Challenges Facing Emergency Department Nurses - Essay Example

Challenges Facing Emergency Department Nurses Challenges Facing Emergency Department Nurses Introduction Hospital emergency units continue to experience mounting challenges on the parts of hospital management, nurses and patients. These challenges arise from several factors such as longer life expectancies and increases in cerebrovascular and coronary diseases. However, hospital emergency services continue to points of convergence for problems that remain either undiagnosed or unresolved at other levels of care(Guedes dos Santos, et al., 2013). For segments of the population that have no regular access to healthcare, emergency departments and situations offer them sole opportunities to access healthcare services. By their nature, emergency units bring under one roof several services and resources that are otherwise inaccessible to ordinary people. These services and resources include consultations, nursing procedures, medicines, laboratory tests and hospitalizations. As a result, the chaotic use of and overcrowding in emergency services, coupled with inadequate bed capacities, present several challenges to patients and health workers alike. This paper’s objective is to examine the challenges that nurses in emergency departments face. The paper goes a step further and proposes possible solutions to the identified challenges. In terms of the organization of the paper, the proposed solution to a challenge comes immediately after it. Discussion Management of Overcrowding The management of crowds in EDs constitutes a major challenge for nurses as it digresses them from their core activity of providing care to patients. Many emergency departments (EDs) across the U.S. are crowded. As a result, some 500,000 ambulances cannot go to the nearest hospitaleach year (McHugh, et al., 2011). Several factors are responsible for overcrowding in emergency departments. According to nurses, for instance, many patients are ignorant of the purpose of the emergency department which is to handle actual emergencies. As a result, some patients may come to the emergency unit with an abdominal pain, for example. Besides ignorance of the purpose of the emergency unit, some patients are simply impatient(Donley, 2014). Therefore, rather than go through regular care procedures, they opt to disguise their problems so they can be attended at the emergency unit where they can obtain most of the services with less hassle. Another cause of overcrowding is low nurse-to-patient ratios which imply that patients have to wait longer to be attended than they would if there were adequate nurses. In order to defeat the problem of overcrowding, nurses propose the reorganization of healthcare systems such that lower level units such as health centres are able to handle the less severe urgent care cases(Lawson , 2012). Otherwise, as things stand today, lower level healthcare facilities lack the capacity to handle the least severe of medical emergencies. The result is the flight to higher level facilities for emergency care. Meanwhile, as they wait for whole healthcare systems to change, nurses could lobby hospital managements to increase the physical capacities of their emergency unit and hire more nurses. In addition, there exists a pressing need to educate members of the public on the types of cases that emergency units are designed handle. This way, the units may experience fewer cases of patients arriving there with severe headaches. Physical Assault by Patients Physical violence perpetrated against nurses in the ED has risen in recent years. A study that Erickson and Williams-Evans undertook revealed that 82% of the nurses that were surveyed had been attacked physically at least once in the course of their careers(Robinson, et al., 2004). The nurses also that many assaults go unreported. Only 36% of the nurses involved in the survey felt safe from physical violence while at work (Robinson, et al., 2004). An earlier survey on the incidents of crime that had taken place in hospitals between 1986 and 1991 revealed that the majority of reported cases of physical assault had taken place in care areas. Nurses were the main targets of assaults, the majority of which happened in Eds. Also, of the 51 cases of homicide that happened in clinical settings in 2000, 23% occurred in EDs. In order to ensure their safety at the place of work, ED nurses, through their associations must push for their employers to create a safer working environment. This may entail demanding that hospital managements beef up security in the EDs. At the same time, nurses must be encouraged to report cases of physical violence to the hospital management and the police. However, this can only happen if nurses have confidence in the said authorities and believe that whenever they report a case, it will be acted on (Robinson, et al., 2004). Otherwise, they may develop apathy and decline to report assaults. Ergonomics and the Design of Facility The current American nursing workforce, including ED nurses, is aging. According to studies by the American Nurses Association, of workers who seek compensation for back-related problems indicate that nurses have the highest rates of claim compared to any other occupation(Robinson , et al., 2004). ED nurses are especially prone to work-related musculoskeletal disorders (WMSDs) as their work involves repetitive movements such as reaching, pulling, lifting and pushing in crowded settings(Robinson, et al., 2004). Other estimates indicate that every year, 12% of nurses leave nursing due to back injuries while another 52% complain of chronic back pain. These trends call for healthcare providers to create work environments that are ergonomically friendly to nurses. Fortunately, for nurses, innovative projects that are designed to improve workplace safety and the effectiveness of nurses are underway. An example of such projects is the Transforming Care at the Bedside (TCAB) initiative. This was a nation-wide joint initiative of the Robert Wood Johnson Foundation (RWJF) and Institute for Healthcare Improvement (IHI) (Anon., 2011). The initiative ran between 2003 and 2008. The initiative aim to develop, test and deploy that would dramatically improve care in EDs and enhance job satisfaction for nurses. Starting September 2007, the initiative was implemented at ten of the thirteen organizations that had been taken on board at the pilot stage. Beneficiaries of the project included Seton Care in Austin, Texas and Childrens Memorial Hospital in Chicago among others. However, the impact of the initiative largely remains unfelt that the needs for more similar projects. Growing Demand for Emergency Care Between 1992 and 2002, the number of ED visitors grew from 89.8 million to 110.2 million in a year. This growth represented an increase of 23%. Over the same duration, the number of EDs in the U.S. fell by about 15%(Robinson, et al., 2004). The rising pressure this scenarios has been compounded by other factors such as the national shortage of nurses and other healthcare workers, poor access to primary care and specialized services and the federal law that guarantees every American access to emergency care. These and other challenges continue to comprise the efficiency of America’s emergency care system. In addition, they have served to make the work of nurses difficult. As this is a multifaceted challenge, this paper will only propose a solution to a part of the problem – the shortage of nurses. By 2020, America will have at least 400,000 fewer nurses that than the country will need (Robinson, et al., 2004). Currently, in their ED staffing decisions, organizations are overly driven by the motive to cut labour costs and maximize profits. The scenario has tended to lead to understaffing in most health organizations in the country. This trend must change. Nurse hiring decisions must now start to be driven by current research on such matters as optimal nurse staffing. Nursing Overload The world over, work overload is a major issue for nurses, especially those working in emergency departments. For instance, in a 2012 survey involving the British Columbia Nurses Unions 5,600 members, 81% of the respondents indicated workload as a problem. To 39% of the respondents, it was a major problem (Berry & Curry, 2012). Nursing overload happens for a variety of reasons. Increased bed capacity, leading to more patients, without matches in the number of patients is a major cause. Inadequate staff, due to insufficient baseline staffing or the failure to replace staff who are away on sick leave or vacation, is another cause. The failure to replace staff could be due to the lack of staff for replacement, or it could be a measure to cut labour costs. Where an organization is understaffed, either temporarily or permanently, ED nurses bear the full brunt of the situation owing to overcrowding in emergency units(Robinson, et al., 2004). Nurses can address this challenge by lobbying their employers, through their unions to address the particular causes of workload at their respective organizations(Berry & Curry, 2012). For example, whereas increasing the bed capacity of the emergency unit is desirable, it must be accompanied by increased staffing of the unit. Otherwise, the result will be the absurd situation of too many patients taken in with few nurses to attend them, with the inescapable consequence of work overload for the few available nurses. In the event that the hospital is not replacing nurses on leave in order to save on labour costs, the management and the nurses may need to strike a comprise on how best to staff the unit optimally yet cost-effectively. Sustaining the Quality of Care Overcrowding compromises the quality of care given to patients in the emergency department(Tang, et al., 2011). Some emergency units lack a referral system where they can refer a patient, after receiving basic care and stabilizing, to other units of the health facility. This scenario compounds overcrowding. Under these crowded conditions, it becomes difficult for nurses to maintain the hygiene and comfort of patients who remain in the emergency unit for observation. Overcrowding affects the quality of services and the level of attention that patients receive. It is of little consequence how well equipped the nurses are. In fact, under conditions of overcrowding, some care that may seem insignificant may be neglected. Again, the surest way to improve and maintain the quality of service that patients receive in the emergency unit is to reduce overcrowding in these units by means of the suggestions provided earlier. In addition, there is a need for healthcare facilities to re-examine their flow of patient care. Currently, nine out of ten hospitals are “boarding” admitted patients in the ED as they wait for beds to inpatient to become available(McHugh, et al., 2011). In this regard, hospitals need to expedite their procedures for admitting and releasing patients. Also, there is a need for greater cooperation among all the professionals in the health team(Collin, et al., 2012). Some nurses also feel that the admission of patients should be left to nurses because their experience and training in management gives them a broader review of the matter(Tang, et al., 2011). The Need for Leadership as a Management Tool In order to initiate and implement changes designed to improve the quality of care in the emergency department, nurses need leadership skills(Vega & McGuire, 2007). However, the practice of leadership is a challenge for many nurses, including those who serve in EDs. Leadership demands that that the leader be dynamic and receptive to change. Many nurses are resistant to change, let alone initiating it. Nurses who have served in an organization longer are especially more resistant to change even if they are aware of the benefits the change will bring to the unit and to themselves. This scenario makes the practice of leadership in the emergency unit difficult. This point is ironical. Because b nurses experience the challenges in the emergency unit first-hand, one would expect them to be enthusiastic about and even initiate any changes that will improve their work conditions and the quality of care they provide. In order to overcome this challenge, some nurses are of the opinion that nurses should return to the classroom and take courses on the management of nursing. Hopefully, such training will equip them leadership skills that include change management(Vega & McGuire, 2007)(Anon., 2011). However, the viability of this strategy in overcoming the challenge is questionable. While it can be learned, leadership tends to be more effective if it is in-born. Thus, a better strategy would be to identify nurses in the emergency unit who are naturally inclined toward leadership and use them to bring about changes in the unit. These “natural” leaders will be better placed to initiate changes and mobilize their colleagues to embrace them. Conclusion There is unquestionable empirical evidence to the effect that the country’s emergency care system is in a crisis. Many factors, some of them beyond the control of health organizations, have conspired to pose untold challenges to regulators, hospital management teams, nurses and another healthcare professionals and patients. Nurses serving in EDs are particularly susceptible these challenges. Some of the challenges these nurses in America and elsewhere in the world contend with include overcrowding in EDs, work overloads, physical abuse and the pressure to maintain quality care in the face of all these challenges. In order to overcome these hardships, nurses, through their associations, must join hands to lobby policy makers and the managers of health organizations(Robinson, et al., 2004). References Anon., 2011. Robert Wood Jonhson Foundation (RWJF), Princeton: Robert Wood Jonhson Foundation (RWJF). Berry, L. & Curry, P., 2012. Nursing Workload and Patient Care: Understanding the Value of Nurses, the Effects of Excessive Workload, and How Nurse-Patient Ratios and Dynamic Staffing Models Can Help, Ottawa: The Canadian Federation of Nurses Unions. Collin, K. M., Valleala, U. M., Herannen, S. & Paloniemi, S., 2012. Ways of interprofessional collaboration and learning in emergency work. Studies in Continuing Education, 34(3), pp. 281-300. Donley, E., 2014. Managing Risk of Difficult Behaviors in the Hospital Emergency Department: The Use of Cigarette Breaks With Mental Health Patients. Social Work in Mental Health, 12(1), pp. 36-51. Guedes dos Santos, J. et al., 2013. Challenges for the management of emergency care from the perspective of nurses. Acta Paul Enferm, 26(2), pp. 136-143. Lawson, R., 2012. Palliative Social Work in the Emergency Department. Journal of Social Work in End-Of-Life & Palliative Care, 8(2), pp. 120-134. McHugh, M., Van Dyke, K., McClelland, M. & Moss, D., 2011. 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