Future Emergency Nursing workforce, what is the evidence telling us?

Mrs Vanessa Gorman1

1The Royal Women’s Hospital, Melbourne, Australia

OBJECTIVE: High nursing turn-over, and low retention rates amongst the field of emergency nursing according to current evidence is a global phenomenon. How is the current evidence influencing managers and organisations to identify key factors that may improve not only retention, but recruitment, into the speciality of emergency nursing?

METHODS:
This study utilised a bibliographic search as well as the authors own experience when performing the integrative review.

RESULTS:
26 articles were identified as meeting the criteria of the integrative review. Both national and international articles that met inclusion criteria were included.
4 key themes were identified that may impact on the recruitment and retention of emergency nurses: workplace environment, demands on emergency nurses, resilience, and education and training.
The key themes identified all impact on emergency nurse recruitment and retention, but the evidence is conclusive that a multi-level approach needs to be adopted internationally.

CONCLUSIONS:
Emergency nursing recruitment and retention is a multi-faceted issue that requires urgent attention to develop tools and strategies to support organizations to build a sustainable workforce. This study has highlighted the need for further studies to understand why emergency nurses lack the knowledge or capability for a long-term career in emergency nursing.


Biography:

Vanessa commenced her emergency nursing career in 1996 and across her career in emergency nursing she has held positions such as Nurse Unit Manager, Senior Policy Advisor – Department of Health, and State Trauma Manager. Vanessa is the appointed Emergency Services manager at the Royal Women’s Hospital, Melbourne. Vanessa is an appointed member of the International Advisory Council for the Emergency Nursing Association (USA), and is appointed to the CENA membership committee. In 2017, Vanessa was awarded the Australasian Emergency Nurse of the year as she strives to improve emergency care for both patients, and the nursing workforce, through various quality projects.

Demystifying the role of the ED Clinical Nurse Specialist

Kevin Dunshea2, Julia Morphet1, Tamsin Jones1

1Monash University, Frankston, Australia, 2Royal Darwin Hospital, Tiwi, Australia

The role of the Clinical Nurse Specialist (CNS) has long been associated with leadership throughout nursing. Advocating for their patients and peers within their organisation whilst exemplifying clinical expertise and practice at the bedside, bridging the gap between front line nurses and their managers.

Yet the constantly evolving needs and pressures of health care delivery globally have resulted in the proliferation of senior and advanced nursing roles and and increase in the local interpretation and contextualisation of the CNS role have made this role synonymous with ambiguity and confusion, with variation common to the role’s nomenclature, meaning, preparation and scope of practice. The extent that this inconsistency affects emergency practice in Australia however remains largely unknown.

Objective: This research aimed to elucidate the role of the Emergency Department (ED) CNS, by exploring the emergency nursing community’s collective position of the role as it stands in Australia.

Method: Three iterative surveys, following the electronic-Delphi (e-Delphi) methodology, were distributed nationally to members of the College of Emergency Nursing Australasia (CENA). After expressing their views of the role of the ED CNS, participants ranked the significance of their collective responses in subsequent surveys.

Results: A total of 445 comprehensive and diverse responses were collected throughout the study, as participants endeavoured to express their perception of the role. Collective consensus was evident regarding many aspects central to the ED CNS role. Most participants were familiar with the title ‘Clinical Nurse Specialist’ and many of their responses conveyed the significance of clinical expertise, leadership and a commitment to enhancing nursing practice to the ED CNS role.

Conclusions: Participants believed that the ED CNS role has a place in the future of emergency nursing practice. Their responses demonstrated that a common understanding of the role is shared by the emergency nursing community, irrespective of any variation that may exist between ED’s. Articulating this collective understanding enables a better understanding of the ED CNS role, while contributing their views to broader CNS discussion.


Biography:

Kevin is currently a clinical nurse educator working with the Emergency Education Service in the NT’s Top End Health.  He has more than 10 years of Emergency and Critical care experience across NSW and the NT.  He values evidence based practice, endeavouring to consistently deliver quality client focused emergency care.  His role as an educator gives him the opportunity to contribute to the growth of his peers, where he hopes to foster a culture that promotes those leadership qualities and skills essential to our emerging nursing leaders whilst also recognising the unique contributions of the emergency nursing community.

Leading the leaders: scaffolded mentorship in clinical nursing through the leaders’ lens

Ms Sarah Borg,1, Ms Karen Taurima1, Ms Karen Robinson, Ms Simone Moodie1

1Department of Emergency Medicine, Princess Alexandra Hospital, Woollongabba, Brisbane, Australia

Clinical leadership has long been recognised as critical for optimising patient safety, quality of care and interprofessional teamwork in busy and stressful healthcare settings(1).  Literature suggests that while nurses are increasingly proficient in emergency nursing technical skills, their training in and knowledge of clinical leadership skills is not always adequate to meet the demands(1).  There is a need to identify effective ways to sustain and develop nursing leaders.

The practices of nurse leaders can have positive impacts on nurse’s job satisfaction, emotional and physical wellbeing, organisational commitment, provision of quality patient care, as well as on developing and maintaining positive organisational culture(2). Studies of nurse leaders show that many attribute their success in leadership roles, in part, to the actions of influential others(3).  Mentoring has been identified as an invaluable tool to attract, develop and retain new nurse leaders.  Mentoring provides an opportunity for both the mentor and the mentee to engage in meaningful professional relationships with the goal of leadership development for all involved(3).

This presentation will outline the development of an ED nursing leadership framework and its implementation through a formal mentoring program aimed at nurses at all levels.  The ‘PODMASTERS’ Nursing Leadership Framework was developed by nursing staff at the PAH-ED and outlines the all-encompassing key leadership skills and attributes for future nursing leaders.  The framework is derived from leadership frameworks used nationally and internationally in various career fields; including healthcare, business, information technology, and public service.

Implementation of the ED ‘PODMASTERS Leadership Framework has been through a formal mentoring program structure, designed to cater for nurses at all levels and development needs. This presentation will outline the core components of the leadership framework and mentoring program, as well as the potential and realised benefits from its implementation.

  1. Husebo, S., & Olsen, O. Impact of clinical leadership in team’s course on quality, efficiency, responsiveness and trust in the emergency department. BMJOpen 2016,1-9.
  2. Sowatzky, J.A., & Enns, C.L. Exploring the key predictors of retention in emergency nurses. JNursManagement 2012, 20(5),696-707.
  3. Hodgson, A., & Scanlan, J. A concept analysis of mentoring in nursing leadership.  OpenJNursing 2013,3,389-394.

Biographies:

Karen Robinson began her nursing career in 1989. She has worked in the Princess Alexandra Hospital Emergency department for the last 18 years and is now a Clinical Nurse Consultant.  Karen’s professional interests lie in developing staff resilience and retention.  She loves working with such a highly motivated and successful team to develop breakthrough Emergency best practice nursing.

Simone graduated from University of Southern Queensland with a Bachelor of Nursing in 2011. She has worked at the Princess Alexandra Hospital for 6 years, 4 of those years in the Emergency Department. During her time in Emergency Simone has acted in a Clinical Nurse role and currently is now acting in the Associate Clinical Nurse Consultant position. Simone is enrolled in Graduate Certificate in Emergency Nursing. Simone has a strong interest in the quality and safety of clinical practices and also how our department can deliver the best patient care.

Disaster preparedness: A refection of interdepartmental collaboration for the Gold Coast 2018 commonwealth Games

Ms Michelle Buckland1, Mr Peter Mcnamee1, Ms Emily Ragus2
1Gold Coast Hospital Health Service, Southport, Australia, 2Health Disaster Management Unit, Brisbane, Australia

Aim of presentation: This presentation aims to provide an overview of the collaboration between two agencies, Gold Coast Hospital Health Service and Queensland Health Disaster Management Unit in the disaster preparedness preparations for the Gold Coast 2018 Commonwealth Games.

This presentation will cover:

A) Four key aspects when planning for a major event, and their application to a mass gathering (the Gold Coast 2018 Commonwealth Games):

  1. Collaboration
  2. Business as Usual (except for where you need to make exceptions)
  3. Analysis
  4. Departmental readiness

B) Lessons learnt from the disaster planning process for the Gold Coast 2018 Commonwealth Games

Central to the success of the disaster planning was the ability for leaders to network via an organised central planning group, clear communication between key stakeholder groups, positive departmental culture, and a commonality of the same goal. Transparency, mentorship and a sense of equality were also featured.

Conclusion: Effective and efficient collaborations between departments facilitated effective resolution of issues that ensured the delivery of a common goal for this disaster preparedness activity.


Biographies:

Michelle Buckland is an experienced Registered Nurse and Midwife, currently employed at Gold Coast Hospital Health Service as the Nurse Manager of Governance, Risk, Audit and Disaster, in the Emergency Department.

Emily Ragus is a Helicopter Trauma Nurse, with a background in Emergency Nursing. She currently works at the Health Disaster Management Unit as the Disaster Liaison Clinical Nurse Consultant. Emily is a member of the AUSMAT team and is the state coordinator for MIMMS – Major Incident Medical Management and Support. She has just been awarded the NCCTRC Winston Churchill Fellowship.

Unravel my mind & cast me to the right direction – Queen Elizabeth II Jubilee Hospital Emergency Department Nursing Mentoring Project

Julie Finucane, Angela Devlin, Mingshuang Ding

1Emergency Department Clinical Nurse Consultant, , , 2Emergency Department Research Midwife, , , 3Director of Nursing (Medical), ,

Background/Rational

The hospital workforce environment has been recognised as an important factor for nurse retention and patient safety, yet there is ongoing evidence that inadequate communication, intra-professional oppression, and lack of collaboration and conflict resolution continue to disempower nurses and hinder improvement of workforce conditions.

Methods

A multiphase, nursing lead, quality improving project was implemented at the Queen Elizabeth II Jubilee Hospital (QEII) Emergency Department (ED) by utilising nursing mentoring framework/model.

Senior nurses who are suitable to be mentors were recruited by the project leader.  The mentors were then asked to complete a template allocated under the department drive.  The template informed mentors’ educational and work experience, particular interests within the current position and interests outside work.

Completed mentors’ profile is available for all junior nurses (potential mentees) to view.  All junior nurses are encouraged to contact mentors at their own convenience.  Once the mentorship is established, both mentors and mentees are able to set and work on tailor made goals based on each individual’s availabilities and timeframe.  Documents such as ‘Mentoring Action Plan, Mentoring Agreement Template and Mentoring Session Record Template’ are publicly to access within the department.  A reliable and valid evaluation questionnaire was distributed to all nurses in order to obtain feedback of this project.

Aims

The objectives of this project is to implement a nursing lead mentoring program to reduce high burn out rates within a critical care area and in turn aid in recruitment, retention and overall job satisfaction.

Expected Outcomes

Numbers of positive outcomes are expected throughout this project, and listed below from mentee, mentor and organisation perspectives Figure 1).

References

  1. Bradshaw, M & Lowenstein A 2007, Innovative teaching Strategies in Nursing and Related Health Professions, 4th Edition, Jones and Bartlett, Massachusetts.
  2. Croxon, L., Maginnis, C., 2008, ‘Evaluation of clinical teaching models for nursing practice’, Nurse Education in Practice, vol. 9, pp. 236-243
  3. Elcock, K & Sharples K 2011, A Nurse’s Survival guide to Mentoring, Churchill Livingstone Elsevier, London.
  4. Goodman, B., 2007, ‘Understanding learning’, Nursing Standard, vol. 21, no. 41, pp. 61
  5. Kopp, E., Hinkle, J., 2006, ‘Understanding Mentoring relationships’, Journal of Neuroscience Nursing, vol. 38, no. 2, pp. 126-131
  6. McBrien, B., 2006, ‘Clinical teaching and support for learners in the practice environment’, British Journal of Nursing, vol. 15, no. 12, pp. 672-677
  7. Prescott, C. 2014, Instruction Guide for DOM Mentorship Program Mentors and Mentees
  8. Richman, A., 2013, ‘COVERSTORY’, Long-Term Living: For the Continuing Care Professional, April, pp. 18-24
  9. Stalmeijer, R., Dolmans, D., Wolfhagen, I., Scherpbier, A., 2009, ‘Cognitive apprenticeship in clinical practice; can it stimulate learning in the opinion of students?’, Advances in Health Sciences Education, vol. 14, no. 4, pp. 535-546
  10. Stillwell, C., 2009,’The collaborative development of teacher training skills’, ELT Journal, vol. 63, no. 4, pp. 353-362
  11. Tang, F., Chou, S., Chiang, H., 2005, ‘Students’ perceptions of Effective and Ineffective Clinical Instructors’, Journal of Nursing Education, vol. 44, no. 4, pp. 187-192
  12. Tigelaar, D., Dolmans, D., De Grave, W., Wolfhagen, I., Van Der Vleuten, C., 2006, ‘Participants’ opinions on the usefulness of a teaching portfolio’, Medical Education, vol. 40, pp. 371-378
  13. Tilley, D., Allen, P., Collins, C., Bridges, R., Francis, P., Green, A., 2007, ‘Promoting Clinical Competence: Using Scaffolding Instruction for Practice-Based Learning’, Journal of Professional Nursing, vol. 23, no. 5, pp. 285-289
  14. Wadell, D., Dunn, N., 2005, ‘Peer Coaching: The Next Step in Staff development’, The Journal of Continuing Education in Nursing, vol. 36, no. 2, pp.84-89
  15. Whitehead, D, Weiss, S, & Tappen, R 2007, Essentials of Nursing Leadership and Management , 4th edn, F.A Davis Company, Philadelphia.

Biography:

To come…

The Northern Hospital Ambulance offload performance improvement – nursing led, nursing driven, nursing success

Jodee Bootle1

1The Northern Hospital, Epping, Australia

The Victorian Department of Health and Human Services require hospitals to rapidly off-load emergency ambulance presentations, to maximise the availability of emergency response to our local community. The Statewide target is 90 per cent of patients transferred from an ambulance service into the care of the hospital in less than 40 minutes. Delivery on this Key Performance Indicator requires a careful balance between emergency department entry and exit, to ensure that a bed is always available for the next ambulance.

Northern Health has implemented an Ambulance Offload strategy which has resulted in significant and sustained improvement, becoming for the first time compliant for a continuous period of six months to present date. Our strategy involved distinct environmental, human resource and process changes, focussed on completing triage, allocation and handover within the 40-minute timeframe.

Environmental changes involved the designation of ambulance offload cubicles during times of peak demand, to create temporary buffer capacity to manage surges in demand. These three cubicles are fully staffed throughout our peak times, to enable offload, handover, and commence early assessment and management. Once occupied, an offload escalation strategy occurs, to ensure that these patients move to an assessment cubicle within 30mins of offload. This is achieved with prioritisation of admissions to ward, and expedition of discharges.

The keystone of this process change was effective accountability, governance and sustainability of proficient and efficient nursing care. The co-implementation of nursing role descriptions, daily performance monitoring, education via a triage self-review package to ensure quality and efficiency of triage as well ED nursing shift reports created staff accountability for this measure. Close monitoring enabled further development of our Ambulance offload process, which is now positioned in the highest performing services of our region.


Biography:

Jodee Bootle explains nursing as her 3rd career after spending 10 years in the Army. After commencing nursing at the  the Royal Melbourne Hospital where she stayed for 13 years. After fulfilling various roles in ED, in Access as an After Hours Hospital Manager and the Nurse Unit Manager (NUM) for the Acute Medical Unit for 5 years. Jodee was the RMH Nurse of the Year for Leadership in 2013 and the recipient of the Hospira Research grant. In July 2016 she has moved to TNH.  She is currently the Nurse Unit Manager of The Northern Hospital (TNH) Emergency Department. Jodee is passionate about leading teams and implementing innovative processes for a sustainable future.

The effect of workplace violence on patient care

Karen Thompson1

1DHHS Tasmania, Burnie, Australia

Background workplace violence (WPV) is commonly experienced by Emergency Department nurses

What is known about this topic. WPV is a long-standing problem for Emergency Department nurses. It takes many forms and has several precipitating factors. The most common form is patient/visitor violence (PVV), but an older and more insidious problem is bullying, harassment and horizontal violence (BHHV)

What this paper adds. PVV and BHHV are recognised and researched problems in nursing; usually studied singularly.  This paper takes a comprehensive approach, looking at the intricate connections between forms, the associated traumatic stress disorders and subsequent effect on patient care.

Implications for practice. The hypothesis is proposed that most horizontal violence is a driven by feelings of oppression and powerlessness to retaliate when subjected to one or more form/s of workplace violence. Consequently, these feelings are projected on a ‘safe’ target, usually a colleague, contributing to compassion fatigue and poorer patient care.

Conclusion WPV contributes to traumatic stress disorders, impacting adversely on patient care.

Key words workplace violence, compassion fatigue, bullying, horizontal violence, case study, effect on patient care, PTSD


Biography:

Karen Thompson comes from a mixed background, with post graduate degrees in remote area nursing and critical care. She is also a certified instructor in de-escalation and management of aggressive situations.   While completing her  Masters in Clinical Nursing (Emergency Nursing) last year, Karen conducted further research into the phenomenon of workplace violence, particularly it’s effect on patient care. Karen works two 0.5FTE positions; After Hours Manager at a small private hospital,  and RN in a medium sized but very busy ED. In 2016, she became a published author and presented at several conferences on this and related topics

Nursing forum for improve staff engagement

Emily Lynch1

1Northern Hospital, New Gisborne, Australia

Aim – The introduction of a regular forum for Emergency Department nurses to present ideas, give feedback and problem solve issues.

Background – Staff engagement in nursing is essential when developing a supportive leadership model (Parliament of Australia, 2002). It is integral that such models value nurses’ ideas in order to improve job satisfaction and staff retention in the Emergency Department Parliament of Australia. (2002). High turnover rates have systemic negative effects on an organisation, resulting in lower skill mix and costly recruitment drives (Tillott et al., 2013). Engaging nurses in workplace change has been shown to have a positive effect on staff satisfaction and will lead to a more progressive workplace (Iqbal Chagani, 2015).

Method – A nursing forum will provide a supported space for staff to identify workplace issues, present a potential solution and provide feedback. The group will identify the key ideas and present them to management via a representative. Department managers will then provide a feedback with potential for improvement projects and further idea development. The forums will be nurse lead, providing leadership opportunities for all levels of employees.

Results – Nursing forum will engage employees, reduce turnover rates, provide an avenue for leadership opportunities and create a progressive workplace.

Conclusion – Regular nursing forums offer a protected environment to engage nurses and provide opportunities to participate in change. They provide a cost effective method of reducing staff turnover and leading to a progressive Emergency Department.

References

  1. Iqbal Chagani, S. M. (2015). Transformational Leadership In Emergency Department For Nurse Retention. Journal On Nursing, 5(2), 4-9.

 

  1. Parliament of Australia. (2002). Inquiry into Nursing. Retrieved from http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Completed_inquiries/2002-04

 

  1. Tillott, S., Walsh, K., & Moxham, L. (2013). Encouraging engagement at work to improve retention. Nursing Management – UK, 19(10), 27-31

Biography:

Clinical Nurse Specialist working busy Metropolitan Emergency Department and a Clinical Support Nurse for Graduates.

Novice to expert emergency nursing

Anna D’Ambrosi1

1Calvary Health Care ACT, Bruce ACT, Canberra, Australia

Emergency nurses pride themselves on the provision of consistently high quality patient care quality patient care measured against clinical and pastoral metrics. This important element of work and personal achievement exists in all Emergency nurses whether they are by experience and/or qualifications a beginner, novice, competent, proficient or expert

The literature suggests that health services benefit from providing the novice nurse a comprehensive yet flexible education program that will incrementally shape the expert clinician. It is essential that this novice to expert pathway is frequently evaluated and accordingly adjusted to ensure the effectiveness of such programs in a constantly evolving profession.

Progression through the designated levels of emergency nurse competency requires the parallel advancement of qualitative (cognitive skills) and quantitative attributes and skills (metacognitive skills).

Qualitative attributes include enthusiasm for practice, self-motivation, intuition, emotional involvement, commitment and personal satisfaction from professional opportunities. It is not possible to apply a simple standard or mark for these characteristics, and additionally they are dynamic in nature and affected by many factors including personal and workplace circumstances.

Quantitative skills are those that can be measured by a standard metric. These include academic qualifications, clinical knowledge, procedural competency and clinical practice. Once attained, these credentials are often regarded as perpetual.

There are two challenges for the health service around the development of the nurse on the capability continuum. The first is the recognition that the nurse requires simultaneous progress in both the qualitative and quantitative attributes. The nursing practice environment needs to perform as a total supportive clinical learning environment to result in emergency nurses transiting from novice to expert. Mentoring and personal development programs need to be provided concurrently with academic or qualification based learning activities.

The second is the service needs to accept that a nurse can make a significant contribution and be a critical nurse team member without wanting to pursue or achieve expert status. If a nurse does not have high levels of the qualitative attributes listed previously the nurse can still be valuable and proficient within the scope of practice that this determines.

Every service should strive to provide a nursing practice environment that continuously upskills its staff against measureable criteria. Additionally, that environment should readily offer the necessary support and opportunities to enable the emergency nurse to explore the potential of their qualitative attributes at the time they feel ready to do so.


Biography:

Anna D’Ambrosi is a senior Emergency Nurse at Calvary Public Hospital in Bruce, Canberra. Anna successfully completed a Degree in Bachelor of Nursing from the University of Canberra in 2006, Post Graduate Certificate in Clinical Nursing (Emergency) from the Australian Catholic University in 2009 and she is currently completing a Leadership and Management Diploma from JCE Positive Outcomes.

Anna has accomplished a high standard of competency in emergency nursing, providing advanced nursing care including advanced life support, is a member of the medical emergency team, patient flow management and triage.

Anna also provides education to emergency staff and clinical governance as the leader of the Blood Safe Quality Portfolio, where she manages many valuable departmental projects.

Anna is an Australian Rugby League Sports Trainer and has National Accreditation Level 1 R.L.S.T..

Introducing simulation for recruitment of nurses in the Emergency Department

Emily Cooper1, Jan Gehrke, Mary Boyde

1Princess Alexandra Hospital , Brisbane, Australia

In our Emergency Department(ED) at a large tertiary referral hospital, the management team made a commitment to introduce simulation to our human resource management recruitment processes specifically for Clinical Nurse and Graduate Nurse Positions.  Previously recruitment processes relied heavily on the written application and interview to give applicants an opportunity to demonstrate their knowledge and suitability for nursing positions through verbal responses. The nursing managers felt that the addition of simulation would offer applicants an opportunity to demonstrate their clinical judgment skills with aim to recruit the best applicant for the position.

The CN recruitment process was comprised of three components: written application, interview and simulation. The written application was scored to qualify the applicant for the next round of the application. The Interview process included a 2 question interview in-front of a panel of 3 which focused on the hospital key attributes. The simulation immediately followed which also included a 3 person panel and was scored by a pre- developed marking guide based on hospital key attributes . Each component was equally weighted and participants had to score >65% to be eligible for a position.

The Graduate Nurse Recruitment structure was very similar in that it comprised a written application, followed by interview and simulation.

Overall the applicants were able to further demonstrate their clinical skills, behavioural attributes and escalation pathways within a structured simulation environment, which does not fully allow within a behavioural interview. We believe we have obtained the best applicants for the positions and made this process fair & equitable.


Biography:

Emily is a Nurse Educator at the Princess Alexandra Hospital Emergency Department. Emily has been an emergency nurse for 10 years and during that time has completed a Masters of Emergency Nursing. Emily has taken on many different nursing roles within this period but her passion is for nursing education and has spent the majority of her career working in this area.

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