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Running head: EMERGENCY DEPARTMENT NURSE MANAGER ANALYSIS 1

Life in E.D.: An Emergency Department Nurse Manager Analysis


Sara Young
Ferris State University

EMERGENCY DEPARTMENT NURSE MANAGER ANALYSIS 2
Life in E.R.: An Emergency Department Nurse Manager Analysis
The emergency department is the heartbeat of a hospital. Fast paced, energetic,
overwhelming, exhausting, demanding, rewarding and a sense of pride can all describe the
various emotions pulsing through the emergency department (ED) staff at any given time. The
ED environment is not for the weak: Many strong personalities co-exist in a setting that is
working toward a common goal: move the patients through triage in a timely manner all while
remaining cool, calm and collected and maintaining optimal patient satisfaction. The ED requires
special skills in a leadership role to hold the department togetherenter nurse manager of ED at
McLaren Lapeer Region- Level II trauma hospital, Betsy Felton. She is a certified emergency
nurse (CEN), holds a bachelors of nursing (BSN) and recently graduated from Oakland
University with a masters degree in business administration (MBA). She has an extensive career
as registered nurse (RN) that spans the course of twenty-three years. She exhibits a competitive
and charismatic drive and has held former leadership roles as a nurse manager of Michigan
Vascular and Associates (2009-2011), nurse manager of ED McLaren Lapeer (2011-2012),
director of patient care services at McLaren Lapeer Region (2012-2014), and finally back in the
saddle as ED nurse manager at McLaren Lapeer, her present role. Betsy is the founding member
of Lapeer County Suicide Prevention Network (2011-present) and is currently on the board of
Lapeer Area Citizens Against Domestic Assault-LACADA. Additionally, Betsy is the founding
team member of the Keystone Sepsis Program, which resulted in staff education, an ED
screening tool, and implementation of a sepsis screening tool for Paragon, McLaren Lapeers
computer charting program in order to improve sepsis awareness and treatment. She co-authored
grants that resulted in the purchase of two LUCAS devices and ResQ Pods for the ED at
McLaren Lapeer, and successfully decreased patient door to triage time by ten percent through
EMERGENCY DEPARTMENT NURSE MANAGER ANALYSIS 3
streamlining processes and team building. Currently, Betsy has an article awaiting publishing
titled Improving Patient Satisfaction in the ER.
Betsy was a clear, non-debatable choice for this interview as she demonstrates top quality
leadership skills and emulates the kind of professional nurse one aspires to be. A detailed
analysis will describe her duties in the ED as well as how collaborative efforts, legal-ethical,
power-influence, problem-solving and resolution of conflict processes are handled.
Job Duties
Job duties reported are numerous: responsible for budgeting sixty full-time equivalent
(FTE) roles, scheduling and vacation time of registered nurses, unit clerks and ancillaries in the
unit. Handles corrective action issues, organizes staff meetings and initiates investigations into
complaints of staff, doctors, and patients. Integral in the development of the unit practice council
which encourages employee engagement, self-governance and policy adherence. Responsible for
the monthly auditing of quality indicators; reports monthly to the board with ED numbers
concerning deaths, transfers and those who went against medical advice (AMA) by refusing
treatment. Works alongside other department managers to improve throughput; closely works
with nursing educators to improve staff education and policy changes based on current research.
Betsy is responsible for yearly employee evaluations and is available and accessible for
mentoring, counseling, and mediating. She reports directly to the Chief Nursing Officer (CNO),
Jeff Euclid; above Jeff is the Chief Executive Officer (CEO) and President, Bart Buxton.
Collaboration
The ED is typically the first stop in patient care. Patients are treated and discharged,
transferred to another facility or transferred in house to another unit. The flow and pace through
ED needs to be efficient and timely. Collaborative efforts with doctors, ED nurses and nurse
EMERGENCY DEPARTMENT NURSE MANAGER ANALYSIS 4
managers of other units will expedite the process. It takes a team to smoothly integrate the
patient through the various networks and layers of care: lab, radiology, respiratory, diagnostic
imaging, surgery, and trauma. Clear and concise communication will avoid delays in treatment
and prevent cumbersome wait times of patients in the ED. Collaborative efforts are present with
nurse educators to ensure that evidence based practices are followed. Additionally, recognizing
where improvements can be realized requires collaboration with the CNO, CEO and board
members to improve patient experience.
Legal-Ethical Issues
The Code of Ethics for Nurses reflects the professions central and enduring values;
provides the basis for nurses commitment to society to provide and ensure safe and quality
patient care (ANA, 2012, pp. 113-115). An issue that recently arose in the ED was the eighteen
hour wait for a bed in behavioral health unit for two mental patients. Unable to bring staff in to
adjust for census, the patients were eventually transferred out of the county which produced a
delay in treatment, additional costs for ambulance transfers, ED staff and additionally loss of
revenue for McLaren Lapeer. The right avenue to pursue in the end was for the prompt care of
the patients. This is an area of ethical concern for needed improvement in the treatment process.
Power and Influence
Betsys theory is that one must do the right things for the right reasons (B. Felton,
personal communication, June16, 2014). She also states that positional power is only good for
so longto lead by example, one must surround themselves with smart and powerful people
(B. Felton, personal communication, June 16, 2014). Mutual respect is a must. Betsys style of
leadership and influence can best be explained as transformational. This type of leadership is
based on inspiring visions, communication, motivation, innovationthe goal is to transform
EMERGENCY DEPARTMENT NURSE MANAGER ANALYSIS 5
people and organizations in mind and heart; evidence shows that transformational leadership
qualities are linked with staff satisfaction, staff retention and patient satisfaction (Yoder-Wise,
2011). Betsys infectious, can-do attitude is paramount in a department that could fall apart in a
moments notice. She is a role model for her staff and maintains an upbeat momentum to keep
the positive flow moving.
Problem Solving
The ability to recognize a problem and move to resolve it demonstrates effective
leadership skills. An area of concern in the ED was the ten minute turn-around time for arterial
blood gas (ABG) results in critical patients. Betsy looked at the process flow and utilizing the
principles of the LEAN approach, was able to decrease the wait time to less than two minutes.
LEAN processes look at the value desired by the end customer, identify the value stream (end-to-
end journey), improve continuous service flow, and manage toward perfection by continuously
improving all processes (ONeill, Jones, Bennett & Lewis, 2011). Following the LEAN
principles incurs benefits for the patient, the staff and the company. In order to evaluate process
improvement and ensure that it continues to be useful, Betsy stated that she follows the
guidelines recommended by the Agency for Healthcare Research and Quality (AHRQ): Plan-Do-
Study-Act (PDSA). This is a checklist and scientific method used for action-oriented learning
that plans the observation or data collection, do, or test the action on a small scale, study or
analyze the data and results, and act or refine changes needed (AHRQ, 2014). An effective
leader recognizes where improvements can be made and seeks solutions.
Conflict Resolution
It is human nature to experience conflict especially on the job. A strong leader keeps their
team focused and working toward a common goal. In the case of the ED, triaging patients
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through the system in a timely manner is paramount in terms of patient, staff, and hospital
satisfaction. The Institute of Medicine has set the expectation that all healthcare providers
function as a patient-centered teamthus the concept of team-building (Yoder-Wise, 2011).
Team-building focuses on goal-setting, interpersonal relationships, problem solving, and role
clarification. Betsy understands and appreciates the value of functioning as a team and aims to
avoid conflict by encouraging the path of self-awareness and open communication. If needed,
she will step in and listen to both sides of the story and mediate as needed. If all else fails,
behavioral then corrective action may be needed. Generally, though, talking it out amongst
involved members produces resolution. Communication is the main ingredient in being
successful. Open communication among team members creates a work environment conducive
to learning, respectfulness, appreciation, and satisfaction.
Pulling it All Together
There is no denying that to be a successful nurse leader, one must be able to work
collaboratively with multiple disciplines, recognize and adhere to the principle of ethics, use
power and influence to motivate the team, have good problem-solving skills, and be able to
avoid team conflicts and manage resolutions. Clearly, Betsy Felton, BSN, RN, MBA, CEN
demonstrates through her knowledge, experience, skills, and actions that she has been an
effective leader and positive role model. A strong woman, Betsy represents the nursing
profession with high standards of professionalism and is a shining example of a true leader.

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References
Agency for Healthcare Research and Quality (AHRQ). (2014). Plan-do-study-act (PSDA) cycle.
Retrieved from http://www.innovations.ahrq.gov/content.aspx?id=2398
American Nurses Association [ANA] (2012).The essential guide to nursing practice: Applying
ANAs scope and standards in practice and education. Silver Spring, MD: Author.
ONeill, S., Jones, T., Bennett, D., & Lewis, M. (2011). Nursing works: The application of lean
thinking to nursing process. The Journal of Nursing Administration, 41, 546-552. doi:
10.1097/NNA.0b013e3182378d37
Yoder-Wise, P. (2011). Leading and managing in nursing (5
th
ed.). St. Louis, MO: Elsevier
Mosby.

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