Emergency Services Management The author of this report has been asked to complete a report about management challenges in emergency services. The report will have two major sections. The first section will be a review and summary of an interview that was completed between the author of this report and a person in the emergency services management sphere. The second and final part of the report will be a literature review that covers the topics and revelations revealed from that interview. While all realms of management have their challenges, there are some fields that have more challenges than others and emergency services certainly seems to be one of them.

Interview

As a condition of doing the interview for this report and in exchange for the person's candor, the person referenced in this section will not be identified in terms of who the person works for, what role they fill and so forth other than to say it is for an emergency services manager at a medical facility fairly close to where the author of this report lives. A few highlights and of that interview are as follows:

The manager says the pay is pretty decent but that is not why he does it. To him, it is all about serving the public and saving lives

He says that burnout is indeed a major problem. He did plenty of papers and research while going through school and read about it. He says it is just as bad as it says it is in those articles…probably worse.

Says that the key to preventing burnout (manager or not) is to have a good work/life balance. Being a workaholic in the emergency services sphere will grind down a person very quickly and this is especially true in a high-volume emergency room or facility.

Mistakes can and so happen and there is full disclosure if/when it happens

There are a lot of potentially traumatic and nasty events that happen before and during a visit to the ER. This tends to wear down nurses and having a support system both within the team and outside of work is non-optional. Extending that support system to the families of patients is beneficial as well.

He says that management and organizational culture are key. There has to be a strong culture that is focused on adherence to procedure, doing things the same way every time barring a good reason not to and so forth

Many people coming through the doors, even the patients, are worried about being able to afford and pay for the services they are receiving. We always have to assure them that we will take care of them and the money part can be worried about later. The EMTALA laws (among other ethical and legal requirements) do not permit us to do otherwise…nor would they.

Literature Review

The author of this report found a source in a fairly recent journal article that ties in directly with the talk about burnout above. Indeed, the study, which was done in 2013, speaks of the determinants of burnout in acute and critical care for military nursing personnel. To be sure, treating and helping injured soldiers in an active military zone and/or in a hospital that is on standby (e.g. Rammstein in Germany) can be very stressful along the lines of what the interviewee assessed. To assess burnout, there is apparently what is known as the Maslach Burnout Inventory. Indeed, being very precise about the mindset and performance level of a nurse or doctor in a military setting would be paramount and important because they always have to be at the ready. The authors of that study did find a few things that were interesting. First, there was a fairly strong correlation (and perhaps a causality) between high levels of personal achievement and having children. Lastly, the study points out that they recommend that administrators should focus most on people that are younger and less inexperienced because they need the most attention in terms of teaching, monitoring and watching for signs of burnout or otherwise being in over their head (Ayala & Carnero, 2013).

The next source talks about another part of emergency services life that the interviewee mentioned before did touch on and that is the experiencing of trauma. Indeed, some of the events and happenings in an emergency services environment can be traumatic and highly affecting of the nurses and other people that practice there and/or bear witness to some of the chaos and such that can occur there. It can get so nasty, some nurses and other professionals can develop post-traumatic...

The authors of the study state their point well when they say that "emergency nurses are routinely confronted with work-related traumatic events and hectic work conditions" (Adrianssens & Maes, 2012). The results of the study found a few things. First, it is said that the frequency of nurses being confronted with "traumatic events" is "frequent." Second, they say that death or serious injury to a child or adolescent was perceived as the most traumatizing event. Further, they found that one third of all nurses meet sub-clinical levels of anxiety, depression and somatic complaints. Nearly one in ten (8.5%) met clinical levels of PTSD. There was also a lot of fatigue found but that was not correlated directly to the number of traumatic events. It was also found that social support from colleagues and supervisors were found to have a protective effect when it came to the experiencing of PTSD symptoms. Much of this echoes with the viewpoints and opinions of the interviewee for this report as well (Adrianssens & Maes, 2012).
Also as noted above, there is a huge upside to when the people in the hospital setting act as an extension of the family when it comes to supporting people emotionally. This can be done through religious accommodations, a kind word and so forth. Obviously, nurses and other emergency personnel have a job to do and they must do it. However, they can be warm and assuring while they do it and a personal touch can make a big difference. This general principle is known as Family-Centered Care, or FCC for short. The concept is far from being new as many authors throughout the years have centered on it to one degree or another. The names include Fond, Gill, Porter and Robinson and the years range from the early 1970's to the late 1990's. To correlate to something that was said about trauma, FCC is especially important to foster and deliver when it comes to pediatric emergencies. Harm to a child, even accidental, is extremely traumatic and challenging. This was mentioned prior as being a challenge to nursing personnel but it obviously would affect the families even more because they have a personal connection to the child. Hemmelgarn, Glisson and Dukes note that the trauma caused concurrently to the parents and the child can cause psychosocial harm to everyone involved and thus must be managed to whatever degree that is possible (Hemmelgarn, Glisson & Dukes, 2001).

When it comes to mistakes by emergency room professionals and what must happen as a result from a legal and ethical standpoint, the author found the work of Smits et al. (2012) to be quite informative. One interesting layer that apparently is the genesis of some differences when it comes to safety would be the specialty that is being practiced. Obviously, emergency services is one specialty and there are others like endocrinology, pediatrics, allergies and so forth. Smits et al. notes that the level of safety performance apparently varies based on which specialty is being spoken of. One possible explanation for this is offered when Smits says "if there is a mediation effect of safety culture in the relationship between specialty and safety, then safety culture could then explain why units vary in performance" (Smits et al., 2012).

Finally, the author of this report will center on the "it's not the money" quip that the interviewee made. Indeed, there are many jobs out there that are extremely stressful and/or are more about the job itself rather than the pay involved. In either case, the person is ostensibly choosing the job based on what they do as part of the job and how they can help and serve people. When it comes to management in particular, this is known as servant leadership. Liden et al. notes that servant leadership theory centers on the idea that "servant leaders guide followers to emulate the leader's behavior by prioritizing the needs of other above their own" (Liden, Wayne, Chenwei & Meuser, 2014).

Conclusion

The author of this report enjoyed the interview with the man referenced at the start of this report. It is very clear that he is very in tune with what is necessary to understand and hold true when one is serving in the role that he inhabits. Hopefully, all emergency services managers out there emulate the approach that this man is taking because it would certainly seem to be the right one.