"They'll worry about what I say," she jokes.

"When the Prime Minister came in I wasn't allowed to talk to him.

"They even checked what shift I was on."

Ms Pears, who goes by Pearsey, is a Launceston General Hospital emergency department stalwart of more than 16 years who tells it like it is.

It is likely why she is in triage, assessing ambulance arrivals, police, GP referrals, rural hospital referrals and the public, and assigns each of them to a category based on the urgency of their condition.

"This is the busiest place ever, right here, before they even get out there," Pearsey says, pointing to the ED behind her.

"The front line is right here.

"You've got to know which way to steer them, and assess them, and with assessing them, sometimes you can get it wrong."

When the hospital is at capacity, as it is tonight, patients crowd the waiting room, lie on trolleys inside the hospital ambulance bay, and can receive treatment in chairs.

The triage nurses are responsible for everyone in the waiting room, and on top of everything else Pearsey must be alert to changes in mood or condition.

In the old department, people would try to access the department by jumping through windows by the nurses' desks.

"The abuse is something shocking, you get called everything," Pearsey says.

There are plenty of patients in the waiting room and just one bed left in the ED when two ambulances arrive at once.

Two motorbike riders, a man and a woman, have been clipped by a car, and the woman looks particularly pained. She lies quiet and still on the trolley, her eyes trained on the ceiling, her shoe missing and her foot swollen.

The other ambulance carries a man in his 90s, who has been disoriented and "a bit off" since waking from a nightmare that morning.

Pearsey, another nurse and two paramedics talk quickly among each other.

From the waiting room, you cannot see the ambulances coming and going, and the patients waiting on trolleys and in chairs at the paramedic entrance.

When an alarm sounds, signalling a code blue medical emergency in one of the hospital car parks, staff know someone else will soon need a bed too.

It would be easier if there were not so many people in the ED who are not meant to be there.

There are 45 patients in the department and waiting room when we first start our afternoon shift about 1pm, and 21 of those have been admitted to the wards.

The wards do not have room for them, leaving the emergency department with no choice but to keep them.

So inpatient teams care for the admitted patients with ED nurses, and nurse unit manager Scott Rigby says ED presentations - an average of 126 a day - will be rotated through the remaining 10 or so beds.

"It's not uncommon to do the ED day through one of two beds," he says.

Mr Rigby says two of the admitted patients have been in the ED for up to five days.

"That's standard for us," Mr Rigby says.

"We've had a big cultural change because we've gone from having a pure ED nurse focus, and we've had to adapt to a longer care-type focus because it was rare for a patient to stay more than 14 hours, historically."

At the same time, demand for emergency services is increasing.

Mr Rigby says that when he first took over as nurse unit manager a few years ago, there would be about 12 people in the ED when he started his shift of a morning.

"Now we'd be lucky to see under 25, or 30," Mr Rigby says.

The emergency department is not a place for long-stay patients to sleep.

It's a 24/7 environment with harsh lighting that isn't turned off, and no windows or natural light.

Most patients have just a curtain for privacy, and there are only two toilets and two showers to share.

Later in the evening, a mental health patient will start ramming a door, a code black will sound, and police will stand by while security comes running from all areas of the hospital.

A toddler with a broken femur is crying.

Among all of this, registered nurse Courtney Hayes is caring for eight admitted patients, some of whom have been in the ED for several days.

She says one of them is dying and their treatment is palliative.

Another has been in the ED since she suffered a heart attack four days ago.

"I think some people are very, very frustrated about not getting upstairs [to a ward bed]," Ms Hayes says.

"We're not assisting them when we're leaving lights on ... and they're confused about what time it is, and they're becoming more and more distressed.

"The amount they have to stay out there, it makes at least their sleeping patterns definitely worse.

"You need sleep to become better."

Research has shown that patients spending more than eight hours in the ED have a 30 per cent increased risk of dying than admission.

The average stay for an admitted patient at the LGH ED is 17 hours.

Ms Hayes says it is also difficult for the nurses, who care for patients with the relevant inpatient team.

"Each different speciality expects us to perform to each of their pathways and all of these things when we might not have any of the resources here to do that," Ms Hayes says.

Late at night, the department receives warning from paramedics that a man with end-stage kidney failure is on his way to the hospital.

Pearsey warns the department is about to get a lot busier.

When the man arrives, at risk of death and refusing treatment, he fills the last of the department's three resuscitation bays for the most serious patients.

The area is buzzing as staff treat an elderly woman who is struggling to breathe, try to determine the damage to a young woman who has fallen off a horse, and convince the man with end-stage kidney failure to accept dialysis.

Medical officer in charge Lucy Reed says treatment will not necessarily guarantee the man's survival.

"At the end of the day, if he has a cardiac arrest it's futile, we will not get him back, because these guys get really bad heart disease as well," Dr Reed says.

Staff work quickly with the knowledge that if another seriously unwell patient arrives, there will not be a resuscitation bed available.

They never know what will come in the door next.

But despite frustration over bed block, staff are clear that everyone who needs treatment will receive it.

Shift co-ordinator Annette Taylor tells me earlier in the evening that while there's not always a solution, there is always a Band-Aid.

"You just move beds, change people around, push them up a little bit further, you can always do it," Ms Taylor says.

"We can treat anyone anywhere.

"You can sit a patient in a chair if they need to be, so no one ever gets thrown out that shouldn't be thrown out."

Mr Rigby says the ED team swings together in a crisis, and people do get beds, they get their surgery, and they are cared for.

"Would you believe we have very few complaints?" Mr Rigby says.

"I think that's a great reflection of our staff."

It seems remarkable that the big challenge at the LGH emergency department is not treating patients, but finding them a bed.

Particularly when you consider all the other issues staff face.

Pearsey discusses some of them over the night, in moments when she's not assessing patients, organising drug tests for police, chasing medication from other parts of the hospital or calling specialists.

She talks about the increasing prevalence of the drug ice and resulting violence, the verbal abuse, and the patient who grabbed her throat and almost killed her.

"We've been attacked, we've been punched, we've had trolleys about us," Pearsey says.

She describes a concern for patients that can keep her awake long after her shift has ended, the pressure of making quick triage decisions and the fear of getting something wrong.

"It's just amazing, what you need to know, and sometimes, yeah, you do get frightened," Pearsey says.

"I don't like making mistakes, because it's someone's life, isn't it?"

Later she mentions a young man she cared for in the ED weeks ago, who later died in intensive care from unknown causes.

"He died very young and they still don't know what he died of, it's a mystery," Pearsey says.

However, for all of this, when Pearsey is asked about the biggest challenge of the job she offers a variation of the same answer offered by most doctors and nurses I speak to that night.

She gets emotional talking about beds.

"When it's busy, it's an emergency department and it's so busy, and there's no beds, it's hard," Pearsey says. "It's hard on the soul and the heart."