6 Strategies for Improving ED Nurse Wellness
Table of Contents
- Strategy 1: Cultivate a strong support system, from the top down.
- Strategy 2: Ensure each nurse has sufficient scheduled time away from the ED.
- Strategy 3: Critically assess staffing models.
- Strategy 4: Train preceptors and managers in trauma processing.
- Strategy 5: Create safety plans that include immediate response strategies.
- Strategy 6: Provide ample and ongoing, quality training with mentorship.
STS and PTSD are linked with increased absenteeism and a mass exodus of highly skilled nurses. Almost half of ED nurses say they have considered leaving the profession.5 This exacerbates staffing problems. When nurses call in sick or quit, EDs are forced to work with suboptimal staffing and may rely on new to practice nurses who might be less experienced and inadvertently cause patient harm.
Organizations must employ systematic strategies to improve the conditions that contribute to burnout, STS, and PTSD. ED nurses shouldn’t have to feel like they are working on the frontlines of a battlefield.
Here are six strategies you can implement to improve ED nurse wellness and enhance patient care.
Cultivate a strong support system, from the top down.
Managers must model transparency and be genuinely concerned for their staff if they want their staff to exhibit teamwork and compassion. Transformational leadership requires teamwork centered around achieving their organization’s goal.6
Unsupportive managers can play a significant factor in the nurses being at risk for compassion fatigue—losing their ability to nurture and care for patients.7 Workplace trauma is compounded when distressed nurses are dismissed by managers.3
Authentic leadership—one in which managers cultivate open communication, respect, a non punitive environment, and teamwork—is effective in reducing nurse burnout.4
Ensure each nurse has sufficient scheduled time away from the ED.
The more extended shifts or consecutive shifts nurses work, the less they feel they can provide safe care.3 Encouraging nurses to work overtime with bonuses contributes to burnout and lessens their ability to cope with trauma. The cumulative effect of routine exposure to trauma increases feelings of STS and PTSD.3 Nurses must be given time to recover.8
Rather than asking nurses to work extra hours, managers should encourage nurses to utilize paid time off.3
Critically assess staffing models.
The ability to manage critical patients requires not just enough presence and attention, but the staffing patterns that make this possible.9 Inadequate staffing by virtue of absolute numbers or inexperienced coworkers impedes assessment across the board and contributes to added nurse stress. Unsafe staffing forces nurses to feel they are compromising patient care.8 Nurse burnout hampers critical thinking and decision-making.4
Managers must conduct a critical assessment of departmental staffing and ensure that adequate personnel are scheduled. They must also have contingency staffing plans in place to account for sick day call-ins.
Train preceptors and managers in trauma processing.
Nurses should not be expected to quickly transition from a traumatic case to another patient. It is critical to provide debriefing opportunities for staff as they need them.
In fact, management can create a toxic work environment when they dismiss nurse stress.3 Nurses cope best when encouraged to process stressful situations with coworkers, especially when it is an informal debriefing.10
Managers should provide ED nurses with regular practical in-service trainings modeled after those provided to emergency responders, to help them cope with continual and traumatic stressors.10
Create safety plans that include immediate response strategies.8
ED nurses experience high rates of workplace violence and harassment is common place. Violence against nurses increases the risk of PTSD, absenteeism, and nurse turnover.
In effect, these causes of nurse burnout decreases cognitive and emotional focus.11
Hospitals must reduce response time when ED nurses are threatened and consider employing a mental health counselor skilled in the de-escalation of violence. When nurses are harassed or a, management should provide immediate intervention including debriefing, counseling, and time off with workers’ compensation if they are injured.11, 12
Provide ample and ongoing, quality training with mentorship.
Managers may be tempted to rush new hires to independence.
Instead, managers should create hands-on, supervised onboarding programs that allow adequate time for nurses new to the ED environment to achieve competency in critical ED nursing functions2 such as the assessment of arriving patients at triage. Mentorship from skilled ED nurses can help less experienced nurses more successfully navigate chaos and trauma and should also foster a supportive work environment.3
Emerging technology such as artificial intelligence (AI) in medicine and healthcare has also shown to provide active learning opportunities which improves critical reasoning on the job while also improving nurse retention.13 An example of such technology includes KATE TM. KATE AI clinical decision support works silently in the background and supports ED nurses by notifying them of possible Emergency Severity Index (ESI) assignment undertriage or overtriage, as well as incomplete documentation or documentation errors.13
KATE has helped ED nurses decrease clinical errors at triage by 41% for high risk patients.14
KATE is associated
with a 30% improvement in ED nurse retention3,13,14,15