THE EMERGENCY department had long been a bustling, busy, high-pressure environment in Ballarat Health Services Base Hospital catering to a region far greater than this city's boundaries.
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Then COVID hit.
This is a chance to see what the average shift was now like from their perspective: the constantly changing safety regulations as health leaders learn more about dealing with COVID; tightly scheduled time breaks; emotionally supporting patients unable to bring loved ones; and the mental toll this can all take.
They do it all to keep us safe in a time like nothing they have experienced before.
NO ROOM FOR THE SLIGHTEST ERRORS IN CHANGING CONTROLS
EXPERIENCED emergency department nurse Jyle Abad says the simple acts of answering a phone or grabbing a sip of water now require tightly choreographed moves at work.
Safety and hygiene measures have always been a strong focus for Ballarat Health Services' emergency staff but Ms Abad said the stress of COVID-19 had taken this to a new level.
The team knows it is not alone in this - these are increasing and constantly changing demands in emergency rooms across the world.
Everything Ms Abad touches, every chair she sits on, every time she opens a door requires time and patience to wipe down for added infection control.
Almost every new interaction on the ward requires donning and doffing of personal protective equipment (PPE), including but not limited to the tightly fitting N95 face masks and gowns.
Even bathroom breaks are rare luxuries best timed for short tea breaks.
There is no room for error or mental fatigue.
Mentally you need to be prepared every single shift. You're dealing with lives...In full PPE, you can't step away to do anything, let alone answer a phone. Everything is more time consuming but these things are to protect everyone and ourselves.
- Jyle Abad, emergency department nurse
"Mentally you need to be prepared every single shift. You're dealing with lives," Ms Abad said. She has been a nurse in the BHS Base Hospital for more than five years.
"Pre-COVID you could quickly sit in the main staff room for a minute but when you're dealing with the really sick it's hard to do that with all our PPE.
"In full PPE, you can't step away to do anything, let alone answer a phone...Everything is more time consuming but these things are to protect everyone and ourselves. We don't want to come home with anything.
"We're being extremely careful and that can make for really stressful working conditions."
The emergency department at the BHS Base Hospital has been divided in two: respiratory zone and everything else. Both demand triage systems.
The aim is to keep the potential deadly coronavirus exposure away from the usual hustle and bustle from the city's most urgent cases.
MORE COVID NEWS
Before COVID, Ballarat's emergency department was already a tight squeeze, waiting for more room from planned renovations.
A giant white marquee just outside the emergency department, in Mair Street, is set to shift people presenting with respiratory conditions to a completely separate space for triage with COVID cases in hospitals set to surge on the back of thousands of new infections across the state each day.
Bay 20, up the back in the emergency department, is a resuscitation bay with only two nurses allowed inside with the patient at one time. The door must remain closed. A third nurse stationed outside the closed door write down vital information. This role makes for a really stressful day, Ms Abad said.
Nurse shifts in Ballarat's emergency department are eight-hours for day and 10 hours for night stints. There is usually half an hour for meal breaks and a 15-minute morning or afternoon tea.
In a pandemic, Ms Abad said safety and infection control had become time consuming and every moment with the sickest patients was crucial.
Working full-time, Ms Abad said often days off were limited to one at a time.
"You never feel time off is long enough," Ms Abad said. "Not when you're wearing full PPE all the time."
FAMILY, LITTLE ONES AT HOME ALWAYS FRONT OF MIND
JOSH Walker's newborn baby is always front of mind from the moment he steps up for duty each shift in Ballarat Health Services' Base Hospital emergency department.
There were often patients with COVID-19 needing care. Last week alone there was quite a few.
At home, his little one does not have an immune system built up at all and definitely is unable to be protected with a vaccine against the deadly virus.
Mr Walker has been nursing since 2017 and has always been particularly concerned with controls to ensure he did not bring anything from his work home with him to family. Let alone now, with a baby in a pandemic.
"Work [in the ED] is completely different to when I started. I never thought I'd do anything like this, it's a whole new learning for all of us," Mr Walker said.
"It's definitely stressful but that's because, a, we're keeping the community safe and b, we're keeping ourselves and out families safe.
"It is stressful but it's more about how we adapt to it and the way the world is changing day to day. We have [nurse unit manager] Grant Berriman and director Pauline Chapman briefing us daily and working on things that change, like new ways to be donning and doffing PPE."
Mr Walker said there was an increasing juggle for staff in the emergency department.
In general, people had been staying away from healthcare needs for longer, so were often presenting sicker or needing more urgent care. Then there were those who perhaps were not emergency cases and more suited to general practice, at least in the first instance.
On top of this, there were COVID patients facing a condition largely unprecedented. They were taken into isolation rooms, wearing restrictive face masks and typically allowed one nurse and one doctor - both in full PPE - to assess them.
Mr Walker said this was often quite daunting for patients, who were already under distress.
We are trying to be as accommodating as we possibly can but it is such a new experience.
- Josh Walker, emergency department nurse
"No-one has dealt with a pandemic like this - the last was the Spanish Flu - and we're all trying to do the best we can...We do still deal with our fair share of unwell people without COVID," Mr Walker said.
"We are trying to be as accommodating as we possibly can but it is such a new experience."
As COVID restrictions ease across the state, the team expected a rise in infections, despite high vaccination rates in Ballarat, largely because people would be moving about a lot more.
Mr Walker hoped most people could avoid seeing him by keeping up COVID precautions, including mask-wearing, physical distancing and hand hygiene, and ultimately keeping space for those who need emergency help the most.
SCARY CHANGE BUT BILLIE FEELS TEAM MORALE IS VITAL
PANDEMIC conditions is all registered nurse Billie Nicholls has really known in her medical career.
Moving back to Ballarat and joining the BHS emergency department team has been a sharp, sometimes scary but overwhelmingly rewarding learning curve for Ms Nicholls.
She had taken up a position in the Royal Children's Hospital nursing children who needed heart transplants for her graduate year. When she started, word COVID was going to hit was starting to heat up.
Professionally, Ms Nicholls felt rather sheltered in her work life and was thankful her ward was never directly impacted by the deadly virus.
Personally, Melbourne restrictions and lockdowns were tough and Ms Nicholls missed her family.
To step up in emergency has been a challenge Ms Nicholls has relished.
A lot of patients...can't have anyone at their bedside with them. I've found in nursing there is a care and advocacy role for your patients more than ever.
- Billie Nicholls, emergency department nurse
"There is an added stress for a lot of patients because they can't have anyone at their bedside with them. I've found in nursing there is a care and advocacy role for your patients more than ever," Ms Nicholls said.
"It is a bit of a stressful and scary environment.
"It is scary for us, too. We're going home to loved ones and you don't ever want to put them in any danger."
The trio has found juggling visitor restrictions hard, mostly in trying to help people understand why they could not have children or others with them in the emergency department.
They said tight limitations were there to best protect the community's most vulnerable people, including children.
They said even seemingly little things, like people getting a COVID test at an off-site screening centre, could make a big difference in helping them do their job.
IN OTHER NEWS
Amid the somewhat chaotic change in her career, and the continuous demands to keep adapting her care and safety, Ms Nicholls said the team working alongside her was incredible.
"We're working well as a team and supporting each other. It's really like I've got a whole other family now, too," Ms Nicholls said.
"We're all trying as hard as we can in keeping our morale up and staying positive.
"...Melbourne was not a great place to be last year but I've been absolutely loving it in Ballarat's emergency department."
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