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Emergency Department Overcrowding: What is the Answer?
LETTERS
Unsolicited Letters With News, Notes, and Comments From Our Readers Always Welcomed Submit all Letters to the Editor online at http://ees.elsevier. com/jen/ Emergency Department Overcrowding: What is the Answer? Emergency Department Overcrowding: What is the Answer?
J Emerg Nurs 2007;33:99-101. 0099-1767/$32.00 Copyright n 2007 by the Emergency Nurses Association.
Dear Editor: During the past decade, hospital emergency departments have been faced with conditions resulting in overcrowding. These issues have ranged from an increase in nonurgent patients’ overutilization of the system to a lack of acute care beds for stabilized and admitted patients. Federal, state, and local agencies have conducted a number of studies to assess the issues and develop and initiate various mechanisms to reduce ED overcrowding. Although these initiatives made an impact, the issue continues to generate national attention without the needed federal assistance. Functioning as a staff nurse in emergency departments during the past 19 years has been rewarding as well as challenging. In the 80s, private hospitals competed for insurance products in an attempt to increase ED visits and net revenues. Public hospitals were stressed, and the federal government responded with the implementation of the Emergency Treatment and Labor Act as part of the Consolidated Omnibus Budget Reconciliation Act of 1986. This act made certain that any American in need of emergency treatment or in labor would receive treatment regardless of payor source. As a result, emergency departments went through a period where the ‘‘screening’’ process was followed; however, due to the litigious health care environment, many physicians did not want to assume the risk associated with only ‘‘screening’’ patients and referring for treatment. ED visits continued to escalate, and overcrowding was witnessed by the private and public sectors. The system has analyzed and developed various methods to decrease
April 2007
JOURNAL OF EMERGENCY NURSING
A Call for Papers
33:2
99
LETTERS
overcrowding—development of fast tracks, tracking systems, charting systems, development of regional centers, etc.— and process this population more efficiently. Causes of the problem are consolidated to lack of ED space, an increase in nonurgent patients utilizing the emergency room, lack of acute care beds, and lack of qualified nursing staff. The federal government has attempted to address the nurse staffing issue with the Nurse Reinvestment Act of 2002. Although the act has not solved the problem, which is expected to get worse, it is time for the federal government to examine mechanisms to improve primary care access and increase acute care beds. The government has spent billions of dollars on defense and foreign affairs without addressing this American crisis. Medical personnel have been victims of criminal charges for quality of care issues as they relate to emergency room overcrowding and continue to focus on mechanisms to solve the crisis without being provided the resources to alleviate the crisis. The federal government needs to provide some assistance to the system as it did with the Hill-Burton Act. The American population has grown, and acute care hospitals have been mandated to provide primary and emergency care in emergency departments. The population continues to age, requiring more acute care hospital beds. Does this country really possess the number of staffed hospital beds per 1000 people? When we are boarding admitted patients in the emergency department and transferring patients across state lines and to other facilities, this is certainly not the case. If we can obtain the necessary funding to increase the number of beds and utilize charity care accounts as a means of forgiveness, this would increase the number of acute care beds available and resultantly decrease the ED wait times.—Gordon B. Natal, Jr, MSN, MHA, RN, Loyola University, New Orleans, La doi: 10.1016/j.jen.2006.12.022
A Call for Papers
Dear Editor: Often, it seems, little events have big consequences, or at least, they have bigger consequences then we envisioned. Case in point: Some colleagues and I were talking about the effects of computerized charting on nursing ethics. The discussion led to a Letter to the Editor of the Journal of Emergency Nursing. It was never the intent of the letter to
100
be published; rather, we wanted to suggest that someone might want to take up the topic in more depth. The Editor’s response was to submit the letter for publication. In response, I suggested that perhaps the Journal would benefit by having a regular column on nursing ethics in the emergency department. The Editor’s response to me was, ‘‘Would you be the section editor for that?’’ That, again, was never in my mind. However, after struggling with the idea for a while, bouncing a few letters back and forth between the Editor and myself, and consulting with some of my friends and my wife, I hesitantly agreed to give it a try. When I look back on all the nurses that I have known who have gotten in trouble in nursing, it was because of ethics. For some emergency nurses a limited understanding of ethical concepts or their implications may lead to poor insight into the ethical consequences of their actions. I really believe that all of us can benefit by raising our ethical sensitivity, and that ethics is very important in everything we do in nursing. Now, it is not my intention to write a lot of papers on ethics, or to try and sell all of you on my personal ethical views. Rather, I would like to see this column become a place where we can carry on discussions, even disagreements, share insights, and ask questions about day-to-day ethical challenges we face as ED nurses. It is also not my intention for this column to become a series of theoretical ethical papers that put forward this or that theory on how to make good ethical choices. A brief review of papers on nursing ethics showed an overwhelming volume of such papers. Frankly, I wondered what most of what was written had to do with where I live, or to use an old expression, ‘‘With where the rubber meets the road.’’ I believe that the Journal would like practical papers that ED nurses can use to help them problem solve the situations that are encountered on a daily basis. This is where all of you come in. I need you to submit articles based on your own ED experiences. They can be articles that provide case presentations of ethical challenges you have faced. They can be articles in which you ask for suggestions regarding how to approach a situation ethically. They can be articles regarding concerns you have about specific challenges to ED nursing ethics. There are a wide range of options. I see an opportunity here to have a
JOURNAL OF EMERGENCY NURSING
33:2
April 2007
Unsolicited Letters With News, Notes, and Comments From Our Readers Always Welcomed Submit all Letters to the Editor online at http://ees.elsevier. com/jen/ Emergency Department Overcrowding: What is the Answer? Emergency Department Overcrowding: What is the Answer?
J Emerg Nurs 2007;33:99-101. 0099-1767/$32.00 Copyright n 2007 by the Emergency Nurses Association.
Dear Editor: During the past decade, hospital emergency departments have been faced with conditions resulting in overcrowding. These issues have ranged from an increase in nonurgent patients’ overutilization of the system to a lack of acute care beds for stabilized and admitted patients. Federal, state, and local agencies have conducted a number of studies to assess the issues and develop and initiate various mechanisms to reduce ED overcrowding. Although these initiatives made an impact, the issue continues to generate national attention without the needed federal assistance. Functioning as a staff nurse in emergency departments during the past 19 years has been rewarding as well as challenging. In the 80s, private hospitals competed for insurance products in an attempt to increase ED visits and net revenues. Public hospitals were stressed, and the federal government responded with the implementation of the Emergency Treatment and Labor Act as part of the Consolidated Omnibus Budget Reconciliation Act of 1986. This act made certain that any American in need of emergency treatment or in labor would receive treatment regardless of payor source. As a result, emergency departments went through a period where the ‘‘screening’’ process was followed; however, due to the litigious health care environment, many physicians did not want to assume the risk associated with only ‘‘screening’’ patients and referring for treatment. ED visits continued to escalate, and overcrowding was witnessed by the private and public sectors. The system has analyzed and developed various methods to decrease
April 2007
JOURNAL OF EMERGENCY NURSING
A Call for Papers
33:2
99
LETTERS
overcrowding—development of fast tracks, tracking systems, charting systems, development of regional centers, etc.— and process this population more efficiently. Causes of the problem are consolidated to lack of ED space, an increase in nonurgent patients utilizing the emergency room, lack of acute care beds, and lack of qualified nursing staff. The federal government has attempted to address the nurse staffing issue with the Nurse Reinvestment Act of 2002. Although the act has not solved the problem, which is expected to get worse, it is time for the federal government to examine mechanisms to improve primary care access and increase acute care beds. The government has spent billions of dollars on defense and foreign affairs without addressing this American crisis. Medical personnel have been victims of criminal charges for quality of care issues as they relate to emergency room overcrowding and continue to focus on mechanisms to solve the crisis without being provided the resources to alleviate the crisis. The federal government needs to provide some assistance to the system as it did with the Hill-Burton Act. The American population has grown, and acute care hospitals have been mandated to provide primary and emergency care in emergency departments. The population continues to age, requiring more acute care hospital beds. Does this country really possess the number of staffed hospital beds per 1000 people? When we are boarding admitted patients in the emergency department and transferring patients across state lines and to other facilities, this is certainly not the case. If we can obtain the necessary funding to increase the number of beds and utilize charity care accounts as a means of forgiveness, this would increase the number of acute care beds available and resultantly decrease the ED wait times.—Gordon B. Natal, Jr, MSN, MHA, RN, Loyola University, New Orleans, La doi: 10.1016/j.jen.2006.12.022
A Call for Papers
Dear Editor: Often, it seems, little events have big consequences, or at least, they have bigger consequences then we envisioned. Case in point: Some colleagues and I were talking about the effects of computerized charting on nursing ethics. The discussion led to a Letter to the Editor of the Journal of Emergency Nursing. It was never the intent of the letter to
100
be published; rather, we wanted to suggest that someone might want to take up the topic in more depth. The Editor’s response was to submit the letter for publication. In response, I suggested that perhaps the Journal would benefit by having a regular column on nursing ethics in the emergency department. The Editor’s response to me was, ‘‘Would you be the section editor for that?’’ That, again, was never in my mind. However, after struggling with the idea for a while, bouncing a few letters back and forth between the Editor and myself, and consulting with some of my friends and my wife, I hesitantly agreed to give it a try. When I look back on all the nurses that I have known who have gotten in trouble in nursing, it was because of ethics. For some emergency nurses a limited understanding of ethical concepts or their implications may lead to poor insight into the ethical consequences of their actions. I really believe that all of us can benefit by raising our ethical sensitivity, and that ethics is very important in everything we do in nursing. Now, it is not my intention to write a lot of papers on ethics, or to try and sell all of you on my personal ethical views. Rather, I would like to see this column become a place where we can carry on discussions, even disagreements, share insights, and ask questions about day-to-day ethical challenges we face as ED nurses. It is also not my intention for this column to become a series of theoretical ethical papers that put forward this or that theory on how to make good ethical choices. A brief review of papers on nursing ethics showed an overwhelming volume of such papers. Frankly, I wondered what most of what was written had to do with where I live, or to use an old expression, ‘‘With where the rubber meets the road.’’ I believe that the Journal would like practical papers that ED nurses can use to help them problem solve the situations that are encountered on a daily basis. This is where all of you come in. I need you to submit articles based on your own ED experiences. They can be articles that provide case presentations of ethical challenges you have faced. They can be articles in which you ask for suggestions regarding how to approach a situation ethically. They can be articles regarding concerns you have about specific challenges to ED nursing ethics. There are a wide range of options. I see an opportunity here to have a
JOURNAL OF EMERGENCY NURSING
33:2
April 2007