason we can sleep most nights on call.
The culture of our ED is the very fabric of it. Our survival depends on attracting the best of the best staff and trainees. We do this by providing an incomparable case mix (tick), a stellar training program (tick), and a happy, psychologically safe environment that creates a sense of community, belonging and value (mostly tick?).
Our influence as leaders in this team is vast.
Our actions are infectious and contagious.
We make an active choice at every juncture regarding the response we want to induce in those around us. We are completely entitled to feel tired/frustrated/angry/sad, but we don’t have to translate these feelings into actions, unchecked.
We can choose to be constructive or destructive. I have done both of those things and, while the latter can be supremely gratifying at a raw human level, it is short-lived – and then it’s come back and bitten me on the backside: because I’ve undermined confidence, or destroyed morale, and now no one is talking to me because they are scared of me**, and then no one wants to tell me that I’m about to hit the femoral artery instead of the vein because they think I’ll bite their head off.
So, particularly as winter sets in, I want to ask us to check ourselves. We create the reality around us, and we choose what that looks like – every single moment of every single shift on every single day. We’re not going to be perfect but let’s work to get it at least mostly right.
*From The Castle (1999) ”probably the greatest Aussie film ever made” – https://www.rottentomatoes.com/m/the_castle
**Again, a little peace can be awesome for a while, but it’s not good for anyone, let alone our patients.