"There has been a hospital in Cardigan since 1922. Operations were done here and an eminent surgeon used to visit to perform them. Over the years the hospital has become a community hospital. It is run by GP's with beds mainly for the elderly recovering from operations or illness. The casualty unit, as it was then known, was open twenty-four hours a day. The local GP's would come and treat any patients turning up in the day or the night. There are many stories about incidents in the middle of the night, especially Saturday nights.

About 12 years ago the casualty unit reduced its hours to coincide with GP surgery hours :- 9-6 Monday to Friday and 9-12 on Saturdays. The unit was staffed by a nurse who was also on duty in the hospital ward. If a patient arrived, the nurse was called away from the ward to attend to the casualty. The nurse would always have to call the doctor to see the patient, even for very minor things. This situation was one that could not continue due to pressure of work in the wards and the lack of nurses with specialist training. There was often a lengthy wait for patients to see the doctor. We felt patients attending with minor injuries could have a better service.

At the beginning of 2005 it was decided to send six nurses for specialist minor injury training, so that patients could be treated without having to see a doctor. The GP's were still involved at that stage and would attend certain patients who could not be treated by the nurse alone.

As the skills of the nurses increased, along with the development of the video conference link with the A&E unit at Bronglais Hospital in Aberystwyth, the decision was taken to make the unit nurse led with the backup of the telemedicine link. The unit went nurse-led in August 2006. 197 patients were seen and treated by the nurses that month compared to the 75 that were seen in August 2004. A total of 586 patients were seen in 2004, and 1016 in 2005. This year we have already treated over 1000 patients.

The nurses treat minor injuries which include conditions such as cuts and grazes, sprains and broken ankles, a painful knee, injured hands and wrists, painful elbows or shoulders. If someone has got something in their eye or splashed a chemical in it, the nurses can deal with it.

If there is something we cannot treat, the nurse will send you to the nearest Accident and Emergency department which is either at Carmarthen, Aberystwyth or Haverfordwest.

We can dispense a limited amount of medicines ourselves and we can ask the Bronglais doctors to prescribe other drugs. We are also able to refer patients for x rays and to refer directly to fracture clinic.

We all enjoy the new challenge that this new service has given us. We support each other in our work and we are all constantly learning new skills. We aim to offer an excellent service to our patients and welcome any comments on how to improve it.

Article written by Rita Fellows and Jennifer Ladd