Stop morale in ED from plummeting

Role `isn’t for everyone’

Your new hire’s impressive experience with registration and financial counseling doesn’t mean he or she is the right fit for the emergency department (ED).

The emergency department is a stressful place for registrars to work, says Vicki Lyons, patient access manager at Baptist Hospital East in Louisville, KY. “It is constantly busy, and involves dealing with sometimes very difficult situations, not to speak of difficult patients,” Lyons says. “It takes a special person to work in the ER. It is not for everyone.”

Weekend and holiday shifts are the hardest positions to fill, says Nicole Marsoobian, manager of admitting at Tufts Medical Center in Boston. “Those who are applying already have full-time jobs and just want to work part-time for extra money,” she explains. “Once they get into the job, they give their notice after only a few months — usually because working seven days a week is too much, or they do not enjoy working holidays.” Here are some proven approaches to keep ED registrars happy:

• After Lyons interviews applicants for emergency department positions, she asks the applicant to “shadow” an experienced ED registrar.

“We have a confidentiality agreement signed upfront before the applicant goes to the [ED],” she explains. By shadowing the experienced ED registrar, says Lyons, the applicant “can see exactly where they will be working, what they will be doing, and how hectic it can be.”

Applicants watch about five patients being registered, including how insurance cards and drivers IDs are scanned, how a picture is taken, and what forms are signed.

Some applicants end up telling Lyons they no longer want the ED position because it’s too hectic. “Others have not worked in healthcare before and do not like working that closely with sick people or the trauma of seeing family members upset about their loved ones,” says Lyons.

• Marsoobian ensures that everyone has a fair share of time off for holidays.

“We came up with a holiday rotation calendar. All employees who work in the ED have to cover a couple of holidays a year,” she says.

Weekend registrars are required to work non-major holidays, and Christmas, Thanksgiving, the Fourth of July, and New Year’s Day are split among all ED registrars.

• Lyons uses “floater” positions to ensure ED registrars aren’t overwhelmed by sudden increases in patient volume.

Each day, some of Baptist Hospital East’s patient access employees are designated as “floaters” and might be pulled to the ED to help out during weekends or during volume surges until staff are caught up.

“We have another employee that relieves employees for lunch breaks so that there are always three employees in the ER,” says Lyons. “The ER staff know they can call for help if they get a big influx of patients.”

The floater positions have improved turnover in the ED registration area, because registrars now have to work only one weekend a month or sometimes no weekends at all, says Lyons. “The ER could not manage with just two employees working,” she explains. “If we are short and do not have floaters available, we pull someone from another area, or have a trainer, lead, or supervisor work in the ER.”


For more information on improving morale of emergency department registrars, contact:

Vicki Lyons, Patient Access Manager, Baptist Hospital East, Louisville, KY. Phone: (502) 897-8159. E-mail:

Nicole Marsoobian, Manager, Admitting, Tufts Medical Center, Boston. Phone: (617) 636-2271. Fax: (617) 636-1046. Email: