Unacceptable working conditions at the emergency department of the west's biggest hospital is driving highly trained and experienced nurses out of the public system into the arms of local private hospitals.
Frustrated by continuing overcrowding, inadequate staffing levels and what a nursing union claims is the ongoing compromising of patient care, a "significant" number of these nurses have left UHG's A&E department to join the Bon Secours and Galway Clinic hospitals in the past two to three months.
Clare Treacy, the Irish Nurses and Midwives Organisation's industrial relations officer in the west, says these top nurses are being lost to the public system.
"A significant number of nurses with significant experience have left UHG recently - many to go to the two private hospitals in Galway - because of the extraordinarily stressful situation in which they work. There is no let up. Most workers will have a busy day but then things calm down the next day. But here there is a really strong element of frustration.
"These are very experienced nurses who are senior in grade. They are being replaced by nurses who are often not as experienced and who naturally will take a while to bed in."
Ms Treacy's comments come as members of her union working in emergency departments nationwide voted overwhelmingly this week to strike.
Up to 100 nurses working in the emergency departments of Galway's two public hospitals (60 at UHG and 40 at Portiuncula Hospital in Ballinasloe ) will take part in the industrial action, involving the withdrawal of labour, which will begin on Tuesday December 15.
The union says the action, which will affect all of the country's public emergency departments, is a direct response to nurses having had enough of broken promises. It says it comes as a result of what it terms the failure of Government and health service management, over many years, to recognise the overcrowding crisis and to allocate the necessary resources to address it properly. The strike action will initially involve action in a number of A&Es on a simultaneous/rolling basis.
"I know there will be work stoppages as opposed to a work-to-rule," says Ms Treacy. "There will be an emergency response team available in the event of an emergency occurring."
She outlines there is a significant difference between UHG and other hospitals in that the INMO has an agreement with the Galway facility achieved through the Workplace Relations Commission (formerly the Labour Relations Commission ). This was hammered out in April of this year and related to emergency department staffing levels, methods of working, health and safety, bed capacity and security issues.
However this has not been implemented in full. "The key element of this was staffing levels. We negotiated an agreement to increase staffing from 10 nurses on a shift during the day to 14. In fairness, the employer is trying to recruit nurses. But a significant number of nurses with significant experience have left UHG in the past two months to go to the two private hospitals in Galway. While the employer has recruited staff it is losing people at the other end. And these are highly experienced nurses."
She says her union is awaiting the publication of a review on the ED carried out by two medical consultants from England and two nursing consultants from Northern Ireland.
"It looked at the method of work in the unit and was to make recommendations including patient pathways (patients' journeys through the department ). It was expected six weeks ago. I have written to Dr Pat Nash, the clinical director of UHG, seeking it but he said he has not received it."
The biggest stressor for A&E nurses is overcrowding and delayed care, according to Ms Treacy. "This involves having to nurse patients in unacceptable and inhumane conditions and not being able to provide care in a timely manner."
The INMO's trolley watch system, which was set up 10 years ago and records the number of patients being accommodated on trolleys in EDs as they await in-patient beds, reveals that there were 132 patients on trolleys at UHG in October 2006. This figure has risen steadily over the intervening years, rocketing to an all time high of 763 in October 2011. Last month's numbers totalled 469. This figure included patients on trolleys and those accommodated inappropriately in wards, ie located on a trolley in the corner of a ward without all the medical elements that a hospital bed normally provides, such as an oxygen supply.
Clare Treacy says a new ED, which has "been on the cards for a while", is a key element in rectifying the problems which have dogged the local A&E for years. "When the Minister for Health visited the hospital he said it was a requirement as the department was not fit for purpose. A new unit is the answer. People must make it an election issue. Even if we got all the nurses we are looking for there still isn't room to manoeuvre in the current unit. There literally are patients head-to-toe on the corridor. There are around 20 patients on trolleys constantly.
"To be fair to management, as part of the agreement we have with them, they appointed a clinical nurse manager with overall responsibility for patients awaiting admission [on trolleys]. This has improved the flow of patients."
She says there are a number of actions that can be taken by the HSE and the Minister for Health to alleviate ED overcrowding.
"They can do a proper recruitment drive, go to other countries, for instance. Why not go to Australia and try to get nurses to come over here? They need to be actively recruiting and offering packages, including ongoing education, which are very attractive for nurses. The new unit needs to be made a priority also. If people knew it was coming they would be working towards it. There needs to be more medical consultants on duty day and night as well as clearer pathways for patients with particular clinical needs. Do patients with cancer really need to go through the ED? These existing patients should be able to bypass it altogether. At least 50 more beds are needed too as well as a system of discharging patients appropriately."