...THE EFFECTS OF OVERCROWDING IN THE EMERGENCY ROOM MICHELLE POWELL MSN –BL 510: NURSING PROBLEM SOLVING SKILLS DEVELOPMENT MAY 20, 2012 PROFESSOR NKECHI ILEKA The Emergency department provides an extraordinary important public service mission by providing emergency care 24 hours a day, 365 days per year without discrimination by social or economic status (Derlet, Richards & Kravitz, 2001). One of the key foundations of EDs is to provide immediate access and stabilization for those patients with medical emergencies (Derlet et al, 2001). The Emergency Department has always been there available to help, unfortunately the basic tenet is now being challenged, and the general public may no longer be able to rely on EDs for quality and timely emergency care, placing the people at risk (Favotich & Hirsch, 2003). According to the Emergency Nurses Association all people are entitled to timely and appropriate access to safe and effective health care. This paper will discuss the problem of overcrowding in the Emergency Room and strategies that the Nurse leader may do to help control overcrowding. Overcrowding in the emergency department (ED) is the most serious issue confronting EDs in the developed world (Favotich & Hirsch, 2003). Overcrowding is a situation “in which the demand for emergency services exceeds the ability of department to provide quality care with acceptable time frames (Joint...
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...Important for Nurses to Allow Family Presence During Resuscitation Efforts? Cloressa Dizney University of Texas at Arlington College of Nursing Why Is It Important for Nurses to Allow Family Presence During Resuscitation Efforts? The idea of Family Presence During Resuscitation is a controversial topic for sure but has been around for quite some time. Most major health organizations such as the American Heart Association (AHA), the Emergency Nurses Association (ENA), the American Association of Critical Care Nurses (AACN), the American Academy of Pediatrics (AAP), and the American College of Emergency Physicians endorse the practice of FPDR and still it is not a widely accepted practice. Why is this? The following three articles will discuss the positive and negative beliefs from the perspectives of both health professionals and the patient’s families. This paper will also support why it is important to offer FPDR and establishing policies to do so. The first article by Jensen and Kosowan (2011) addresses cardiac health care professional’s perspectives on FP during CPR. Some opponents in healthcare argue that FPDR would be too traumatic of an experience for families to watch. Family interference, increased staff stress, and legal action on the resuscitation team were also concerns of healthcare professionals. The article reports research done in several Canadian hospitals regarding the beliefs of health care providers on the topic of FPDR. The research found that nurses are more...
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...Quality Research Article Critique Factors Influencing Emergency Use of Nurse Practitioners: A Critique Problem and Purpose This is critique of a Qualitative Nursing article, the article is: Factors Influencing the Decision to Use Nurse Practitioners in the Emergency Department by Laurie A. McGee, MN, ARNP and Louise Kaplan, PhD, ARNP, published in Journal of Emergency Nursing, Volume 33, Number 5, October 2007. The problem that is stated in the article is there is a growing and serious problem facing the overcrowding of emergency rooms within the United States. There is a current epidemic of the population that relies on emergency room care as primary care. “The 2004 National Hospital Ambulatory Medical Care Survey (NHAMCS) reports an 18% increase in the number of visits to emergency departments from 1994 to 2004.” This causes long wait times and may cause emergency room doctors and nurses to be overworked allowing for a possibility for mistakes to handle the volume. “Overcrowding is defined as a situation in which demand for emergency services exceeds the ability of a department to provide quality care within acceptable time frames.” Overcrowding can delay care which is a patient safety issue and can lower patient satisfaction. “The Joint Commission on Accreditation of Healthcare Organizations' review of sentinel events has attributed patient deaths to delays in patient care. In hospital emergency departments, delay of treatment is the most common type of sentinel event.”...
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...For the past two years, I have worked in an emergency room that has pushed me and taught me like no job has ever before. My experience in the emergency room is what sparked my interest in becoming an advanced practice nurse and what has helped to shape my short-term and long-term career goals. I want to attend the University of South Alabama’s graduate program to advance my nursing career and to achieve these goals as a dual focused Family Nurse Practitioner /Adult-Gerontology Acute Care Nurse Practitioner (FNP/AGACNP). I frequently work as the triage nurse; I see almost every patient that enters the emergency room and I am responsible for initiating his or her care. I have to decide what level of urgency their condition requires and order any tests that are pertinent to their complaint. This role continually pushes me to grow as a nurse. I am always thinking ahead to anticipate what the clinician will need ordered. My short-term goal would be to further my education and career by becoming a nurse practitioner. Becoming a nurse practitioner would allow me to take a step further in patient care by actually treating and educating the patient on...
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...paper. “Collaborative practice is intended to combine the knowledge and skills of several health professionals to maximize the efficiency of both the clinicians and the health care system” (Slippery Rock University, 2007). In other words, it is the intermingling of multiple healthcare disciplines in order to provide the best patient care. An example of this could be the work on a surgical floor where nurses, physicians, surgeons, physical therapy, respiratory therapy, social work, and home health all work together to ensure that each aspect of the recovery is managed well. The clinical case to be discussed is a two month old male who arrived in the pediatric emergency room after a referral from the pediatrician’s office. The child presented to the pediatrician with a two day history of coughing, runny nose, decreased intake and a fever. The child had very few wet diapers in the past 12 hours. The child showed signs of dehydration and was sent by helicopter with the pediatric transport team to the regional children’s hospital. Upon arrival to the emergency room the child had increased work of breathing and was intubated due to impending respiratory failure. The child was fluid resuscitated and lab and chest films were obtained. Once stabilized, the patient was transferred to the pediatric intensive care unit. Once the parents arrived, social...
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...of nursing practice. The American Nurses Association states that nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations. It is this thinking that nursing continues to strive to assist patients not only achieve their optimal physical health, but also their family culture is equally important when it comes to healing. As nurses continue to understand the dynamics of a patient’s family system, it is clear that the word “family” draws upon much more than just blood relatives. In the health care setting a family can be viewed as the people who come together to support a patient during a health crisis. That support may be seen directly at the bedside, through conversations via phone, or helping to assist in the discharge process. As a nursing workforce it is our responsibility to understand how the roles of a family affect our individual patients, and work to incorporated those roles into their therapeutic environment. An issue in today’s emergency departments that continues to draw attention from aspects of the medical profession is the use of family presence during cardiopulmonary resuscitation. “While it appears that the evidence clearly indicates positive outcomes from family witnessed resuscitation (FWR), a majority of emergency departments fail to implement or...
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...In preparation for meetings or projects, there are various program planning models that can be used to assist decision makers depending on the goals of the program. These models have greatly helped leaders as the outcomes have benefited from careful planning. As decision-makers have gained great amounts of knowledge and experience, I have experience that collaboration within a group can be best effective when these factors are used. This allows different perspectives to be realized and produce a more professional product. Continuous quality improvement does not just happen, it has to be planned and managed using tools such as PDCA and DMAIC. If you want to be better than your competitors and to flourish as a business then you must ensure that business processes are continually improved (Liesener). In order to do this action plans need to be developed. For many employees, experienced or less experienced, the variety of problem-solving approaches for action plans can get confusing. But there are not so many differences between these approaches, as you could expect. All differences are depending only on the type of problem, which has to be solved. Various problem-solving approaches like PDCA and DMAIC can be sorted in the following categories (Liesener): 1. Is it a small, medium or large sized problem you want to solve and is the solution of the problem unknown? 2. Does your problem solving strategy follow a continuous improvement process or do you want solve a single...
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...There were several factors that played a role which included high patient census, poor staffing, alarms dismissed by staff members, patient was left unmonitored, and no supplemental oxygen initated prior to the procedure. When the patient was pulseless no CPR was initiated until the code team arrived and critical interventions were delayed by the emergency room staff. The patients medication reconciliation or history weren’t reviewed by the emergency room physician. Tripple doses of intravenous valium and dilaudid were given without a lapse in time. The patient was elderly and on chronic oral opioid medications. “Normally these types of medications are administered with low doses and titrated per patient’s sedation level. Patient, monitoring or sedation level weren’t assessed between doses. This event is known as a sentinel event. In any situation that causes injury, or death a root cause analysis must be completed and reported to the Joint Commission. B. To implement a change in the conscious sedation procedure a team or committee needs to be established. All staff in the emergency room can become active participants by joining a committee or subcommittee. These main categories may include patient characteristics, task factors, individual staff members, team factors, work environment, and organizational management (IHI, 2014). A cause and effect, or wishbone graph can be constructed to clarify the error and process for the team...
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...HOW TO USE CLASSICAL MANAGEMENT APPROACH IN UTILIZING ACCIDENT &EMERGENCY DEPA RMENT? BY ZAHRA AHMED EBRAHIM Master in Business Administration General Management Organization and Business Management Open Asia e University 2011 Introduction Background of the Study A number of approaches to the structure and management of organizations developed during the late 1800s and early 1900s .The early philosophies are traditionally labelled classical theory while the later approaches include systems theory and contingency theory. The classical approach to organization focuses efficiency through design. Eleanor and Phillip (2009) kept four elements to build classical theory: division and specialization of labour, chain of command, organizational structure, and span of control. The first element emphasised about dividing the work reduces the number of task that lead to proficiency and specialization. The second element is the chain of command which is meant the hierarchy of authority and responsibility within the organization. However, the collaboration between staff and there managers improve the efficiency and productivity of the unit. Moreover, the third element is organizational structure that describes the arrangement of the work group. The design of the Organization is intended to faster the organization survival and success. Finally, the span of control addresses the pragmatic concern of how many employees a manager can effectively supervise. The later approaches...
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...Values Employee Suggestion Implementation Project Yarenis Alba Western Governors University Abstract Working in a hospital unit can sometimes be very difficult. Nurses must do everything accordingly to practice positive time management while still providing quality care to their patients. In emergency situations, certain supplies should readily available when needed in order to effectively respond to patients needs during emergency situations. Sometimes making sure the unit is adequately stocked with supplies gets put aside or forgotten simply because we become occupied in everyday tasks. This research includes identifying deficits in supply demand and proposition of solution to positively affect time management and patient satisfaction using suggestions voiced by current stakeholders. Employee Suggestion Implementation Project Working on a busy Medical-Surgical hospital unit can sometimes be difficult. Although we (Nurses) generally have all the tools, supplies, and resources to correctly care for patients, sometimes there are areas that can be improved in our department to maintain the fluidity of caring for patients seamlessly. In preparation for this upcoming project, I placed an employee suggestion box in our departments break room back in November 2013. Staff on our floor was advised of this box via our hospitals email system. The staff was advised that this box was placed to serve as a means of communicating our...
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...Violence Against Nurses in the Emergency Department Kimberly L. Kirk Professional Nursing Practice of the Baccalaureate Nurse August 8, 2014 Violence against Nurses in the Emergency Department According to the National Institute for Occupational Safety and Health, workplace violence is defined as “an act of aggression directed toward persons at work or on duty, ranging from offensive or threatening language to homicide” (Wolf, Delao & Perhats, 2014, p.305). Workplace violence (WPV) can include verbal, physical, and emotional abuse, or any type of threatening behavior that can cause physical or emotional harm. According to the Emergency Nurse’s Association Position Statement (2010), “workplace violence is a serious occupational risk for the emergency nursing workforce and has been recognized as a violent crime that requires targeted responses from employers, law enforcement, and the community.” Due to the lack of research concerning workplace violence and other barriers such as underreporting, failure to prosecute, and lack of management support the enormity, of this issue is grossly underrepresented. Individuals who assault ER nurses should be prosecuted. Without increased and consistent prosecution for assault on emergency nurses, patients and families will still think it’s acceptable to physically or verbally assault a nurse. As the ENA position statement (2010) proposes, stronger legislation is necessary to help decrease the view that violence...
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...Critical Analysis Paper Introduction This paper is an academic critique of a qualitative research paper written by Bridgitte Cypress (2014) entitled “The emergency department: Experiences of patients, families, and their nurses.” In this research, the subjects were investigated with regards towards lived experiences to gain insights on how each key elements correlate in the Emergency Department. This academic critique will highlight its strengths and gaps by operating an analytic approach based on the research process in which it exemplifies the parts and qualities of a qualitative research Research Design There is a commitment in maintaining the social context/emic perspective in this study to capture and reflect worldviews...
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...Executive Summary Nurses do more than care for people. Ever since Florence Nightingale led the effort to improve hospital sanitation and became known as the founder of modern day nursing, nurses have been at the forefront of change in health care and public health. Nurses provide ongoing assessment of patient’s health. Their round-the-clock presence, observation, skills, and vigilance allow doctors to make better diagnoses and develop proper treatments. Many lives have undoubtedly been saved by an attentive nurse who saw early warning signs of an impending cardiac arrest or some other crisis. Given the importance of nurses to the health of Americans, it is unfortunate, indeed, that the nation is facing a critical nursing shortage. There is a sense of urgency about the shortage this year as the first wave of baby boomers begins turning 60. As the country ages it means Registered Nurses will play an even larger role as the 78 million baby boomers require additional health services. Hospitals have struggled to attract more nurses, but working conditions keep getting tougher. Nurses frequently have to work double shifts, and new insurance rules, under which only the sickest people are treated in hospitals these days, mean that each of the patients requires much more care and attention. Introduction The United States is facing a critical shortage of registered nurses -- particularly the specialized, highly trained nurses who staff intensive care...
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...people in this world, the kind that jump into the swimming pool and the people that slowly creep in inch by inch before finally fully submersing themselves into the water. I’m more like the later type of person especially when it comes making big life decisions. Not surprisingly it has taken me many years to finally decide that I want to be a nurse. It took a lot of thought and prayer to finally come to this conclusion. I initially had the idea that I wanted to pursue a career in the nursing field when I was in high school. My mother had gotten sick and almost died when I was a junior. We were in and out of the hospital for several months. During that time what I remember the most is the kindness and compassion that was given to my mother by the nurses at the emergency room. Their example during that trying time made me want to become a nurse....
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..._____Thao Nguyen________________________________________________ 1. For the community health nurse, what is the process of data collection in the community? Give 2 examples from textbook, lectures, and your community assessment project. Course Objectives 2,3,4,5: Chapter 15 and your community health assessment project (20 points or 10 pts. for each example and the written description of the example) Be sure to include two of the following: Observing the community; Interviewing people in the community; Reviewing records (what type of records); Reading local news/Media; Professional literature; Conduct surveys; Governing body or policy changes (CDC recommendations) The process of data collection starts with assessing the community. For my community health project at the AFLAC Children’s Hospital, I and Alyssa went up there to observe the community and it was in the middle of downtown Atlanta. We got lost for an hour on the road and the community was over-populated, there was no more parking space on the deck by the hospital, so I and Alyssa had to get Valet parking. Windshield survey is an observation of the community, it was a clean hospital but the location was hectic and unsafe. We interviewed the Nurse Educator at the hospital named Elizabeth Holtzshaw and she gave us a tour of the hospital and explained the different specialty teams for chemotherapy, lymphoma, and leukemia. The rooms had video games and PlayStation for the kids to play and a playground outside for recreation...
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