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A senior nurse at Wales’ busiest emergency department has given a distressing insight into the stress A&E staff are under – saying it is worse than she experienced during the second Iraq war.

The sister, who has worked in A&E at Cardiff’s University Hospital of Wales for 14 years, gave a brutal account of her working life in a three-page piece read out at a meeting for staff with the hospital’s senior managers.

The nurse, who worked on the front line during the 2003 invasion of Iraq, details how a pregnant mum miscarried on the floor, a suicidal patient locked herself in the toilets and a woman suffered a suspected heart attack in the waiting area.

Her account of the Sunday night shift was pinned to a staff noticeboard and a copy was sent to WalesOnline.

Adam Cairns, chief executive of Cardiff and Vale University Health Board, said the nurse “in no way” intended for the letter, which contains patient information, to be made public.

But he confirmed the nurse’s story had been shared at a forum last year and highlights the “very real” challenges facing the unit.

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He said the health board is taking “extraordinary measures” to ease the daily pressures, including opening more beds, bringing in more staff and reallocating staff from non-clinical duties to clinical duties.

In the piece, the senior nurse said the department was unable to cope with the amount of patients coming through the doors due to a lack of beds and experienced staff.

The nurse, who spent six months in the emergency department of a field hospital during the second Iraq war, said: “Our 10-bay resuscitation unit [in Iraq] was full most days of multiple traumas, gunshot wounds, explosive device injuries, children shot and damaged by warfare.

“I spent weeks in and out of the trenches being shelled, nursing soldiers under trolleys as the warning sirens went off.

“I know what stress is. I know what it is like to work under pressure and yet I can guarantee that the nurses with me in EU today are facing higher levels of stress than we ever did in that warzone.

“We cannot, as a senior nursing team, continue to put our staff and our patients at this heightened risk any longer.”

Pregnant woman 'miscarried on the floor'

The senior nurse said some junior members of staff were not confident of assessing patients’ levels of consciousness.

She said she attempted to divert incoming patients away from the University Hospital of Wales to other sites in South Wales to give her team “breathing space”.

The nurse said: “I had to continue to make decisions that put patients at risk and put the staff under extreme pressure.”

She said one of the most upsetting moments of the day was treating a pregnant woman who had spent two-and-a-half hours waiting to be triaged.

The nurse said: “She was bleeding heavily. On walking into the triage room, she miscarried on the floor and passed the foetus at the feet of the triage nurse.

“While this happened, there were [ambulance] crews waiting to hand over, and relatives and patients hanging around by the door. We had nowhere private to take her and had to pick up everything from the floor in front of her and scoop it into a pot.”

During the night, she said the arrival of ambulance crews was “relentless”, which stopped many paramedics from offloading their casualties into the emergency unit.

“In order to avert long delays, I had to think about what patient I could offload and what patient absolutely needed to stay on a ‘truck’ and have continual monitoring.”

She also had to deal with a suicidal woman who had locked herself in the toilets.

“The nurse looking after her was distraught as she felt she had failed to keep her safe, and so I spent time reassuring her that the fault was not hers, but mine, as it is my job to support staff and make sure the patients were getting the care they needed in a timely fashion.”

'I got home and sobbed my heart out'

The experienced nurse said the pressures of the day finally hit her when she returned home.

She said: “I got into bed and sobbed my heart out.

“I didn’t sleep at all that day and I went over and over in my head about the decisions I had made, the risks I allowed the junior staff to carry, the patients I allowed to be nursed in inappropriate places by nurses too junior to carry that responsibility.

“I grieved that I had not been able to support the young girl who lost her baby in the most awful fashion, and for the nurse who had never seen a fully-formed foetus and had to cope without me there to help.

“And most of all, I cried because this was not an unusual night – by any stretch of the imagination.”

More than 135,000 people are treated at the emergency unit at the University Hospital of Wales each year, making it the busiest department in Wales.

A total of £4.4m was invested in the emergency unit last year to pay for vital refurbishment, but despite improvements the nurse claims the unit is “not working”.

Nurses' leader: Letter is 'absolutely shocking'

Tina Donnelly, director of the Royal College of Nursing in Wales who also worked in Iraq, described the nurse’s letter as “absolutely shocking” and “worrying”.

She said: “This is a blow-by-blow account of a sister in an emergency unit demonstrating how complex and challenging working in emergency care is.

“Every single issue that she raises relates to emergency care. Sometimes we hear about inappropriate attendances at A&E but that doesn’t apply here.

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“All of these challenges relate to a need of staffing levels to be at their optimum level to deal with these complex care issues.”

The sister’s report comes the day after a paramedic described how the past month had been “the worst he has ever known in term of delays”.

“Some 999 calls could be an hour old before they were answered,” he said.

“We’re talking about a system failure, not a service failure. It’s not A&Es that are failing or the ambulance service, but the system.”

Hospital chief exec: These challenges are being faced everywhere

Adam Cairns, Chief Executive of Cardiff and Vale University Health Board, said: “This is a story that was shared by Emergency Unit staff at our highest level forum a few weeks ago.

"It describes the very real, very challenging level of serious, complex care that is being provided on an almost daily basis.

"As difficult as it was to hear it was a powerful motivator, so much so that it was shared widely with staff and has been used to inspire all of us in finding solutions to these significant challenges.

"These challenges are not unique and are being faced across the UK. But here in Cardiff and Vale we are working tirelessly at all levels to meet this extraordinary demand.

"Sharing this story and the realities of how hard it is on the frontline is an important part of that.

"How we react is vital and over the last few weeks staff have been making enormous efforts to manage pressures and provide safe care. We are taking ‘extraordinary measures’. This includes opening more beds, bringing in more staff and reallocating staff from non-clinical duties to clinical duties.

"The health board, at all levels, is doing all it can to meet this incredible challenge and I would like to thank everyone for their continuing professionalism, dedication and humanity in serving patients.

"I would also like to thank staff who shared their experiences – they can only serve to ensure that we continually focus on the needs of patients at all times.

“I would also ask the public to play their part in easing the pressures on our emergency and urgent care systems.

"That means taking the Welsh Government’s Choose Well advice and using the most appropriate service for them and to make best use of their local pharmacy, optician or GP before turning to under pressure emergency services.”

Excerpts from the nurse's account of her Sunday shift: