The Nurses' Emergency Department Working Group: addressing issues, step by step
It started with a day-long session that brought together nursing representatives of the city's six emergency departments, Misericordia Health Centre's Urgent Care and Pan Am Clinic. The goal? To hear nurses' observations, frustration and concerns from both a facility and system perspective.
From this day, 10 themes emerged. The Manitoba Nurses Union included these 10 themes, and recommendations, based on feedback from the nurses and research, in a report that was presented to the Minister of Health in 2012.
To begin working on these recommendations, the Nurses' Emergency Department Working Group was started in 2014. Co-chaired by Lori Lamont and president of the Manitoba Nurses Union Sandy Mowatt, the group has union representation, as well as participants from the six emergency departments, and program directors.
The group has four priority areas they're working on: redirection, the emergency department as an outpatient clinic, overcapacity protocols and staffing. The work is complex and this is where the persistence of nurses has really been required.
With redirection the goal is to educate the public about other ways to access the right care at the right time. In some cases, an option like a Quick Care Clinic could be a better choice for a person and the group is not only looking at how to communicate that, but how sending someone to a Quick Care Clinic, for example, would best be done and followed through on. One sub-group is examining how to redirect, and what is required to do so.
In some cases, people are asked to go to an emergency department and it is used as an outpatient clinic. This sub-group is starting with a mental health focus.
While work on overcapacity protocols is happening at a regional level, a sub-group is also looking at this issue.
Exciting work is being done in the area of staffing by a sub-group. While some initial recommendations are to increase staffing to address flow issues, the truth is that some organizations could use additional staff and others don't. Models for staffing in the emergency department are being examined, along with the way an event is coded or proceed, and the logistics and proximity of people who are being nurse monitored or not.
After reviewing work done in Australia around workload, the group is looking to pilot a project around workload measures. The evidence received will then help inform and support necessary decisions around staffing.