ED Management – December 1, 2022

Staffing Shortages No. 1 Challenge in Healthcare

Short-staffed EDs mean patients have to wait longer for laboratory and diagnostic testing results, which could lead to delays in administering life-saving treatment.

ED Violence Pushes Out Top Employees

While multiple factors can figure into an emergency provider’s decision to leave his or her profession, receiving threats or winding up as assault victims while on the job easily can be the final straw. Those who work in the ED say the violence in this setting is only growing worse.

Inexperienced Nurses Placed in Unsafe Roles Due to Staffing Shortages

Because of staff shortages, inexperienced nurses are placed in roles that may be unsafe for patients — and for the nurses themselves.

Beware Venting About Staffing Problems

Emergency providers should follow proper channels for making such complaints. There may be a patient safety organization to which staff are directed to submit complaints, or the hospital could view the situation as a human resources issue.

EMTALA Concerns if Patient Harm Is Linked to Staffing Shortage

It is important for administrators to understand an individual emergency physician or facility can be held liable under EMTALA, even if no one is hurt.

The Legal Standard of Care if ED Is Understaffed

Frustrated emergency physicians want to be sure the lack of nursing staff is duly noted in the mistaken belief such a note will change the legal standard of care to which they are held. However, that documentation is ammunition for plaintiff lawyers to use against the provider, and leaves the standard of care unchanged.

Documenting Understaffing Could Sound Like Blame-Shifting to a Jury

Jurors are going to expect everyone in the ED is working together for the patient’s benefit. If the emergency physician has valid safety concerns, the medical record is not the place to voice those. Patient safety committees or the peer review process are better options, and generally are not discoverable during malpractice litigation.

Not Just an ED Problem: How to Solve the Boarding Problem Caused by Staff Shortages

It takes thought, planning, and some amount of money.

Travel Programs, Flexible Work Options Shore Up Retention, Recruitment

Two nurse leaders explain how their healthcare systems incentivized nurses to take some extra shifts without placing undue burdens or giving the appearance outsiders are invading to take someone's job.

Avoid Disaster by Properly Preparing New Nurses

Ideally, new graduates should not practice in an ED without first undergoing an intense preceptorship overseen by experienced nurses, followed by undergoing proper precept with a seasoned professional. Even if the hospital is not held specifically at fault for a failure to prepare new graduates, the lack of training can be the cause of a negligent act that leads to a lawsuit.

Operational Countermeasures Help EDs Navigate Staffing Challenges

A possible solution involves moving care to the front end of the visit. Depending on the size of the department and acuity level, this might involve putting a physician or an advanced practice clinician out front, supported by a nurse, a tech, a phlebotomist, and a transporter. The goal of this approach is to ensure patients receive everything they would need if they were able to be in a room.