Emergency Nurses Week(TM) is from October 9 - 15, 2022, and is designated to celebrate the unique contributions of emergency nurses to healthcare worldwide. In the US, there are approximately 167,00O emergency nurses.1 While the past two and a half years have been challenging for everyone in healthcare, this has been especially true in the ED. To recognize emergency nurses for "always standing strong in the face of adversity," this year's Emergency Nurses Week theme is "Standing Strong."1
Emergency nursing comes with many unique challenges. First and foremost, we recognize that inpatient nurses are intelligent and very hardworking. All nurses have some experience on inpatient units as students if not as staff members, but most nurses have little to no experience in an ED. In honor of Emergency Nurses Week and to support communication, collaboration, and healthy inter-unit teamwork, we asked emergency nurses what they would like inpatient nurses to know. Several common themes emerged from their responses. Here are the top three:
1. Our doors never close. ED nurses do not know what they will encounter next. We see patients of all ages, acuities, and conditions involving all body parts and systems. We are mandated by federal law to evaluate and stabilize all comers, even some who have not yet made it through our doors.2 It does not matter if there are no rooms or not enough nurses. We treat patients in the hallway, waiting room, and parking lot. At any given time, it is not uncommon for one nurse to have a toddler with an earache, a hemodynamically unstable patient with sepsis, a middle-aged woman with abdominal pain, and an older adult with new onset altered mental status. Most states do not mandate ED staffing ratios, so assignments of six to eight patients or more are possible. Patients typically arrive with undiagnosed conditions and without I.V. access or results of diagnostic tests. Caring for patients under these conditions requires much knowledge, flexibility, and the ability to prioritize and re-prioritize continuously.
2. We cannot provide comprehensive care in the way done on an inpatient unit. Our main objectives are to resuscitate, stabilize, and disposition a patient. We typically cannot start inpatient orders unless they are emergent or urgent given our resources. We rarely have time to review the patient's past medical history in depth, especially for information not germane to their current complaint and ED care, like their last bowel movement (BM), for example. Inpatient nurses asking about the patient's last BM ranked the single most common annoyance identified in our survey. Similarly, unless the patient comes in with multiple trauma, we likely have not examined every square inch of their skin. We start antecubital I.V.s because those veins are easy to access, less likely to yield hemolyzed blood specimens, and may be required for contrast media injection during diagnostic imaging.
3. Please take report and the patient promptly. We often try multiple times to give report only to get responses such as "the nurse is busy," "the nurse is at lunch," or "the nurse will call you back" (but then they may not). This process usually takes over 30 minutes, which pulls us from our other patients and ties up the ED room longer. We respectfully ask that if the assigned nurse is not available, another nurse take the report or receive the patient; the entire medical record can be reviewed electronically and the ED nurse called with questions. Because we must constantly shift our focus to new patients who may be critically ill or injured (see #1 and #2 above), the patients we send to the inpatient units may not receive the care they need while waiting in the ED. The ED is not set up for inpatient care; routine medications, bathing, turning, and meals may be difficult or impossible to provide. Evidence shows that patients have better outcomes when they receive care on an inpatient unit.3,4 If you are viewing our tracking board, remember that numbers seldom tell the whole story, like the number of infusions the patient has, if a patient with a psychiatric diagnosis is violent, or if the patient arrived in an ambulance or a private vehicle.
Collaboration is considered an important value by many healthcare organizations including the Emergency Nurses Association (ENA) and the American Association of Critical-Care Nurses (AACN).5,6 Inter- and intra-disciplinary collaboration has been shown to improve patient outcomes.7 Healthcare should ideally be delivered by one big team, and we all have our place and job on it. Emergency nurses start the patient's assessment and treatment, then hand-off to inpatient nurses for more in-depth and comprehensive patient care.
In the spirit of fostering improved working relationships and collaboration between the emergency and inpatient nurses, we invite you to shadow us. We are interested in what you would like us to know, so feel free to send a letter to the editor with your comments.
Happy Emergency Nurses Week!
JEAN A. PROEHL, MN, RN, CEN, CPEN, TCRN, FAEN, FAAN
KATHY VAN DUSEN, MSN, RN, CEN, CPEN, NHDP-BC
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