This is the official podcast of the Canadian Journal of Emergency Nursing www.CJEN.ca, a free open-access peer-review journal. We share content related to emergency care, interviews with published CJEN authors and members of our emergency care community. We are the journal of the National Emergency Nurses Association (NENA) www.NENA.ca
Jiun-Yi Zullo, Lynn Corcoran & Karen Cook (Summer 2022) Occupational Disappointment and Emergency Nurses: A Qualitative Descriptive Study
Background: Occupational disappointment is a novel concept in emergency nursing. It is a feeling of disheartenment with career choice. It results from prevalent, unaddressed verbal abuse in the emergency department directed towards nurses from patients and/or their visitors. Occupational disappointment is conceptually different from burnout and compassion fatigue. In the context of the COVID-19 pandemic, it is important to acknowledge this phenomenon and understand its implications while considering strategies to mitigate it.
Method: A qualitative descriptive methodology was used in this study. Nurses were interviewed to explore the question: How do emergency department nurses experience occupational disappointment as a result of verbal abuse?
Results: Three major themes with several subthemes were identified: (1) nurses’ experiences of occupational disappointment with sub-themes of powerlessness and normalizing; (2) nurses’ responses to occupational disappointment with sub-themes of changes in nursing practice, retention, and nurses’ mental health; (3) nurses’ concerns regarding occupational disappointment with sub-themes of nursing and organizational leadership.
Discussion: Policies addressing verbal abuse would help guide nurses when managing this violence. Failure of nurse leaders to implement such measures contributes to nurses’ occupational disappointment, consequently affecting nurses’ practice, mental health, and retention. While these implications are not new, the COVID-19 pandemic has exacerbated this phenomenon. The magnitude of verbal abuse that emergency nurses currently face has increased exponentially; a renewed urgency for strategic action is necessary.
Conclusion: Occupational disappointment is a direct result of verbal abuse and an indirect result of organizational failures to support nurses and empower them to mitigate this abuse.
Keywords: COVID19, leaving, occupational disappointment, retention, wellness, organizational leadership
Samantha Horvath & Nancy Carter (Summer 2022) Emergency Nurses’ Perceptions of Leadership Strategies and Intention to Leave: A scoping review of the literature
Retention of registered nurses in emergency departments (EDs) is as a critical issue, further exacerbated by the COVID pandemic. Leaders influence work life and working environment, but it is unclear what strategies leaders use to address nurse staffing issues in the ED. The purpose of this scoping review is to understand if leadership strategies used in EDs have links to nursing retention and turnover.
This scoping review was completed with a comprehensive search within Cumulative Index to Nursing and Allied Health Literature, EMCARE, EMBASE. Two authors developed inclusion and exclusion criteria, did title and abstract screening, and full text screening using review software. Data extracted from included studies was analyzed to determine leadership strategies and relationships to intent to stay, retention, intent to leave, or turnover.
Of the 553 records identified, nine met inclusion criteria. Leadership strategies identified in the studies included support from supervisor, engagement by the leader, organizational culture assessment, and a cultural change toolkit. No leadership strategy influenced nurse intention to stay, retention, intention to leave or turnover.
Emergency nurse retention and the prevention of turnover is a multidimensional issue stemming from various factors that may not be controllable due to the nature of the setting. However, leaders can implement strategies and provide support to staff to enhance quality of work life and the work environment. More information is needed to understand how leaders can influence the current and future supply of emergency nurses to produce quality patient care outcomes.
Keywords: emergency nursing, turn over, intention to leave, management, leadership, scoping review
Jennifer Davis & Dawn Peta (Spring 2021). What's in a BP: Do you Follow the MAP?
The purpose of this case study is to help determine if emergency nursing education should include a focus on mean arterial pressure (MAP) and Pulse Pressure (PP) as part of their regular curriculum. We also considered if monitoring and trending BP, MAP and PP in patients who present with symptoms that may indicate a pulmonary and/or cardiac complaint, along with abnormal vital signs or abnormal lab values, would result in more timely intervention. Through this case study we hope to show that trending MAP may help identify early hypovolemic shock, severe sepsis and other significant life threatening conditions.
Keywords: MAP, aortic injury, AAA, thoracic aneurysm, emergency nursing
Aditi Sharma & Mohamed Toufic El Hussein (Fall 2021) The impact of COVID-19 on the cardiovascular system
Mohamed El Hussein
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an infectious disease where symptoms can be mild, requiring no treatment or severe, requiring hospital admission for hemodynamic support and mechanical ventilation. Given the affinity of SARS-CoV-2 to angiotensin-converting enzyme 2 (ACE2) receptors, the heart is a highly susceptible target to its associated damages. Knowledge about SARS-CoV-2 modes of transmission and their impact on the cardiovascular system is paramount for emergency department (ED) nurses to protect themselves and competently care for their patients. The authors of this manuscript aim to provide a clinical overview of the impact of SARS-CoV-2 on the cardiovascular system based on the latest scientific evidence. A profound understanding of SARS-CoV-2 and its related consequences has the potential to minimize its associated mortality and morbidity.
Keywords: SARS-CoV-2, cardiac, heart, COVID19
Kara Payne & Sandra Reilly (Spring 2020). The continuity of care: From admission to the recovery at home
The treatment and support patients receive in their transition from the Emergency Department (ED) to the patient care unit (PCU), and eventually, the community, have clinical consequences, psycho-social outcomes, and financial ramifications. This quality improvement report provides recommendations intended to improve patient experiences and outcomes, in the context of ED crowding. The recommendations provided are informed by the findings of a master's project that examined the transfer of patients from admission in a crowded ED, to a select PCU, and then to the community using process mapping and patient surveys. The purpose of this project was to examine the sequence of care beyond the walls of the ED and include the PCU (McHugh et al., 2011) using a systems approach (Villa, Prenestini, & Giusepi. 2014). We believe that by understanding process successes and failures, between EDs and PCUs, we can make improvements to ensure efficient, effective, and streamlined transitions to promote continuity of care.
Keywords: transitions, quality improvement, health systems, continuity of care, handovers, patient perspective
Shand, Klemmer, Grubb et al. (Spring 2020) Nurse practitioners in the ED, Transition Clinic & IV Therapy at SCH
This article is about nurse practitioners' effectiveness working in the Strathcona emergency department (ED), as well as the efficacy of two nurse practitioner-led clinics that run parallel to the ED. Prior to opening Strathcona Community Hospital in 2014, site leadership were tasked with developing an innovative care model with the aim of improved patient safety and quality of care delivered, incorporating a nurse practitioner (NP) model. There are NPs in three areas at Strathcona Community Hospital. NPs work directly in the ED, assessing and treating patients autonomously and with emergency physician collaboration. They also complete diagnostic and microbiology reviews and perform triage liaison nurse practitioner duties. There is also an NP led Emergency Department Transition Clinic for urgent or emergent follow up patients from the ED. Lastly, the NP-led Intravenous Therapy Clinic was developed to see patients previously attended through the ED for IV antibiotic and other IV non-antibiotic treatments, while supporting increased community access to IV treatments. Evaluation of the three areas was completed using qualitative and quantitative methods over the period of 2015–2018. Statistical analysis was completed by
the Alberta Health Services workforce team. Outcomes included reduced patient return visits, decreased wait times and patients leaving without treatment, and high patient satisfaction. Other results included improved staff satisfaction, facilitation of continuity of care and avoiding unnecessary ED visits.
Keywords: NP, nurse practitioner, quality improvement, operations