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Top Issues Transform ED Nursing

Wednesday March 10, 2010
Diane Gurney, RN, president, Emergency Nurses Association
Diane Gurney, RN, president, Emergency Nurses Association
(Photo by Russ Price Photography)
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Earthquakes, hurricanes and global outbreaks of infectious diseases are events that put emergency care in the spotlight on a regular basis. Responding to trauma and disaster is the heart and soul of emergency nursing for many ED nurses. However, other top issues of the day, such as possible healthcare reform, patient safety, access to care and healthcare cost containment, go hand-in-hand with saving lives. Together, all these elements are swirling into a perfect storm to challenge and change the future of ED nursing.

“The best thing we can do for ourselves is to own our skills in critical thinking and problem solving,” says Diane L. Gurney, RN, MS, CEN, president of the Emergency Nurses Association. “ED nurses have always been intuitive, intelligent and innovative and are quick to assess a situation and come up with solutions. They will have much to offer as our EDs prepare to meet the challenges of the future.”

Are You Ready?

Gurney stresses that ED nurses will need to expand their current abilities and develop new skills in order to step up to the anticipated demands of such events as healthcare reform and proposed Medicare cuts. Reimbursement from Medicare and other insurers based on quality outcomes also will call for the best ED nurses have to offer.
“Healthcare reform may be an overriding focus as we move through 2010,” Gurney says. “Excellence and quality are the two traits that will take the spotlight, and we will need to look at how we have been delivering care and transform it.”

Being prepared to tackle the transformation of healthcare will require a blend of education and the ability to access best practices and apply them effectively to ED nursing practice. It also will demand the leadership skills to collaborate with and guide the whole healthcare team by effectively articulating and sharing expertise, Gurney says. Professional networking, specialty certification and pursuing a BSN or advanced degree will be key to developing and honing these skills for ED nurses, she adds.

No Easy Answers

ED nurses will be expected to play an expanded role in patient safety and a hospital’s bottom line. This includes preventing serious adverse events, also known as “sentinel events” or “never events,” for which Medicare will no longer reimburse. According to the Joint Commission, many of a hospital’s serious adverse events occur in the ED, including delays in treatment, falls, hospital-acquired infections and medication errors.
There are no easy answers to the stresses and difficulties inherent to the ED, which can lead to issues with quality outcomes and adverse events. For example, the many distractions of today’s crowded and overburdened EDs can lead to medication errors and treatment delays, Gurney says.

“ED nurses will need to find ways to decrease distraction in a fast-paced and stressful environment,” she says.

To tap into best practices that address hard-hitting ED challenges, such as crowding, patient safety and cost containment, it will become more important than ever for ED nurses to become active participants in professional organizations. These include the ENA and the American Nurses Association. Regularly attending events and educational conferences, such as the ENA’s annual conference and its leadership conference, provides the resources, continuing education and networking ED nurses will need to provide their facilities with effective solutions.

“Each year there are so many changes and advancements in practice and products,” Gurney says. “Conferences are where emergency nurses can keep up with upcoming trends and best practices and then bring them back to their own organizations.”

Additionally, conferences offer opportunities for ED nurses to influence the development of medical products to be more efficient, safe and cost effective. “Vendors listen to nurses, and ED nurses can use their purchasing power to influence the direction of healthcare suppliers,” says Gurney.

Working Smarter

Gurney anticipates healthcare reform and possible Medicare cuts will have a trickle-down effect from leadership to ED nurses as leaders make hard financial decisions. “We may have fewer nurses to do the job,” she says.

ED managers and directors will be looking for job candidates who not only have sharp clinical skills and specialty certification, but can brainstorm and collaborate to help the whole ED team work smarter, according to Gurney. This includes demonstrating effective participation in cost containment and performance improvement activities, such as improving Press Ganey scores.

Being able to initiate best practices and develop innovative cost-effective models of care that secure efficient and safe patient care with quality outcomes will be key. This includes ensuring optimal plans of care for discharged patients to avoid unnecessary and costly repeat visits to the ED.

The Global Picture

A well-known issue in the ED has been crowding, which developed on an underpinning of decreased hospital beds coupled with increased ED visits, will continue to be an issue that impacts patient safety and quality care. ED nurses will need to understand the global picture — that ED crowding is also hospital crowding — and access best practices and resources to provide low-cost solutions to improve throughput and patient flow throughout the organization, according to Gurney.

The pace only picks up in the ED when the department also must deal with events such as the H1N1 pandemic. Occurrences such as this will continue to complicate the capacity and capabilities of the ED and their hospitals.

“Infectious disease is a part of our everyday life, and emergency preparedness will continue to take center stage” says Gurney.

She adds ED nurses will need to stay on top of the rapidly changing trends in infectious disease. They will be expected to quickly and proactively adapt and promote methods to protect patients, the staff, and the community from newly emerging strains of influenza and other communicable diseases and the threat of bioterrorism.

ED nurses’ expertise also will be in demand to create processes and mobilize resources that provide quality care to all patients under high census conditions, such as an influenza outbreak or local disasters. ED nurses also will continue to be leaders in helping a healthcare organization and a community prepare for disaster.
Building on Success
Data collection and benchmarking will be vital responsibilities of ED nurses as hospitals and healthcare organizations strive to improve patient safety and outcomes while containing costs. Organizations will want to improve and build upon the benchmarks for performance measures developed for stroke care, trauma care and cardiac care, which were developed on a foundation of nursing documentation.

“More and more healthcare organizations are talking about data-driven healthcare, and nursing documentation is at the root of that,” Gurney says.


Catherine Spader, RN, is a freelance writer.
Resources at Your Fingertips

The Emergency Nurses Association provides many avenues for ED nurses to acquire additional education, certification and specialization in emergency nursing. This includes certifications and courses, such as:

Trauma Nursing Core Course (TNCC)
Certified Emergency Nurse (CEN)
Certified Pediatric EmergencyNurse (CPEN)
Certified Flight Registered Nurse (CFRN)
Certified Transport Registered Nurse (CTRN)

For more information go to the Board of Certification for Emergency Nursing page at ENA.org/bcen/pages/default.aspx.

ENA also offers an annual conference and a yearly leadership conference, which provide resources and networking to help ED nurses to access, understand and implement evidence-based practices for the ED. For more information go to ENA.org/coursesandeducation/conferences/pages/default.aspx.

The organization also has compiled a list of quality and patient safety resources at ENA.org/practice/patientsafety/pages/2007ResourceList.aspx.