On the water's edge of Salford Quays, England lies a stone with the words "From the labour of yesterday lives the spirit of tomorrow". This verse is very apt for our association because throughout its 30 year history hundreds of A & E nurses have shaped its activities and that spirit continues today.
The words are also very appropriate for emergency care. Our speciality is young compared with other areas of medicine and nursing. In fact the whole speciality of emergency care only emerged in the 1960's. Prior to that orthopaedic surgeons had run "casualty departments".
During the first couple of years of the 1970's a small group of dedicated A & E nurses, no more than about 60, came together to start the first moves towards an A & E group within the RCN.
The main supporter and enthusiast for this group was Margaret Lee, the nurse advisor at the RCN.
This work paid off and in 1972, the RCN A & E nursing group was established. This was a great step forward for A & E nurses especially as the speciality was so new.
The first chair of the group was Betty Hoy 1972- 1974.
Betty was nurse manager of the A & E department at the Brook Hospital Greenwich. During these early years meetings were held throughout England and local groups were established. One of the main functions of the group was the provision of clinical updating and education for A & E nurses. Remember in the early 1970's there was no A & E courses
In fact this was one of the first major tasks of the group - to set up a joint board of clinical nursing studies course. This was successful and was the for-runner of the current ENB 199.
1974-1976 the group was chaired by Susan Moore.
All the activist continued to push forward A & E nursing in a speciality that was still medically dominated. Many departments were still run by orthopaedic surgeons.
In 1976 Kate O'Hanlon took the helm for a period of seven year
Kate was the senior sister of the A & E department of the Royal Victoria Hospital Belfast. During this period, in 1978, the group became a forum within the newly established RCN Association of Nursing Practice.
In 1979 the first annual meeting was held and it is interesting that so many of the subjects discussed are still with us today - violence and the extended role of the nurse was two such subjects.
At the 1980 annual meeting, closure of A & E departments and collecting prescription charges were hot issue
Significant events during the years 1976 - 1983 includes
- Joint working with the Casualty Surgeons Association (now the British Association for A & E Medicine)
- Work to push for seat belt legislation, which as we know was successful. This type of activity also shows how A & E nursing is not just about treating the sick and injured but also about how to help the community prevent injuries.
- The first joint Casualty Surgeons and RCN A & E nursing forum conference was held in Ireland
- One of the key partnerships that until very recently existed - the start of the 3M Health Care/RCN A & E awards. Particular thanks need to go to Peter Radcliffe who was until his retirement the Public Relations manager for 3M Health Care and the key player in establishing the awards.
- And if all that was not enough, the first Emergency Nurse newsletter was born in 1983
Between 1983 - 1985 the A & E Forum was chaired by Jill Milnthorpe
Jill was nurse manager A & E Milton Keynes. Local groups were growing with 11 established by the end of 1983. Topics discussed at conferences and study days included solvent abuse, ambulance paramedic training, staffing levels, the role of nursing auxiliaries and clerical duties undertaken by nurses. The Norfolk & Norwich infusion box was launched (the forerunner to the current level 1 pressure infusor)
In 1984 because of the continued increase in violence, the Criminal Injuries Compensation Board was set up. We also started seeing the increase in new patient attendances. In 1984 it rose by 2.6% to 10.2 million.
In 1985 dealing with body fluids was never going to be quite the same again. HIV had arrived. We also started seeing territorial issues coming to the fore as both ambulance personnel and nurses flexed their individual muscles. The paramedic and extended role of the nurse debates were coming thick and furious.
The first ever A & E International Conference was organised by a group of forum members and held in London in May 1985. Never before had so many A & E nurses come together. Over 600 delegates attended from 28 different countries.
At the AGM of the international conference a new executive was elected with Peter Blythin elected as chair.
Peter Blythin chaired the forum from 1985 - 1987.
During this two-year period the forum continued to grow. Sixteen local groups had been established by the end of 1987. Significant activities included
- During 1986 we welcomed the debate on the care of children in A & E
- The A & E forum put together a new A & E course which had an extensive curriculum and was based around the nurse working from a basic to advanced level of competency (sound familiar). Unfortunately in 1988 the ENB stopped us in our tracks. Still we knew it would only be a matter of time before we tried again.
- 1986 was also the year A & E nursing became well known throughout the whole of the UK; Casualty hit our television screens.
- Other important developments in 1987 included a greater awareness of the needs of the suddenly bereaved, Bob Wright & Lisa Hadfield were becoming well known names in this sub speciality of A & E care.
- Triage and nurse practitioners were high on the agenda. Many A & E departments started using triage in a formal way, again this major initiative came from nurses.
- The Emergency Nurse newsletter took on a more professional appearance, thanks to the support of Smith & Nephew.
1986 saw a major change in the way the annual conference was organised and in 1987 the first A & E conference was held at The Lord Daresbury hotel.
In 1987 I (Gary Jones) was elected chair of the forum and was privileged and honoured to hold this post until 1995.
- 1987 saw the introduction of mega codes and UK guidelines for the treatment of cardiac arrest. The forum continued to be very active at RCN congress.
- The last few months of 1988 and the early part of 1989 again saw the A & E service well publicised. This period saw some of the most horrific major incidents of our time. In the space of a few months we had Kings Cross, Clapham, Lockerbie and Kegworth.
During my term of office a number of changes occurred
- In 1990 the trauma pioneers hit Chicago and returned with the Trauma Nursing Core Course and within just 3 weeks the first course was held in the UK.
- By 1990 we had 23 local groups and to keep things moving, three special interest groups were formed and A & E monitor was published.
- 1990 The forum became an Association,
- 1992/93 Emergency Nurse became a journal with Brian Dolan as editor. A separate newsletter continues to be published.
On December 27th 1991 the A & E nursing world was shattered by the sudden and untimely death of Ethel Buckles. Ethel the senior A & E sister at Preston had been one of those early pioneers back in 1972 and was the main force behind the conference coming to the Daresbury and TNCC coming over from the USA.
1992 saw the publication of the patient's charter and all that it brought to A & E. We also celebrated Ethel's life with the first Ethel Buckles Memorial Lecture. Bareness Caroline Cox who was the Deputy Speaker in the House of Lords and a nurse gave that first lecture.
1994 saw the publication of Challenging the Boundaries. Challenging the Boundaries was one of the handful of major events in our 25-year history and this document continues to form the blueprint for future work.
Another significant event during my term of office was the 75th anniversary of the RCN. The A & E Association had a new leaflet published and this lead to yet more members joining the association
1995 saw Rob Crouch take the chair.
Rob steered the association through the two years 1995 - 1997. During those two years we again saw major changes to the annual conference, joint working between the A & E association and BAEM resulting in the publication of the Manchester (national) triage scale. A & E association members were also involved in a number of Department of Health working groups, again demonstrating how influential the association has become.
- One of the most important events since the Association (A & E group as it was called in the early 1970's) was established has to be the move to the establishment of the Faculty of Emergency Nursing. Although just in the discussion stage in 1997 this has continued to be one of the most radical yet most important events since the A & E group joined the RCN.
1997 Karen Castille becomes chair of the association.
During Karen's term of office the faculty under the RCN Council's steering group moved forward in leaps and bounds. In 1998 a 2-year feasibility study was financed through RCN Council. Nurses across the UK have been involved in its establishment and it certainly belongs to all A & E nurses.
Because of a change in Government we saw major changes in the way the NHS was to function. At the same time the NHS celebrated 50 years (1948 -1998).
Kathy Butcher Nurse Manager at Addenbrooks Hospital Cambridge retired from her editorship of Emergency Nurse News. Kathy one of the association's key players had edited the newsletter since 1991.
Although trolley waits had increased over many years the real "winter crisis" was being recognised at National level. Both the RCN and Government were attempting to tackle the growing crisis in our A & E departments.
Violence had been a major agenda item for the association for many years. One of our key players was Una Bell Director of A & E Services at Whipps Cross Hospital London. Unfortunately despite Una's knowledge and skills in tackling violence she herself became a victim when she was held hostage in her office by a woman who tied her up and threatened to set her alight. Fortunately due to Una's ability to deal with such a crisis and the staff's quick thinking the incident was concluded without any physical injury. Ironically the judge gave a 2 year suspended sentence.
1998 saw lots of activity on the IT front. Both NHS Direct and RCN Direct were launched.
Liz Hewitt formally a treasurer of the association and chair of the A & E group in the Midlands was appointed RCN Welsh Board Secretary.
The 2nd edition of Children in A & E was published and £30 million was earmarked for A & E modernisation.
Una Bell was awarded a RCN/Nursing Standard Lifetimes Achievement Award
1999 Linda Holt becomes the ninth chair of the Association
Linda took over the chair from Karen due to her move to the Department of Health. Karen was the second A & E chair to advise at department level. In 1994 - 1997 I had held the position of Honorary Consultant Adviser in Accident & Emergency Nursing to the Chief Nursing Officer.
The association continued to produce a number of position statements on issues such as health care assistants and care of the elderly in A & E.
The Paddington rail crash demonstrated how adaptable A & E nurses are with Sarah Caine Staff Nurse at St Mary's Paddington using her initiative when faced with a supermarket full of injured commuters. She used post-it notes as triage labels.
Within the RCN Fields of Practice were established. This brought the association working with other forums and a direct link into Council with a named council member as part of the advisory panel.
So to last year. 2000 was again very busy. The association worked closely with the CHC's and the RCN Council on pressures in A & E. This work continues. Linda Holt has been involved in top level meetings both at RCN and Government level over A & E trolley waits.
Elizabeth Yates Nurse Manager at Preston was awarded the Nursing Standard Millennium Medical Nursing Award for her work with victims of domestic violence.
The faculty project announced the five pilot sites.
A & E attendance's in England rose by 2.4% to 14.6 million.
In August the International Emergency Nursing Conference was held in Edinburgh. Like the first international conference back in 1985 it drew nurses from all over the world. Nurses representing 19 countries signed a declaration of co-operation and friendship. This declaration has led to the International Committee for Nurses (ICN) offering to support a webpage for emergency nurses and a 2-hour workshop slot at ICN Congress this year (2001).
In closing this review I must pay tribute to all the activists within the association. Although I have used the chairs periods of office to give a structure to this paper, the chairs are only as good as the other honorary officers, and they are only as good as all the members of the association. People like Gabby Lomas who has for many years been the organiser of our conferences, Brian Dolan who so successfully edits Emergency Nurse and the numerous people that have taken forward the work of the Faculty, all really committed nurses to A & E
Gary J Jones
Summary of Key Events
- 1972 A & E Group established in the RCN
- 1972-1974 A & E Course developed
- 1978 The group becomes a Forum within the RCN
- 1979 1st A & E Forum conference
- 1983 Emergency Nurse Newsletter launched
- 1985 1st International Emergency Nursing Conference, London, England
- 1986 Forum proposes new A & E Course
- 1987 Annual conferences start at the Lord Daresbury Hotel
- 1990 The Forum becomes an Association
- 1992/93 Emergency Nurse Journal launched
- 1994 Challenging the Boundaries published
- 1997 The Faculty of Emergency Nursing starts its journey
- 1998 The Faculty starts its 2 year feasibility study
- 1990 Fields of Practice start operating within the RCN
- 2000 Faculty pilot sites announced
- 2000 International Conference in Edinburgh, Scotland. Declaration of Co-operation & Friendship signed by 19 Countries.