If you and your staff are overworked, consider some creative delegating. "As the nursing shortage grows, we should start looking at what other professionals can do within their area of expertise," says Barbara Weintraub, RN, MPH, MSN, coordinator of pediatric emergency services at Northwest Community Hospital in Arlington Heights, IL.
Identifying ways to better use staff skills is time well spent, stresses Paula Hafeman, RN, MSN, director of the cancer and emergency center at St. Vincent Hospital in Green Bay, WI, a 517-bed tertiary care hospital. "It is extremely important to utilize staff as efficiently as possible, especially in a busy emergency department [ED]," she says.
Here are innovative ways to utilize ancillary staff in the ED:
• Find new ways to cross-train staff. Hafeman says that cross-training of staff has provided many benefits at her ED. "This has given us flexibility and eliminated bottlenecks in patient flow," she says. Emergency medical technicians and certified nursing assistants set up patients for procedures, apply orthopedic supplies, dress wounds, perform ear irrigations, handle oxygen saturation, order and stock supplies, discontinue intravenous lines, perform laboratory tests including venipuncture and arterial draws, and give electrocardiograms, she says.
In addition, the ED uses health unit coordinators to register patients, address insurance issues, enter charges and orders, notify physicians, and transport patients, says Hafeman. (See the facility’s job description for health unit coordinators.) The health unit coordinators have improved patient flow by registering patients at the bedside so that patients no longer wait in line for registration, she says.
Three health unit coordinators work each shift and rotate team assignments every six hours in a 12-hour shift, says Hafeman. She adds that the health unit coordinators and technicians also are cross-trained to do each other’s jobs. "The benefits of this are a tremendous amount of flexibility in scheduling, and an increase in salary if staff work additional hours," she says. "They are also more satisfied in their positions because of their increased value as part of our team. We could not do it without them."
• Use physical therapists. Orthopedic patients often have complex follow-up needs that aren’t easily addressed in the ED, and a dedicated physical therapist can be of tremendous value, says Weintraub. For example, orthopedic patients may be sent home in a cast, and then they may realize that they can’t use a bathroom, she says. "When I had foot surgery a month ago, they gave me a special shower boot to go over my lower leg," says Weintraub. "For 17 years, I’ve been telling people to put garbage bags over their foot to avoid getting wet. This was something that existed that I didn’t even know about!" A physical therapist can provide exactly this kind of information to ED patients, she says.
Weintraub adds that it’s often a tough call whether it’s safe to send an elderly patient home after experiencing a fall. "We do a road test,’ and if we can get them up and walking, then we send them home. But I’m not sure how scientific that is — just because you can walk, doesn’t mean you’re not at risk for falling again," she explains.
A physical therapist can perform a more detailed assessment to evaluate elderly patients with unstable gait and also determine what devices a patient may need. "Often, you would feel comfortable sending a patient home if you could just get them a walker or a commode seat," Weintraub says. "But there is no way a busy ED nurse could do that."
Having a physical therapist address these needs decreases the number of elderly patients admitted because they can’t manage at home, she adds. The physical therapist also could handle follow-up care and address ongoing concerns of patients, Weintraub suggests.
• Use phlebotomists to follow up on orders. In some EDs, the phlebotomist is responsible for not only drawing the blood, but entering the orders, and then following up to see where the results are, Weintraub says. "This follow-up is an area that ED nurses spend an inordinate amount of time on," she adds. The phlebotomist also can be responsible for point-of-care testing done in the ED and for maintaining compliance with Clinical Laboratory Improvement Amendments (CLIA) standards, advises Weintraub.
• Use paramedics for specific tasks. Weintraub suggests cross-training paramedics to perform phlebotomy, but she cautions that many state nursing and emergency medical services practice acts prohibit them from giving medications in the hospital setting. "They can apply post molds, finger splints, ace wraps, and other orthopedic tasks," she says. "As their assessment and training are higher, they can transport more critically ill patients than many other technicians can." Respiratory therapists also can be cross-trained to do phlebotomy and electrocardiograms, she adds.
• Hire an individual devoted to patient needs. Weintraub suggests having someone in your ED who is solely devoted to updating patients on their waits; making sure they are comfortable; updating family members; and bringing in telephones, TVs, magazines, or food. "This can significantly raise customer satisfaction scores," she says. n
For more information about utilizing ancillary staff in the ED, contact:
• Paula Hafeman, RN, MSN, Director of Cancer and Emergency Center, St. Vincent Hospital, P.O. Box 13508, Green Bay, WI 54307-3508. Telephone: (920) 433-8428. Fax: (920) 431-3093. E-mail: email@example.com.
• Barbara Weintraub, RN, MPH, MSN, Coordinator, Pediatric Emergency Services, Northwest Community Hospital, 800 W. Central Road, Arlington Heights, IL 60005. Telephone: (847) 618-5432. Fax: (847) 618-4169. E-mail: firstname.lastname@example.org.