Patients at ER departments regarded as "symptoms", shunted around as "production units”

These are the conclusions of a thesis presented at the Sahlgrenska Academy, University of Gothenburg, in which research student Henrik Andersson describes observations and/or interviews with 12 doctors, 24 nurses, 23 assistant nurses and seven managers at two Emergency departments in western Sweden.

Training limited by economy
One of the managers interviewed says: "Providing nursing care and explaining why the patients must wait, or how long the wait will be...there's no time for those... medical measures must come first."

The results presented in the thesis show that both managers and practitioners desire more training, but the amount available is limited by economy. This affects the opportunities for the practitioners to develop the necessary competencies.

"This leads to tension between the professional groups that work at Emergency departments. As one nurse puts it in an interview: Courses are often extremely expensive, and it's obvious that nurses have a greater chance of taking a course than assistant nurses," says Henrik Andersson.

Limited mandate
The result also shows that managers do not always regard it as their sole responsibility to manage and develop the competencies of the practitioners. The managers themselves state that they have a limited mandate to control the healthcare work, and this limits their freedom to act and their ability to develop healthcare work at the department.

One manager says: I believed when I became a manager that I would be able to develop the work. I find, however, that I am extremely limited by economy, structures and the organization.

Knowledge about traditions
The studies have given Henrik Andersson new and useful knowledge about the traditions and perspectives that control the healthcare work at an Emergency department in practice.

"This knowledge is important, since these traditions and perspectives determine whether the patients are offered the care they need or not. In order to revolutionize the medicalized and result-driven Healthcare work at Emergency departments, managers is required who have the courage needed to critically examine and evaluate the structures, power balances and perspectives that influence the healthcare work at Emergency departments."

The thesis Medicalized and Result-driven Healthcare Work in the Emergency Department - a Study Based on Practitioners' and Managers' Perspectives will be defended at a disputation on 12 December.