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Here is how two ED Nursing editorial advisory board members answered the question: What are some of the top challenges emergency nurses will face in the future?
• Continued overcrowding.
Overcrowding is a major problem in even small and rural emergency departments (EDs), according to Trudy A. Meehan, RN, CHE, director of emergency services at East Jefferson General Hospital in Metairie, LA. She expects that this trend will continue. "Unless there are some legislative reforms to provide primary care physicians and clinics for the uninsured, I am not certain this problem will be one ED nurses can control," Meehan says. "Unfortunately, with legislative reform, we will move to a more socialized form of health care, which causes me trepidation."
• The need for appropriate staffing.
There is a trend of states passing legislation to require a specific nurse-to-patient ratio, but this is not evidence-based, doesn’t address patient acuity, and may not provide safe, quality care, says Meehan. "These laws also do not address the importance of ancillary personnel in the scheme of good patient care," she says. "This potentially could leave the nurse with a 1-to-4 patient ratio and no support staff to assist in patient care or enter orders."
An important step in the right direction is the new staffing guidelines developed by the Des Plaines, IL-based Emergency Nurses Association (ENA), Meehan says. "Once facilities begin using this database, we will be able to share information and begin to develop guidelines that optimize patient care and use the appropriate resources," she says. (For more information about the staffing guidelines, go to the ENA’s web site, www.ena.org.)
• More professional standing for ED nurses.
The ENA has approved a resolution to explore establishing an Academy of Emergency Nursing, Meehan notes. The academy would recognize outstanding achievements and contributions to the field of emergency nursing; provide leaders who would provide vision to advance emergency nurses; and allow more ENA members the opportunity to impact the direction of the profession, says Meehan.
After nurses complete an application, acceptance into the academy will be done by a peer review process, she explains. Members would then be entitled to use the initials FAENA, standing for fellow in the Academy of Emergency Nurses Association.
While the process has not yet been completed, Meehan says that approval of the resolution is a giant step forward for emergency nurses. "As the academy evolves, nursing could develop the same level of acceptance and prestige as physicians who are fellows in their area of specialty practice," she says. "I look forward to the evolution of this process."
• Increased diversity.
There is increased cultural diversity in areas of the country where this was not common only five years ago, and this is reflected in the languages, customs, and religions of ED patients, reports Reneé Holleran, RN, PhD, chief flight nurse and clinical nurse specialist at University of Cincinnati Medical Center. "Many health care providers are learning Spanish, including myself," Holleran says. Use EDs in larger cities such as New York and Los Angeles as models, since they have been working with diverse populations for years, she suggests.
Holleran also advises familiarizing yourself with accreditation guidelines on diversity and the ENA position statement on this topic. (Editor’s note: This statement can be accessed at no charge on the ENA web site, www.ena.org. Click on "Publications," "Position Statements," "Diversity in Emergency Care, 7/01.")
• The growing use of alternative medicine.
Patients will continue to use alternative medicine in growing numbers, due to dissatisfaction with traditional care, Holleran predicts. "Drugs are causing more harm in some cases and not helping at all in others," she says. "Also, drug interactions and mistakes have increased significantly."
Ask patients specifically whether they take herbs or undergo any alternative treatments, Holleran emphasizes. "One of the most serious things to avoid are drug interactions that may cause bleeding," she says. (For more information on this topic, see "Do you screen patients for alternative therapy use?" ED Nursing, August 2001, p. 133.)
• Need for better bioterrorism preparedness.
EDs will continue to invest in bioterrorism preparedness only if they are directed to do so, Holleran predicts. "This is the problem now; mandates keep coming with no financial consideration," she says. "EDs do not have the staff or monies for a lot of this training." There is a lack of coordination and direction for how to prepare, Holleran says. "There is very little research that addresses what is the best method of preparation," she adds.
For more information on challenges facing emergency nursing, contact:
• Reneé Holleran, RN, PhD, Chief Flight Nurse, University of Cincinnati Medical Center, P.O. Box 670736, Cincinnati, OH 45267. Telephone: (513) 584-7522. Fax: (513) 584-4533. E-mail: firstname.lastname@example.org.
• Trudy A. Meehan, RN, CHE, Director, Emergency Services, East Jefferson General Hospital, 4200 Houma Blvd., Metairie, LA 70006. Telephone: (504) 454-4018. Fax: (504) 456-5428. E-mail: email@example.com.