Britain will be hit by an unprecedented nurses' strike next week as one frontline carer reveals the relentless pressure they are under.
It is likely to be the first of a wave of strikes planned for the NHS after a decade of below-inflation pay awards and an exodus of senior medics.
A lead nurse at a major hospital has penned a diary of a typical day in A&E dealing with open wounds, broken bones, stabbings and abuse.
Shifts assessing as many as 20 patients an hour are getting busier and longer, taking a gruelling toll on workersâ family lives.
Her candid account comes after an international report found that UK nurses are among the worst paid in Europe after real terms salaries fell since 2010.
Royal College of Nursing General Secretary Pat Cullen has written to Health Secretary Steve Barclay, demanding nurses be "valued" in Britain and that the government "opens formal negotiations" over pay.
Here Rachael, who oversees an A&E department at a major hospital in South East England, describes a typical day at work. We have withheld her surname at her request.
06:20 This is my first of three long day shifts, workÂÂing from 7.45am to 8.15pm. As I leave home, my kids are still asleep, so I hug and kiss them goodbye. I probably wonât see them now until breakfast on Saturday unless I can squeeze in a quick video call on my break. They are good kids. They always ask me: âAre you going to work today?â and pull a mock-sad face when I say âYesâ.
07:10 I arrive early so I have just enough time to get changed. Iâve been an A&E nurse for 11 years and our shifts are getting busier. We work all bank holidays and treat everything from open wounds and broken bones. I can assess as many as 20 patients in one hour, as well as having to maintain those booked in, and dealing with the patients coming in from ambulances. I also oversee the whole department, managing students and junior staff and taking care of the admin.
07:45 While seeing patients who are now booking in, I can see from the night teamâs faces it has been a tough night. Thereâs been more acute care as well as high levels of aggression. One of my colleagues was quite upset by this, so I make a mental note to check in with her. My âwork familyâ is amazing, we try to swap shifts to allow each other to go to social events when we can. The morning department checks need to be done, and itâs just me and two other junior nurses.
08:20 I get the night team home as soon as I can, as they are back on the ward tonight. I check with my colleague about how she is feeling now, and we talk about the confrontation, the accusations that we are not âdoing enoughâ, along with some of the worst language we hear. I give her a big hug and off she goes. That leaves me with only one room and three seated cubicles to run the department and see patients, so this is going to be tough! I meet all the patients. My team take their 15-minute breaks now, otherwise they will never go.
11:00 I talk to the patients while checking for pain and providing comfort as needed, and explain the wait will be a little longer yet due to numbers here. There are medical emergencies, cardiac arrests, acute problems with breathing, septic patients and intubations. These are all happening among the medically unwell, injured, or those who look well before quite how gravely unwell they are becomes apparent via assessment. I liaise with doctors, making up âtake awayâ medications, chasing plans and decisions regarding patient treatments. We have to keep all the plates spinning!
12:00 The department is now heaving. We are still nursing unwell patients while assessing new ones who are a mixture of injuries and people with medical complaints. When the queue is long it always leaves a knot in my stomach. As the patients come in, I look at their walking, breathing, colour, and any signs of distress, so I pick out the really unwell ones for urgent treatment. I also prepare medicines to take away.
13.20 We had someone in with a broken elbow and another who had slipped down stairs and broke their elbow. One patient arrives with a badly broken leg sustained at a sporting event. They had broken both bones in the lower leg. The leg was visibly broken and they were in a lot of pain and they had been for some as it was a long way to the hospital and they had to come in by taxi. Itâs difficult knowing you have 15 people already here waiting to be seen but you know that this patient needs you now.
15:45 At my first sit down away from the department, I should call home as my boys should be home from school but I only have 15 minutes so I need to eat and drink as quickly as I can. Then I head back as itâs too busy.
16.20 A young person came in the middle of my triage queue who had been stabbed. They had walked in and were quite calm but itâs clear they are just shocked more than anything. Other than the wound you can see there may be other injuries so that becomes the primary focus. This person then becomes the priority and pulls the team away from whatever else theyâre doing. We do a trauma call. That means the most senior person from each speciality in the hospital comes down to see the patient who is reviewed top to toe.
17:00 I bring my drained team back together, and tell them weâre nearly there. Itâs tough but I try to rally them, discuss tasks and off we go. A nurse comes from next door and the extra help is such a relief. I take all the injuries as the next wave comes in and we power through. We all know nursing is rewarding in many ways and Iâve always said weâre in a very special position to be able to assist patients and families at their best and worst. We know how vital the NHS is to everyone â it binds and holds us all.
19:00 The last push as we are nearly there. I have a last round of observations, and we stock up and make up the rooms to get them ready for tonight.
19:30 The night team arrive and the department definitely looks better.
20:00 Hand over. Thanking them for their hard work, I send the day team home, and still have my left over non-clinical work to do. In A&E youâre making multiple decisions constantly and your decision matters at every point. That is the hardest thing because it is relentless for 12 hours or longer. The other day I worked 15-and-a-half hours and then did a 12-and-a-half hour shift the following day. Thatâs the reality because we donât just leave at the end of our shift. We keep going until the situation is stable and itâs safe to leave.
20:45 I change to get ready to go home. We work 37.5 hours a week but it ends up being much more than that. It doesnât leave much time to juggle your own family life. Itâs emotionally draining work and it can be difficult to keep a harmonious personal life. I work two to three extra shifts a month to make ends meet. If our full-time pay doesnât cover the cost of your outgoings then thereâs something wrong with the system. You canât keep telling nurses to âget better jobsâ. They are doing better jobs. Many nurses are struggling, particularly as the workforce includes more women and single parents. We also have nurses starting with up to £50,000 worth of student debt on £24,000 starting salaries.
22:00 Iâm finally back home so I put the laundry on, kiss my sleeping kids, pack my bag for tomorrow, and head to bed about midnight. I remember that once my oldest joyfully told me he wants to help people like me when he is older, which makes me feel better. I tell myself that there are only two more days of these shifts to go now.
