Emergency Room Nursing: A Unique

Emergency Room Nursing: A Unique Segment of Healthcare Delivery

The role of the registered nurse in a hospital emergency department (ED) or trauma center (TC) is unique compared to that of other nursing specialties, such as a surgical nurse. The emergency room nurse often works a twelve hour shift, but is often called in to work when there are emergency room patient loads in excess of the recommended patient to staff numbers, or in the case of a local disaster. The ED nursing staff is responsible for assessing patients as they enter the emergency department. The assessment is an intake of the patient's complaint, so that in this overburdened area of healthcare delivery, the nurse can make decisions about prioritizing patient care. Prioritizing patient need for emergency care is one of the most critical areas of emergency department nursing; and it is an area that is being impacted by emergency department patient overcrowding with non-emergency patient visits.

Emergency department overcrowding and the impact it is having on the delivery of quality emergency care is increasingly a focus of concern and discussion amongst healthcare providers, and other professionals, and oversight agencies. This essay will examine the responsibilities and risks facing the ED nurse, and how those responsibilities and risks are compromised by ED overcrowding.

ED Nursing Responsibilities and Risks as Compared to Surgical Nurses

Entering a hospital emergency room, as most of us have done at least; it quickly comes to the attention of the patient or family member that a central figure in the ED's operations are the ED nurses. A nurse sees the patient upon arrival in the ED, takes an assessment of the patient's reason for being there, or complaint, as it is referred to. In order to provide the physician with the information upon which to build the patient history of treatment and care, and to arrive at a diagnosis of the patient's condition; the nurse takes the patient's vital statistics: blood pressure (BP), temperature, and performs a brief physical examination that routinely involves looking in the ears, eyes, throat, and nose. The nurse will ask pertinent questions about the time of onset of the patient's condition, diet, liquids, medications being taken by the patient, and other such questions that could be contributors to the patient's complaint and need to be seen by a physician.

The ED nurse, having completed the assessment, must then prioritize the patient's state of urgency. Certainly patients complaining of chest pains accompanied by numbness in an extremity would be urgent, because such a patient could be in the process of experiencing a stroke or heart attack. Once in the emergency room itself, the patient will probably be seen either by the same nurse, or a second nurse, who will work with the physician who examines the patient. The nurse will then be responsible for coordinating the physician's orders with the various departments: pharmacy, radiology, and the other departments like ICU, or surgery. There is a need for the nurse to be proficient and efficient in her work, because ED's are experiencing an increasing number of patient visits, and there are normally more patient's waiting to be seen than is appropriate for the size of the facility's ED (GAO, 2008).

If we compare the patient flow and the speed with which the ED nurse must work in order to accomplish her responsibilities and duties with those of a surgical nurse; we would rapidly find that the pressure on the ED is much greater on a patient flow capacity. The surgical nurses' patients are scheduled, not random, except in the case of a surgical emergency. The ED nurse must often deal not just with the patient, but with the patient's family too. The surgical nurse has little interaction with the patient, or the patient's family, and does not see the patient flow that is seen by the ED nurse on a single shift (except perhaps a war zone surgical nurse). The Government Accounting Office (GAO) released a study in 2008, citing 20 of 34 emergency departments were functioning at over capacity. The emergency department at the Washington Hospital Center (Washington, DC) was operating at 286% capacity at the time of the survey (p. 5).

In addition to the primary problem of over capacity, ED nurses:

Use cleaning disinfectants that can be hazardous to their health

Are exposed to anesthetic gases, drugs, and radiation

Risk injury by sharp needles and potential exposure to infectious diseases

Risk exposure to infectious bodily fluids

Suffer risks from lifting heavy patients, standing and walking for prolonged periods of time