The Emergency Department At St. Mary's Medical Center

Providing the best care to each patient starts with providing the proper amount of staff members to each unit. Looking at the needs of different units not only allows administration to see areas for improvement, but also areas that are being handled correctly. Utilizing the indicators provided by The Joint Commission, 4 East, a pediatric medical/surgical floor, has a high rate of falls and nosocomial pressure ulcers that appears to be related to the increase overtime nurses have been working for that floor (Nightingale, 2010). Research has shown increases in adverse events have been related to nurses working over 40 hours a week (Bae, 2012).

Inadequate nurse staffing is commonly cited as a factor in unanticipated hospital events (ANA, 2015), whereas higher staffing levels are related to lower rates of negative patient outcomes (Registered Nurse Safe Staffing Act [RNSSA] of 2015, 2015; MN study links nurse staffing to patient outcomes, 2015). For example, inappropriate nurse staffing can result in increased infections such as pneumonia, shock, cardiac arrest, and urinary tract infections (Stanton, 2004), longer hospital stays, medication errors, falls, injuries, and death (ANA, 2015; Stanton, 2004).

The concept of this EBP change project is compassion fatigue as it relates to nurses working in an emergency department (ED) dealing with secondary trauma causing symptoms of compassion fatigue (CF). Compassion is defined as the empathetic awareness of another’s distress, united with a desire to alleviate it (Merriam-Webster’s online dictionary, n.d.). Fatigue is the physical or mental depletion that can be the result of strain, overwork, or disease (The Free Medical Dictionary,

S (situation): Hi, my name Kelsey and I am a nurse in the emergency department. I am calling about Shannon O’Reilly’s most recent laboratory results.

Bedside reporting involves giving information or a report to the oncoming nurse in the presence of a patient. This method gives the patient an opportunity to ask questions and get clarification regarding his or her care. Bedside reporting increases patient satisfaction, quality of healthcare and nurse-to-nurse responsibility. Hospitals need to design a better handoff process that can easily reduce patient risks and increase patients’ involvement in their care. Emergency rooms shift reports usually take place at the nursing station of every patient care area. The departing nurse gives information verbally to the oncoming shift. Therefore,

Mandating safe staffing levels for registered nurses in acute care settings has been an important topic of discussion for many years. As the demand for registered nurses continues to rise, so does the clinical demands on the nurses currently working. If there are no specific policies in place that mandate safe and appropriate nurse-to-patient ratios for all acute care facilities, registered nurses (RNs) may be required to take on even more patients than the already high numbers currently given to many of them. Inadequate RN staffing has the potential to cause increases in adverse patient events (American Nurses Association (ANA), The registered nurse safe staffing act, 2015) as well as an increase in nurse injury (Musick, Trotto, & Morrison,

Beaufort Memorial identifies ED patients ' level of urgency by the triage. They are assigned a level from one to five with one being the least emergent. Levels one through three are considered non-emergent and could be handled outside the ED. These visits make up 53.3% of Beaufort Memorial 's ED visits. (A. Hildreth, personal communication, August 12, 2015)

I would like to give you some insight as to the daily operation of a major Emergency Department in this city. Not unlike many other “ER’s” the nursing staff is tasked with the triage or assessment of patients in order to sort by priority. The nurse is then tasked with maintaining flow of the department and ensuring the timely care and physician evaluation of patients. This requires clinical nursing judgement and expertise which is tested constantly. To explain this plainly, nurses are faced with a meat grinder which cannot stop. There may be twenty patients in the lobby with ambulances lining up. The room nurses are trying to

Several studies have shown that patients get well faster and safer when they receive more nursing care. Even more importantly according to Linda Aiken study (2003), mortality rates and staffing ratios are closely tied. Each additional patient per RN after four patients, chances of dying in the hospital is increased by 7%.Patient on a surgical unit with patient –RN ratio of 8:1 were 31% more likely to die within 30days than those on surgical units with ratios of 4:1.Studies have shown that more infections like UTI, pneumonia, shock or cardiac arrest increases when patients receive fewer hours of nursing care. Medication errors and unsafe hand washing techniques were found more in increased patient workloads. Unsafe staffing gave more job dissatisfaction, job burnout and more nurses quit or drove nurses away from nursing. This increased mandatory overtime and increased nurse shortage. According to survey of California state

I am an Emergency Department nurse whose goal is to care for patients as a Family Nurse Practitioner. I have had the privilege of working in a fast pace setting with patients of all ages and I’ve been exposed to various medical illnesses. As an Emergency Department nurse, I feel these qualities have provided me with experiences that further my education and allow me to provide care to patients. Furthermore, I have gained valuable knowledge from recognizing and stabilizing critical patients to help with the care for uncomplicated medical conditions.

Any patient brought into the Emergency Department, is first signed in at ED receptionist desk and triaged by a triage nurse, prioritized and brought to patient room by a charged nurse either by wheelchair or stretcher or walking by the patient depending on patient’s illness. A nurse is assigned to the patient. Emergency Doctor comes in and if the patient illness is life threatening it is stabilized and the Doctor orders test such as blood work and x-ray if necessary to be conducted. Based on the test result the patient is either discharged or admitted. Certain times the emergency department is filled with a lot of patient that there is no place to sit and patients keep coming in and creating

Imagine the following scenario: A 43 year old male and his 41 year old wife have just finished celebrating their twentieth wedding anniversary at a local restaurant. The husband had a cocktail at the bar while waiting for the table, and then had a couple of glasses of wine with dinner. After dinner, the happy couple drive their vehicle home on a snow covered highway. The car begins to swerve on the ice and enters oncoming traffic and hits a semi cab head-on. After an extended extraction of the driver by paramedics, the driver is found to be unconscious, has multiple head lacerations, chest contusions from the steering wheel, and his left leg is bleeding profusely from a compound femur fracture. The female is conscious, in shock, and states that she is 36 weeks pregnant and has pain in her abdomen. Both victims are flown via helicopter to the nearest level 2 trauma center where 2 teams of emergency room doctors, trauma surgeons, respiratory therapists, x-ray technologists, phlebotomists, chaplains, social workers, and of course, trauma nurses, are waiting to assess the patients and provide life-saving care. This scenario is not the exception in a level 2 trauma care center of the emergency-room, it is the average situation that a trauma nurse will find his or herself in every day. Because of the fast paced situations that require split-second critical decisions, the advanced life support training that is required, and the often unrewarded care, a career in trauma

As a new graduate nurse, I am deeply passionate about starting my nursing career at Desert Regional Medical Center’s Emergency Department or Women and Infants’ Center. Prior to starting nursing school, I took an Emergency Medical Technician course where I had the opportunity to perform my clinical rotations in a Level I Trauma Center and assist in ambulance transports. My interest for working in a fast-paced environment and in unpredictable emergency medical scenarios motivated me to pursue my senior nursing preceptorship in the Emergency Department. During my preceptorship experience at Inland Valley Medical Center, Level II Trauma Center, I performed 120 hours of ED nursing care and safely treated trauma patients across the lifespan. I helped stabilize patients involved in motor vehicle collisions

The setting for this project is a trauma center in Nashville, TN. The unit has a 28-bed capacity. These beds are specifically assigned to patients sustaining traumatic injuries. Patients are classified as Level 1, 2 or 3 according to the trauma activation criteria for the hospital. Level I patients are patients with 1 or more of the following characteristics: Intubated patients with any type of artificial airway, unsecure or unstable airway or oxygen saturation 9. Level II patients are those with HR >120 bpm, GCS 10-13, paraplegia or hemiplegia, known intraabdominal or retroperitoneal bleeding or solid organ injury, >2 long bone fractures AND injuries sustained as a trauma from falls, cars, bicycles or motorcycle accidents, gunshot wounds or

The United States of America has around 5,534 registered hospitals. Out of the 5,534 hospitals, only about 250 of them include level one trauma centers and certain states do not occupy a level one hospital. Major problems develop from the low number of trauma centers, especially when the role of overworked and shortage of staff comes into the picture. According to studies, “Intensive Care Unit (ICU) patients cared for by hospitals with below-target RN staffing levels had a 2% to 7% increase in mortality” (“Nursing”). Continuing along, patients mortality rate when not in the ICU, increases 12%.