North Shore Hospital. Photo: rafaelbenari/123RF
Patients sometimes have to go to the toilet or have a medical device attached behind a portable screen in a room with 10 other people as they wait for care in North Shore Hospital's ambulance bay.
Nurses are speaking out about the lack of dignity for patients, and the fear they feel working in the ambulance bay - a large room next to the ambulance drop-off point which has become a waiting space to get into the overcrowded emergency department.
There was just one privacy screen in the bay which was moved from patient to patient as needed.
Those who could not walk or be moved into the department had to use a bedpan, have a pad changed, or get a monitor placed on their chest behind it.
Four current and former North Shore Hospital nurses spoke to RNZ via email and interviews about their experience in the ED.
They wanted to remain anonymous, fearing professional repercussions for speaking up.
"It is very hard to maintain dignity in the ambulance bay," said one.
"We have a screen we can use as a division but people can still see through the gaps."
The nurses stressed they tried to put patients into the small room off the bay when privacy was needed but that was often being used by mental health patients or Covid-19 positive people.
They would also try to get someone to take them to the toilet inside if that person was free, or move them into the hospital, but that meant some ended up there earlier than patients who needed more urgent care.
All four nurses said it was incredibly stressful working in the bay - which was often sole charge.
Many patients had not been triaged to see how urgent their condition was and there was no access to full monitoring equipment.
"When I come onto a shift to a full ambulance bay and I'm on my own I can feel scared ... I don't get time to make my own assessments," said one.
"I imagine it is quite distressing for the patients ... they can see how busy I am and avoid bothering me with basic care such as analgesia or a drink of water."
Some patients may witness very distressed people for the first time, while being very unwell themselves, they said.
Most were not allowed a family member with them.
The ambulance bay was one of the areas highlighted in a six-page health and safety complaint made by staff to hospital bosses about the department.
It said the emergency department was equipped and staffed to deal with 35 patients at a time but very regularly had about 60.
'My biggest worry is someone is going to die'
One of the nurses told RNZ stress levels was so bad, it was not unusual for a nurse to be in tears at work. Some had to leave a shift early.
They were frightened they would miss something important.
"My biggest worry is someone is going to die. That is my biggest fear," said one.
"If we're in the ambulance bay for example, and not necessarily the ambulance bay, it's really difficult to sometimes get around every patient in a timely way."
Most nurses had been shouted at by aggressive patients, some had been physically assaulted, and many felt vulnerable, they said.
"Overcrowding of the department probably doesn't help that ... it's hard to de-escalate them because they've got themselves so worked up," said one of the nurses.
Last week, a patient was punched and knocked to the ground when she defended a nurse who was being verbally abused.
The nurses said they could not talk about that case or talk about any specific incidents involving patients.
They felt the managers at the hospital were taking their concerns seriously but one said the problems were complex and would take a long time to fix.
North Shore Hospital said in a statement it was working with staff and unions to address concerns raised in the health and safety complaint and it has a number of initiatives to try and improve the situation.
That included a pilot of extra staff to help with urgent care in the afternoons and evenings.
The department was fully staffed but was often impacted by staff illness, like many other workplaces, a spokesperson said.
They thanked staff for their professionalism, compassion and commitment in the face of challenges in the ED.
"We want to assure the public that those who require hospital-level care at North Shore Hospital ED will continue to receive it," they said.