Reviewing Emergency Nursing Essay

Emergency Department (ED) overcrowding has been gaining increasing national and
international attention in recent years, yet little research has examined the emergency
nurse’s experience of this phenomenon. Undertaking this study allows me to share my
experiences of providing care within an overcrowded emergency department that
emergency nursing colleagues may find relation with, and connect one nurse’s
experience with others in the ED nursing workforce. The experience of being an
emergency nurse working within a demanding department cannot be adequately
measured by statistics. The intensity of the experience and current working

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Reviewing Emergency Nursing Essay
environment can be best understood by the sharing of my experiences. The aim of this
study is to examine and highlight nursing issues associated with working within an
overcrowded emergency department, and to examine my experiences of difficulties
providing care. As a research methodology autoenthnography allows me to use
personal narratives as research data and by doing so give voice to my experiences of
providing care in an overcrowded emergency department.
Three themes entitled ‘What’s the harm in waiting,’ ‘Too busy to care’ and ‘Feeling Reviewing Emergency Nursing Essay
all used up’ were established from the data analysis. These three themes all have
many common characteristics and can be easily overlapped. The cultural theme that is
identified through the data is that the notion of caring is at the root of my nursing
practice and working within an overcrowded ED can compromise these values. This
experienced distress is the painful feelings and the disequilibrium that happens when I
am conscious of the appropriate action required but I am not able to carry it out due to
barriers. This distress is a major problem in the nursing profession that affects nurses
internationally and is described as moral distress.
I compared my experiences in narrative formation against published literature
examining the issues that face ED nurses. I felt uncomfortable and simultaneously
disappointed to uncover similar feelings of powerlessness and distress within my
nursing culture. Like me many other emergency nurses ability to provide care is
impacted by issues due to ED overcrowding. Writing and sharing my personal
experiences using narratives and analysis has provided me with strength that I am not
alone in this issue, and optimistically this will also educate and empower the reader,
who may also face similar issues within their workplace. The issues and difficulties
associated with overcrowding in the ED are complex and multifaceted, and it is
important that ED nurses at constant risk of moral and emotional distress are not
forgotten in strategic attempts to manage and improve this issue.
First and foremost I would like to acknowledge my partner, close friends and family
whom have been very supportive throughout this process. Thank you for your
patience and giving me endless support in so many ways.
I would also like to thank my colleagues and nurse manager who have been excellent
at ensuring that I can maintain all my study and work requirements, throughout this
process. Also I am grateful for the financial support provided from the Clinical
Training Agency and the Bay of Plenty District Health Board.
Thank you to my supervisor and tutor Patricia McClunie-Trust and Helen Nielson
whom have been very understanding and accommodating of the personal challenges
this process has held for me.
I always envisaged my mum and dad being at my graduation, but now I have now
learnt that they are always with me guiding my way. Reviewing Emergency Nursing Essay
Chapter One – Study Overview
Introduction to the study
This study is the examination of my experiences of a senior nurse working within an
overcrowded emergency department (ED) in New Zealand. Internationally and within
New Zealand nurses are faced with increasing demands on our emergency services
and fulfilling our emergency nursing profession. As a senior nurse within an
emergency department I am finding it more difficult to meet the demands asked of
me. I have also witnessed these demands on my nursing team and find evidence of
similar situations throughout nursing literature. Many ED nurses are working to full
capacity, and with the current common state of ED overcrowding we are asking those
nurses to provide additional care to a larger patient group in an environment with
restricted or diminishing resources (Kilcoyne & Dowling, 2004).
The purpose of this research is to examine my experiences as a senior nurse and the
impact that overcrowding has upon the care I provide, and to interpret my experience
in relation to the wider emergency nursing profession. The foundation of this research
is based around the research question, what are my experiences as a senior nurse
providing care within an overcrowded emergency department? I will conduct a
literature search examining the notion of care, the essence of emergency nursing and
provide an overview of the problem of ED overcrowding. I have used self narratives
to portray my own experiences of working within an overcrowded ED, and have used
autoenthnography to provide the tie between the wider cultures of ED nursing.
According to Wall (2008) autoenthnography is a research method that provides a way
of giving voice to personal experience for the purpose of extending sociological
This chapter provides my personal interest and background for conducting this
project, my responsibility of care within the ED, exploration of the essence of
emergency nursing, ED overcrowding and discuss the notion of caring and its
application to my role. I will also outline other conducted studies that are relevant to
this work.
Personal interest in this study
On reflection I believe my interest in this research started several years ago. I felt as
though my workload in a demanding emergency department was increasing with due
to patient presentations and higher acuity levels, and the available resources were not
expanding in the same manner. My experience and skills were at an expert level and I
was engaged in higher levels of responsibility and seniority within my workplace. I
felt this was the right thing to do for my career, but why was I left feeling that I was
leaving my core values of nursing behind? I became feeling increasingly stressed and
dissatisfied with my role and my profession and the care I was providing. I
recognized that the care I provided within my emergency department did not meet the
gold standard or optimum levels that I knew were the most beneficial for the patients Reviewing Emergency Nursing Essay
and the staff, and even occasionally I was unable to meet basic patient’s rights by not
addressing their comfort and dignity as deserved. Continuous strategies to improve
systems and multiple requests for further resources in the department were declined
regularly by management due to financial and resource issues. I held a residual feeling
of knowing what to do, knowing how to do it, but yet not having the inability to
provide this great care due to restrictions on space, funding and many other
organizational barriers. I am confident that these frustrations leading to my overall
dissatisfaction are not an individual experience, but a common reality in my ED
nursing world. This I believe is how my research started.
My designated senior nurse position is Clinical Nurse Coordinator (CNC) within the
ED. My population of responsibility includes all patients and staff within the ED. The
main purpose of my role is to provide direct clinical coordination and expertise while
ensuring a safe effective practice environment which supports the management of
patient flow in the ED. As the senior nurse in charge of shift I jointly hold the
responsibility for care with the senior medical officer (SMO) in the ED as outlined by
the Australasian College of Emergency Medicine (2003). However due to difficulties
recruiting and retaining SMO’s, this position is often filled with locum or junior
doctors, therefore the responsibility of care for the department frequently is held
solely by me. I have an overall accountability to bring together the physical aspects
of the patient journey and process which include, reception, triage, initial assessment
and resuscitation, detailed assessment and investigation, progress evaluation and
monitoring and the finally disposition (ACEM,2003). There are many members of
different professions, specialties and locations throughout the hospital that I am
required to communicate with and coordinate to facilitate the patient journey in a
timely and safe manner. The roles and responsibilities of my clinical role are required
to be visible, responsible and delivery of efficient care must be facilitated. The
increase in requirements that I outline within this project are expected from our
service which is difficult at a time when resources are limited and this presents the ED
team with daily challenges.
I believe it is very important to protect and retain our workforce within the emergency
nursing profession. By undertaking this study it allows me to share my experiences of
providing care within a demanding ED that emergency nursing colleagues may find
relation with, and connect one nurse’s experience with others in the ED nursing
workforce. The experience of being an emergency nurse working within a demanding
department cannot be adequately measured by statistics. The intensity of the
experience and current working environment can be best understood by the sharing of
my experiences. What it is like being and ED nurse at this time in a heath system with
scarce resources and the increasing challenges of an aging nurse and patient
population can be further understood by my personal nursing narratives that also
support statistical and evidence within nursing literature. Nursing perspectives of their
jobs and workplace matters greatly as it affects career patterns and the supply of
registered nurses. If delivery of patient focused quality care in ED’s is to be achieved
it is imperative that nurses are listened to, and their expertise acknowledged and they
are allowed to become more involved in decision making processes. Issues associated
with overcrowding in the emergency department are complex and multifaceted and it
is essential that nurses whom are at a constant risk of emotional, physical and moral
distress are not forgotten about in strategic attempts to recognize and manage this
issue. Therefore this becomes the justification for undergoing this study. Although
this study is based upon my own personal practice narratives, the issues of ED nurses
occur nationally and internationally, therefore the collection and analysis of these
narratives of being an ED nurse in a busy department are also applicable and
transferable within a wider nursing community. By using the methodological
framework of autoenthnography this allows me to bring together my experiences  Reviewing Emergency Nursing Essay

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