The Impact Of Emergency Department Overcrowding : How It Affect Nursing Professional Practice And Patient Care

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).

A visit to the emergency department (ED) is usually associated with negative thoughts by most people. It creates preconceived images of overcrowded waiting rooms and routine long waits for treatment (Jarousse, 2011). From 1996 to 2006, ED visits increased annually from 90.3 million to 119.2 million (32% increase). During this same time period, the number of EDs has declined by 186 facilities creating the age old lower supply and greater demand concept (Crane & Noon, 2011). There are many contributing factors that have led to an increase in ED visits. A few of these key drivers include lack of primary care access, rising of the uninsured population, dwindling mental health services, and the growing elderly

In a different review of literature on staffing and patient outcomes, Heinz (2004) describes the relationships between staffing and mortality, length of stay, and complications of patients. At first the article paints a clear picture of the future of nursing as it starts to feel the shortage which is approaching due to aging of present nurses, lowered nursing school admissions, and other hospital issues including financial hardships. In looking at the impact of ratios on mortality there were five different studies identified that showed that the lower the ratio, the lower the risk of mortality of patients. A patient's length of stay was also influenced negatively with higher nurse-to-patient ratios and positively with specialized units and care from nurses. The impact of staffing on patient complications also showed that there was an inverse relationship between the two. Heinz concludes that the key to solving these problems in nursing and reducing negative patient outcomes is nursing recruitment and retention (Heinz, 2004).

For over a decade researchers have been performing studies examining the effects patient-to-nurse ratios have on adverse outcomes, mortality rates, and failure-to-rescue rates of patients and on job dissatisfaction and burnout experiences of nurses. Aiken, Sloane, Sochalski, and Silber (2002) performed a study which showed that each additional patient per nurse increased patient mortality within 30 days of admission by 7% and increased failure-to-rescue by 7% as well. This same study also showed that each additional patient per nurse resulted in a 23% increase in nurse burnout and a 15% increase in job dissatisfaction. Additionally, Rafferty et al. (2007) performed a study in which the results showed that patients in hospitals with higher patient-to-nurse ratios had a 26% higher mortality rate and nurses were twice as likely to have job dissatisfaction and experience burnout. Blegen, Goode, Spetz, Vaughn, and Park (2011) performed a study where results showed that more staffing hours for nurses resulted in lower rates of congestive heart failure morality, infection, and prolonged hospital stays. The same study also showed that increased nursing care from registered nurses resulted in lower infection and failure to rescue rates and fewer cases of sepsis.

14 million Canadians visit Emergency Departments (ED) every year, and also reported to having the highest use of EDs (Ontario Hospital Association, 2006). ED overcrowding in Canada has become an epidemic. ED overcrowding has been defined as “a situation in which the demand for emergency services exceeds the ability of an (emergency) department to provide quality care within acceptable time frames” (Ontario Ministry of Health and Long Term Care, 2014). This has been an ongoing problem across Canada. Ontario has developed an initiative to reduce ED wait times by implementing a variety of strategies and collaborating with other institutions. This paper describes the Emergency Room National Ambulatory Intuitive (ERNI), an

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

Adequate nurse staffing is clearly a crucial element in safe, effective hospital care. A 2011 study by nurse researchers concluded that adding more nurses to a unit markedly improves patient outcomes and safety in hospitals (Griffith, Ball, Murrel, Jons & Rufferty,

Is emergency room patient (p) safety at greater risk by medication errors and near miss events (I) in an emergency room with poor nurse retention in comparison ( C ) to Magnet emergency rooms with a more stable nurse staff in a calendar year(o)? The dependent variable is the patient safety differences between hospitals with good nurse retention in comparison to poor nurse retention. The databases used were EBSCO and Cochrane Library utilizing the keywords; emergency room patient, nurse staffing, patient safety, and nurse retention. The limitations used varied by database but were the frequently year of research and physician to exclude physician staffing issues.

Doctors are busy giving family members updates on their loved ones. Traumas are coming in with families in complete fear. Admitting staff trying to get information from the families to get patients registered while trying explain to patients why they must stay, and why some procedures aren’t covered by insurance. The thousands of questions the admitting staff get from patients about their stay all the while being invisible to majority of the staff. That is the Emergency room, that is what an ordinary person walking in does not see. The clicks and the social norms and the hierchy involved in hospital care. The disconnect of clinical staff from non-clinical staff. This same disconnect that contributes to low emergency room patient satisfaction scores, the reason why people leave the ER unhappy. People who work in the ER come in all shapes and sizes. Most of the nurses are females with just a few male nurses, all of which are between 20 to 60 years of age. Admitting staff is made up of males and females from different social backgrounds. The ER is a melting pot, which sometimes can be difficult to

The abstract clearly outlined every aspect of the article in a concise and acceptable manner. Data was obtained through several interviews with nurses that practiced in the Emergency Room. The abstract concludes with the results of this study.

The Emergency Department (ED) is the highest cost environment to receive non-emergent care. The public views the ED as a safety net; more and more people are seeking treatment in the ED for non-urgent problems. This circumstance not only exacerbates overcrowding, it diverts attention from critically ill or injured patients and can diminish the quality of their treatment. Overcrowding in the ED is a problem that leads to delays in treatment and poor health outcomes (Hutchinson, 2015). ED overcrowding historically has been a problem seen most often in inner-city academic hospitals, but the issue is now a crisis in both urban and rural settings. Such use of expensive

Overwhelming workloads of hospitals nurses present a considerable problem for the American health system. With the growing nursing shortage resulting from an aging population and the pressure felt by health care organizations to reduce nursing staff in response to massive budget cuts, nurses are being forced to care for too many patients at one time causing severe work stress, fatigue, and burnout. Consequently, the quality of patient care suffers. Implementing a safe staffing strategy to assess the needs of registered nurses (RNs) in the acute care setting would ensure better patient outcomes and guarantee the diminution of the current healthcare crisis.

Constantly being understaffed in a medical environment, where patients lives are at risk, adds stress on the nurses and it is wrong. “Nurses often need to work long hours under stressful conditions, which can result in fatigue, injury, and job dissatisfaction. Nurses suffering in these environments are more prone to making mistakes and medical errors.” ("Nursing Faculty Shortage.”) If the supply increases than the environment of working in hospitals will be sure to improve. Less mistakes, and medical errors will diminish as well. “Dozens of studies have found that the more patients’ assigned to a nurse, the higher the patients risk of death, infections, complications, failure-to-rescue rates and readmission to the hospital — and the longer their hospital stay. “ (Robbins, Alexandra.) The health care system must change their ways, and hire more nurses to improve patients’ safety. If the supply increases than the environment of working in hospitals will be sure to improve. Increasing the supply of nurses will make the patient to nurse ratio reduce the potential risk of malpractice. Additionally, it would yield less over-worked nurses, which would provide nurses with increased energy, which would make it much easier to tend to patient care.

The ED staff nurses also agreed with the statement “Enough registered nurses to provide quality patient care” (2.69). The 3rd statement “Enough staff to get the work done” garnered an average of only (2.7). This mean generally showed an agreement with the statements on the low side validation, poor staffing of both RNs and support personnel was cited by ED nurses as the reasons for unproductive and poor quality of work. ED nurses provide emergency care ranging from an average of one hundred (100) to two hundred fifty (250) patients per

The broad research problem leading to this study is the belief that nursing shortage in facilities leads to patient safety issues. The review of available literature on this topic shows strong evidence that lower nurse staffing levels in hospitals are associated with worse patient outcomes. Some of these outcomes include very high patient to nurse ratio, fatigue for nurses leading to costly medical mistakes, social environment, nursing staff attrition from the most affected facilities. The study specifically attempts to find a way to understand how nurse