Yesterday, the ED was on Red which means there were no beds available. My side wasn’t quite slammed yet but with the acute side of the ED full, it was only a matter of time until our side got full not only from our own designated patients, but also with patients who may better have been on the acute side, were there any room. Basically, a relatively normal day.

I got to work prepared for a busy 12 hour shift. I asked the charge nurse, who is one of our Nurse Leaders, what my room assignment was and she smiled. handing me the charge phone, she said “We’re training you today for charge.” Now, I have asked for this opportunity several times and I feel ready for it. But the minute that phone was in my hot little hands, I felt a surge of panic.

Me? In Charge of the whole Urgent Care section of the biggest ED in my city?? ME???

I swallowed hard, my mouth gone dry. “Cool!” I managed to say, telling myself that I want this.

The Nurse Leader took pity on me. “You’ll only have two beds to care for all day, and I’ll be here,” she said. “Until 4″. Which meant that from 4pm until I was scheduled to leave at 10pm, she wouldn’t be there.
I smiled weakly. This is something I can do, I thought. I hope.
The phone started ringing almost immediately. Calls were coming from Triage..can I take this or that patient, do we have a bed for one patient, can the attending come to triage and evaluate another patient….I just kept answering calls and doing my best. Using critical thinking and my nursing judgement, (which apparently I do have!), I fielded each call and cared for my two beds.
I did my best to assign beds fairly, alternating between the different zones so that no nurse was unfairly overloaded. I asked lots of questions, and helped the other nurses as much as possible.
Before I knew it, it was 4pm and the Nurse Leader was leaving. She told me not to worry and told me I could page her at home if I had to. “But really,” she said. “You are doing fine. You won’t have any trouble.”
So I kept on going and the night was going very smoothly.
Until we ran out of beds again.

Around 9pm, we start to taper the patients we take on the urgent side, since staffing goes down for the overnight shift. Concurrently, at 9pm not only did we get five more patients to be seen, the rest of the ED had gone red again and there were 10 acute patients who had been waiting for hours in the lobby. The charge nurse from the acute side called me, begging for me to take some of their patients into the urgent side.

I sat and thought.

I had five patients waiting who were appropriate for my side of the ED, and I had to take them first. The urgent patients become my priority. Not because they are sicker than the acute patients, but because after midnight, we would go down to one nurse and one provider and if I took patients with heavier needs, the nurse/provider team would become overwhelmed and the patient care could be compromised.
I reviewed some of the charts for the acute patients, and found a few that could conceivably come over to our side if necessary.
I helped the rest of our nurses with their discharges, opening beds and filling them just as quickly.

All the while, I kept the attending physician aware of the plans, as well as the other providers and nurses.

When I left, all of our waiting urgent patients were roomed, we had one room reserved for patients coming in via ambulance/EMS, and there was a working plan for dealing with the overflow of patients from the acute waiting room.

When I walked out, my legs were sore and my brain was tired. It had felt good to give report and hand that ever-ringing phone to the next nurse. But I felt invigorated as well.

I did it. I ran the show for 12 hours. Everyone survived, no one complained.

Me in charge? Oh, yeah. I showed myself I can do it, and I can’t wait to do it again!

The Presidential Election is fast approaching. Every politician has the ability to impact your career and the state of health care in this country. Have you chosen a candidate? Do you know your candidates views on nursing legislation or health care issues? The AMA-PAC (American Nurses Association – Political Action Committee), working hard to ensure the quality of nurse’s professional lives and patient care, issued a questionnaire to all Presidential candidates about policy issues that impact nursing and health care.

Click here to see which candidates have responded to the ANA, and how the 2008 Presidential candidates health care plans compare to ANA policy.

Guest Post by Laura Gasparis Vonfrolio RN, PhD

greatnurses.com

Let me begin by saying that there is no shortage of nurses. There are over 2.8 million of us. Interesting to note, only 66% are working and 44% are employed full time with 10% of working nurses being “very satisfied” with their jobs. A recent survey found that an astounding 75% of RN’s feel that the quality of nursing care at their facility has declined, with over 68% citing staffing levels as a major contributing factor to this problem.

The statement made by hospitals and administration that there is a nursing shortage, are patently false and evade the real issues of why nurses leave nursing thus contributing to the lack of a sufficient number of nurses at the bedside to meet patient care needs. The term “nursing shortage” becomes a pat excuse for every vacancy that can’t be filled. It is the ultimate answer that absolves the people who are responsible for creating problem – shortage of nurses at the bedside.

There is an annual turnover of approximately 200,000 nurses, which cost the hospital industry a total of nearly 10 billion dollars per year. This staggering cost is the result of the hospitals industry’s failure to retain nurses. If the funds now spent fighting a losing battle to replace disheartened nurses with travel and agency nurses, were instead devoted to improving job conditions, the nursing “shortage” could be largely solved. The Harvard School of Public Health conducted the most comprehensive study linking staffing levels to patient outcomes. The researchers found a strong and consistent relationship between nurse staffing and the outcomes in patients. Higher nurse staffing ratios result in shorter lengths of hospital stay and thus reduce both direct hospital costs of treatment.

Other studies include:

August 2005 – Medical Care
“Improving Nurse to Patient Staffing Ratios as a Cost Effective Safety Intervention”
Research showed that when nurse staffing is improved, lives are saved in a cost efficient manner.

February 2004 – Medical Care
“Nurse Burnout and Satisfaction”
Patients were more likely to report high satisfaction with their care and nurses reported less burnout when nurses worked in conditions with adequate staff.

March 2004 – The Agency for Healthcare Research and Quality released its report entitled “Hospital Nurse Staffing And Quality of Care.”
Hospitals with low nurse staffing levels tend to have higher rates of poor patient outcomes such as pneumonia, shock, urinary tract infections and cardiac arrest.

January 2003 – Medical Care
“Fewer Licensed Nurses Leads To A Greater Number Of Adverse Events”

August 2002 – JCAHO issued a report “Nursing Shortage poses Serious Health Care Risk.”
Focuses on the severity of the current and future nursing shortage and its detrimental effects on patients.

May 2002 – New England Journal of Medicine
“Nurse Short Staffing Leads To Deadly Complications”
Jack Needleman and Peter Buerhaus found that nurses short staffing leads to deadly consequences for patients. Attention nursing administrators – focus on retaining your nurses – improve the staffing levels at the bedside!

A Nurse With a Heart

Laura Gasparis Vonfrolio, RN PhD is one of the most dynamic and entertaining speakers you will have the opportunity to experience. Laura has held CCRN certifications for over 15 years and CEN certifications for 13 years. Laura has helped thousands of nurses over the last sixteen years to prepare for the CCRN and the CEN examinations. She has held positions as staff nurse, Staff Development Instructor and Professor of Nursing.

Dr. Vonfrolio is the proprietor of Education Enterprises and the former publisher of REVOLUTION – The Journal of Nurse Empowerment. Laura has authored numerous articles in Nursing, RN, AJN and co-authored/edited eleven books such as NURSE ABUSE: Impact and Resolution, Critical Care Examination Review and 12 Lead EKG STAT! In addition to being series editor of a six volume State Board Review, Nursetest. Dr. Vonfrolio was the organizer of the Nurses March on Washington DC, March 1995 and May 10, 1996 and has appeared on Good Morning America and Nightline with Ted Koppel (May 1996). You can contact Laura at afeduprn@aol.com.