Just a few days before I wrote this message, the Institute of Medicine (IOM) released the report “The Future of Emergency Care in the United States Health System,” outlining the challenges faced by health care providers and, even more alarming, the challenges faced by patients as they seek care in a time of need. The report describes what emergency nurses across this country already know to be true: that the emergency care system is underfunded, overcrowded, and understaffed.
The report highlights several aspects of the US health care system that are faltering. Crowding, fragmentation of the Emergency Medical Services system, a lack of coordination between emergency departments and EMS, shortfalls in disaster preparedness, the unique needs of the pediatric population, and workforce issues, especially the nursing shortage, are identified as contributing factors in a “perfect storm” bearing down on us.
Crowding is one of the leading stressors of the emergency care system and can be traced to the declining number of US hospitals combined with an ever increasing number of patients seeking care. The IOM report states there were 113.9 million ED visits in 2003, 23.6 million more than in 1993. During that same time interval, the number of hospitals decreased by 703, the number of hospital beds dropped by 198,000 and the number of emergency departments fell by 425.1 More patients and less space is only the beginning of the “perfect storm” emergency nurses face.
The organization and delivery of emergency medical services is fragmented and variable across the nation. Lack of national standards for care delivery and communication impedes coordination and regionalization of care, which can provide the best outcomes for patients by getting them to the right hospital for the right care in the timeliest manner.
Disaster preparedness is in the forefront of our minds these days, with terrorism warnings and worries of pandemic diseases as the leading news stories. One has to ask “If the emergency care system is already at or over capacity, what will happen in the event of a mass casualty incident? Will our nation's emergency departments be able to take on the added volume of acutely ill or injured patients?”
The IOM report estimates that children comprise 27% of all emergency department visits. Yet many emergency departments lack the proper equipment and staff have little specialized education and competency in dealing with this fragile population. Fortunately, ENA offers an educational program, Emergency Nursing Pediatric Course (ENPC), and is investigating the development of an emergency pediatric certification examination. These strengthen the knowledge base and skills of emergency nurses caring for pediatric patients.
The intensity of care in the emergency department setting is unique in the US health care system. Factors contributing to the intensity of our work include boarding of critically ill patients, violence toward ED staff by drug and/or alcohol influenced patients, emergency departments full of mentally ill patients who have nowhere else to go for care as community resources diminish owing to lack of funding, and keeping a watchful eye on the ever-increasing number of patients in the waiting room. Coupled with ineffective staffing systems and the nursing shortage, it is easy to understand that ED nurses feel thwarted in their ability to provide the highest level of care to their patients.
Emergency nurses play a pivotal role in all phases of a patient's sojourn through the emergency care system. You coordinate the care delivery process by drawing lab samples, administering medications, timing radiology tests, and organizing consultations with specialists. You assess the patient's rapidly changing condition and autonomously intervene to “rescue” patients. You teach patients how to manage their condition and to prevent injury. And, you play a very important role in emergency preparedness planning and response. You do this with grace and compassion, with competence and commitment, despite short staffing, despite long hours, and often, little thanks. But you are keeping the fragile emergency care system afloat through your efforts.
I urge you to read the full reports released by the IOM, which are located on the ENA home page at www.ena.org. Over the coming weeks and months, ENA will be carefully reviewing the recommendations contained in the reports. We are convening member experts to assist us in identifying solutions and strategies based on the recommendations. I encourage you to register your interest in assisting ENA in addressing the recommendations by becoming a Resource Specialist. You will find the enrollment information on the ENA website under the Members section. The contribution of your time, talent, and expertise will improve the emergency care delivery system.
Despite the challenges described in the report, the emergency care system remains the safety net for our country's communities. As emergency nurses, you are the heart of that safety net. Combining our efforts with key stakeholders; patients, physicians and the government, we will successfully quell the storm.
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