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 EMERGENCY DEPARTMENT NURSE MANAGER ANALYSIS 6 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.