DNP Prospectus Corrections

Staff Education to reduce overcrowding in the Emergency Department (ED)
Name: Joslynn James
Institutional Affiliation: Walden University
Staff Education to reduce overcrowding in the Emergency Department (ED)
All employees want to feel valued and supported in their field, which is the same for the nurses. Additional education and training are essential to help nurses grow in their obligations within the institutions that, in the end, realize job satisfaction and enhance the commitment to the job they do. Moreover, education and training to the nursing staff are important to improve their knowledge and skills to facilitate efficient care delivery. With the increasing technology and the outbreak of the different disease conditions, the staff nurses must be continually updated through training programs to improve their knowledge and skills of the nurses to help them tackle the different conditions within the healthcare environment. For instance, the coronavirus pandemic that has currently hit the world has posed a serious challenge to the medical providers across the globe. Even though series of researches have been done to realize the effective vaccine for the virus, there have been series of education on the nurses to help contain the virus from spreading and claiming more lives, a great example of the reason the nursing staff should consistently get an education on the medical provision.
Worst still, overcrowding at the emergency department (ED) is a serious concern for the nursing staff and has significantly compromise how they deliver medical services. The current coronavirus pandemic has even placed the lives of the individuals in the ED at risk since one of the primary precautions is to maintain the social distance that can be difficult to achieve when there is overcrowding. Also, the long wait hours at the ED has resulted in high mortalities due to negligence, and the staff nurses not having the needed knowledge to handle the large numbers in the ED. The impact is enhanced pressure on the staff nurses to get the needed training to ensure that such mortalities and risks that the other individuals get exposed to due to contact and the long wait hours are reduced. It is, therefore, mandatory that the nursing staff get equipped with the needed knowledge to help ease patient flow in the ED to help save lives and deliver quality care services. Also, continuous education will help the providers to get equipped with the needed skills and the knowledge that will help them confront the arising issues in the medical field.
Problem Statement
Over their careers, the nurses always attempt to provide excellent care and make a meaningful difference in others’ lives. Yet, the same nurses have also been faced with challenges where they face high mortalities, especially in the ED due to failure to attend to the patients in the critical conditions in time, some leaving the ED without being seen after long wait hours while some parents leave with their kids upon discharge without receiving any significant counselling due to lack of time. All these problems arise from poor patient flow in the ED and failure to establish the needed educational programs for the that the nursing staff should be put to address the issues (Herron, 2017). Some nursing staff areis young individuals who have recently graduated and have not been in the field for a long time to apply the needed strategies to ease the patient flow. Also, most medical facilities have not implemented the right programs to help the young staff on what needs to be done to help with the flow in the ED. At the same time, some of the organizations have also attempted to use programs that have entirely failed in the end.
The enhancement of patient flow is a worthwhile pursuit for staff nurses. However, the pursuit may seem completely unachievable, with limited financial resources and leadership opportunities. There is a need to establish nursing educational programs that will help in the establishment of strategies to help improve the flow in the ED. The nursing staff has significant roles to play in ensuring that the overcrowding and the wait time in the ED are minimized to help reduce the dangers such as high mortalities that are associated with the poor flow (Johnson & Winkelman, 2011). Moreover, the strategies establish within the medical centers should reflect what the nurses have learned in practice. The educational programs should have a primary focus on the changes that will enhance efficiency and the optimization of the resources. Also, the nursing staff should be made ready to be able to handle the rising cases of pandemics in the world. While coming up with the educational programs, the safety of the nurses should also be a primary focus.
In the past, numerous methods have been used by staff nurses to help ease patient flow. One of the primary strategies that have been in use in the ED is to reduce bed holds. The staff nurses are always encouraged to keep a bed or two at all times for emergencies, a concept called “bed holding.” Even though this practice has been practical in numerous instances, it also comes with certain challenges. It can result in more patients leaving the ED without getting attended to, or seen or cause long delays in care, which enhances poor patient flow.
Furthermore, even the placement of the patients in the ED beds by the staff nurses can result in longer wait hours and additional time in the waiting rooms over the day. For the ED staff nurses, the limitation of the amount of time the ED beds are held and enhancing the general flow of the patients in the department can be ensured by making certain integral changes that may include filling the beds despite the wait times of the physicians (Chan, & Stackhouse, 2014). Even though the method implies that the patients may not be seen right away, they would be accessible to the physicians right away once they are ready. The placement also ensures that the staff can monitor the patients and offer time to prepare for the assessments.
The second practice that has been put in place to ensure the staff nurses ease the patient flow in the ED is to provide educational materials with efficient and timely discharge teaching. The poor communication in signaling the end of the visit and answering the questions has been one of the primary drawbacks to the staff nurses ensuring a good flow of patients in the ED. Poor communication has created a dilemma where the patients in the ED do not know when to leave. However, with the educational guide, the staff nurse can effectively access information that will help ensure that they learn about the patients who need assistance with the dressing, mobility aide, or those who require phones before they get discharged. Having the staff nurse in place to aid in completing such tasks can help enhance the flow. However, this can only help with sufficient information and guidance to help the staff nurses step up to complete these tasks to enhance patient flow in the ED.
Purpose Statement
This proposal aims to establish the most effective educational program for staff nurses to improve patient flow in the emergency department. The issue of the poor flow in the emergency departments has been associated with the lack of education for the staff nurses. The fact that different hospitals have different operational cultures should mean that the staff nurses coming in should be put into programs that will acquaint them with the processes and practices at their new workplaces. The research will aim to establish which measures and a staff teaching program s that the nurses should be able to applyput to ensure that they familiarize themselves with the existing culture. Also, the familiarization can get enhanced through their interaction with their co-workers. However, this is not enough as the co-workers should also get updated due to the rising pandemics in the world full of uncertainties and requiring new strategies to help combat them from spreading and affecting new numerous individuals.
This research proposes the use ( I am unclear. Is this your proposal within the newly developed staff education program? Are there any references that could be added to support the idea?) of steering committees who are charged with facilitating the ED change and recommends the inclusion of the nursing staff. The nurses should jump at the chance to sit with the committees so that they are educated on the identification of the changes that may occur in the ED. The nurses within the committees will also learn how any change will impact the nurses, enabling them to advocate for enhancements in patients flow from the perspective of the nurses. Ideally, upon the conceptualization of the changes and obtaining the staff teaching from the committees, the staff nurses should get educated based on the streaming process. The process will involve grouping or teaming up the nurses based on a given discipline or disease suffered by a particular group of people. Every group will be assigned an educator that helps update them on the various changes in disease conditions and the measures they need to have in place to handle the conditions within the shortest time possible. The approach will further have facilitated by the pivot nurses at the ED who asks about the patient’s condition and give appropriate directions to different groups of staff nurses based on the condition of the patient.
Research Objectives
To establish the most effective educational program that will help the staff nurses ease patient flow at the ED.
To establish the effectiveness of the streaming process in reducing overcrowding under the help of pivot nurses. (Do you plan on implementing your teaching strategy and measure actual outcomes of crowding? )
Practice Focused Question (s)
Does stay in the loop on ED changes by the staff nurses improve flow in the ED? How effective is the inclusion of the staff nurses in the steering committees charged with the ED change-facilitation to help reduce overcrowding in ED?
Does the allocation of similar patients to given work stream help improve flow in the ED? (Are you measuring this for this study?)
Social Change
The effective application of the educational practice to the staff nurses has a significant implication on social change. The focus of the two research questions is to bring the staff nurses together and work as a unit. Even though the streaming process involves the allocation of patients with different disease conditions to a particular group of the nurses or physicians, the various units are linked to particular pivot nurses at the ED who communicate on the various conditions and get directions to the right group of staff nurses. The approach fosters collaboration and teamwork, which is an integral social change. Also, with the facilitation for the fast medical delivery to the patients, the staff nurses aim to reduce the wait time in the ED that will, in turn, minimize the anxieties amongst the affected people and, worries and for the betterment of the medical conditions. The approach aims to will result in the reduction of the number of deaths that are a social problem. The new protocols imply that the nurses will be in a pole position to offer faster medical care to improve the ED’s health conditions. The approach will boost the confidence of the people within the communities on their health facilities and believe in the care provided within the hospital. Effective provision of care in a timely and with great quality is a significant social change.
Moreover, this project supports the mission of Walden’s University in its bid in the promotion of social change. The project aims to improve the skills and the knowledge of the staff nurses to offer diverse, timely, and quality care to promote a positive change in the health care system. Also, the project improves the belief of the community members in their healthcare system with the improvement of the quality care provided to the patients. The implication of the streaming system and nursing staff education is bringing hope to the ED. This will make the members of the community have faith and belief in the emergency department and seek to get the health services with no fear of long wait times or enhanced mortalities. Thus, the project is crucial for timely and quality care, which is the primary goal of Walden’s University.
Literature Review
Poor patient flow at the emergency department has been an issue over a long period in most health provision facilities and has resulted in massive mortalities over time. Numerous providers have made efforts, all focused on the reduction in the wait times and overcrowding, while having their focus on the patients (Herron, 2017). The patients’ focus has resulted in massive failure in most hospital facilities because there are no adequate strategies placed on the nursing staff. The nursing staffs are essential resources when it comes to easing the patent flow in the ED. Numerous research has been done on how the patient flow can be enhanced in the ED through the education of the nursing staff and pivot nurse.
According to Jarvis (2016), one of the surest ways to ensure that the nursing staff improves the patient flow at the ED is through the streaming process. Streaming refers to the allocation of patients with similar conditions (concerning the nature or severity of the disease) to a given workstream (Jarvis, 2016). The process involves evaluating the patients by the nursing staff in a given geographical area with the emergency department. A good example is “see and treat,” an example of a streaming process where the patients with less severe disease conditions are allocated to a dedicated clinical area and then get an assessment and treatment from a clinical team from the only “see and treat” patients. The aspect implies that an organization must establish a system where the medical providers are grouped based on their knowledge and skills or the area in the medical field where they are more interested. The firm then sets a training program that is geared towards their areas of specialization (Johnson, & Winkelman, 2011). However, the organization must ensure that the different teams get staffed by nurse practitioners, physician assistants, senior doctors, or even a combination of all to ensure that the nurse staff has the right education regarding their areas of specialization.
The nursing staff’s division to different groups is associated with a significant reduction in the waiting times and realizes shorter journey times when compared to the non-streamed systems. This method’s efficiency is ensured on how the patients get signposted in the different streams by the pivot nurses within the ED. The pivot nurses should be trained to ensure that they can immediately communicate with the patients when they get into the ED and learn about their conditions. They will then immediately direct to the various streams where the nursing staff with the needed knowledge to handle their conditions are placed. This will ensure that the flow is improved as the attendance will be directed by the nurses with the needed knowledge about the disease conditions. Also, with the experiences in dealing with the areas of specialization, the treatment plans will be enhanced, and this will mean that the patients spent the limited time possible as they get assessed. If the case is critical, they then get transferred to the appropriate health facilities or areas, and this will ease the flow that has been a problem over time. This method’s efficiency is further enhanced by adequate staffing and the physical space available in the health care centers to help meet the demand of the increasing and different cases in every individual work stream. However, with the right education and direction, this method will effectively help improve the flow. The organizations must ensure that they get the senior doctors with the right knowledge to impart to the nurse staff and the pivot nurses.
Moreover, the nurse staff must be included in the committees that decide on the training processes. The practice involves staying in the loop on the ED changes. It is important to realize that changes occur every time in the emergency department, which often affects the nurses’ work and has a significant influence on the patient flow. Before, the nurse managers and the physicians did not significantly predict how the changes will influence nursing, or did they know how to advocate for the enhancements in the patient flow from the perspective of staff nurses. Thus, the research recommends the establishment of steering committees charged with the facilitation of any changes in the ED to include the nursing staff who should take any chance to sit on the committees to ensure that they get updated on how to handle different cases with the changes in the ED and to help tackle the emergencies in the form of the pandemic.
The advantage of joining these committees is that the nurses joining these communities will have a chance to share their concerns and educate other colleagues on how nursing roles affect the flow of the patients in the ED. For instance, if a nurse in the steering committee foresees a change being unpopular among the ED nurses, then the nurse should be in a position to forward the ideas that should be implemented to enhance the implementation success or the areas that the educational practices should focus on to realize success and improve the flow (Derlet, Richards, & Kravitz, 2001). The ideas involved may incorporate seeking assistance from the organizations that are trusted and selecting the staff nurses that are respected to help foster or pilot the change. In the committees, the nursing staff will be adequately represented in the steering communities. Since they interact with the patients, they are in better positions to determine what should be done and the needed changes that can help improve the patient flow. Also, with the application of the knowledge of the nurses or the inclusion of the nurses in this decision making, they will feel part of the process and have up to date information on the happenings, and this will be a massive benefit to the ED.
The context for the Doctoral Project and Methodology
The research will primarily employ the use of a survey as the main method of data collection. The use of a survey will be integral as a measure to the staff nurses within the emergency department, determining the areas of weakness and what needs to get improved to realize the quality and timely care to the patients. The practice makes it feasible for the project to be accomplished in the ED due to the verse information offered by the medical providers and their educators. The research will strive to involve every individual with no bias in the collection of data, and this will ensure that the information provided is just.
Apart from the surveys, the literature review will also be complemented through the use of different search engines on the internet and also the library database. In the process, the researcher will use various keywords such as nursing staff, improving flow, decreased provider timeframe, streaming in ED, and other relevant terminologies that will help support the research findings. However, the search for this information must be directed towards using reliable sources such as PubMed, EBSCOhost, CINAHL, and the Journal of Emergency Nursing. Most importantly, the research on the secondary sources of data will be done using the Walden University Library. The secondary information will be important because they help the researchers establish the concepts and the theories that have been used to describe the concept of strategies that can be used by the nursing staff to enhance patient flow in the ED. Moreover, the information will include the various methodologies that have been used in the past to strive and address the issue, including those that have been feasible and those that have failed and the reason some have not worked.
The intended setting for the doctoral project is in Regional One Hospital (Regional One Hospital, 2016). I think it is feasible to accomplish this project by performing a survey study in the hospital among the health workers (nursing staff) through the recommendations on the teaching practices that can be applied to enhance the patient flow in the emergency department. Also, since the project setting involves a Regional One hospital, I believe the validity and the reliability of the information will be assured. The involvement of the hospital stakeholders at this point will enable understanding the patient care processes at the facility and help determine the shortcomings and the possible causes (Regional One Hospital, 2016). It will help in the explanation of the reasons for the provision of low-quality care and the poor patient flow in the emergency department (Chan & Stackhouse, 2014). Such information will be integral in implementing the process to implement the nursing staff’s educational practices. Also, it will be essential to use the information in the application of possible solutions.
Will this project protect human subjects? Yes, this project will protect the human subjects as this is a survey to observe for improvement in flow and care. The project’s primary goal is to ensure that the subjects are satisfied with the services they get from the medical providers and that the information they give the nurses remains confidential. Also, the process is aimed to enhance the low self-esteem that most patients have suffered from and thus perfect for the protection of the human subjects. Besides, the enhancement of the number of nurses through pivot nurse will ensure that the number of practitioners attending to the patients is improved (Burt & McCaig, 2006). This will ensure that every patient is satisfied with the services offered to them with equal service delivery without leaving them stranded in the waiting rooms. At the same time, they are hurt without the nurses giving them the needed care. The confidentiality that the individuals can get from the nurses can help establish the trust that is significant in giving information about the condition of the patient.
Are there potential ethical issues that may present problems for the completion of this project?
This project has no perceived negative impact on the ED nurse staff, patients, or others associated with the ED. The project is primarily a quality improvement practice that did not involve any nurse staff markers or identifiers. The only data that will be extracted in the process is the ED metrics. Moreover, the data that will be extracted for use in this project is public knowledge available in the public domain. Also, the individuals will be set to give an honest opinion based on the survey questions used and provide the primary issues that limit the efficiency of the nurse staff in the ED, compromising the patient flow. Thus, the project will not have any negative consequences on the staff working at the emergency department, and the other individuals associated with the emergency department. Also, the process will not involve any bias on the people getting surveyed. The survey questions will be given randomly to the individuals to ensure there are no discriminative practices or bias in choosing the respondents. The practice will ensure that the respondents’ answers are accurate and will be a significant directive to realizing the project’s goal of the project.
Moreover, no individual will get surveyed without their consent. The survey questions will not require the staff nurses to provide their personal or private information, but it will be exclusively professional and focus on the main pointers that can be used to eliminate the staff nurses to help with the improvement of the patient flow in the ED. Also, they will not be asked to share their patient data but will give a general overview of the primary factors that influence the provision of timely and quality care and how the use of the streaming process will enhance the enhancement of the patients in the ED.
Do the various aspects of the prospectus align overall?
This project aims to establish an educational program and a strategy that will ensure that the nurse staff gets the needed knowledge and implementation of the required strategy to improve patient flow in the ED. The improvement of the patient flow through streaming process and inclusion of the nursing staff in the steering committees involved in the implementation of changes will help with the improvement in the patient flow that will result in the enhancement of the health outcomes, and this aligns the various aspects of the prospectus to the research study (Herron, 2017). The prospectus attempt to illustrate the various issues that have influenced the crowding and long waiting hours in the emergency department and strive to establish the various measures that can be used to address the problems. Most of the prospectus’ recommendations directly influence the issues raised and aim to give real and long-lasting solutions to the various processes and thus are relevant.
Moreover, the ED metric timeframes will be analyzed and evaluated before the implementation. The prospectus also suggests that after the implementation, the lead project management and the stakeholder will re-evaluate the process and establish the changes that have been made and their effectiveness (Burt & McCaig, 2006). The practice will ensure that the practice is relevant to the various concerns. The stakeholders will also be tasked with placing the pivot nurse in the waiting room to improve patient flow. Since this project involves both the pre and post evaluation, the aspects discussed will be ensured to align with the primary objective. The pivot nurse’s (is this role part of the streaming process?) utilization in reducing the timeframes will help the staff visualize the quality improvement plan’s reality.
Nurse Staff education is an integral component of ensuring quality and timely care in every hospital facility. Most hospitals have faced problems of poor patient flow in the ED, and this has resulted in high mortalities. Most of the strategies that have been put in place have failed since most of the staff nurses do not have enough information on the strategies and thus failing to implement them in the organizations to ease the flow in the ED. However, in this research, we have recommended using the streaming process where the staff nurses are grouped and equipped on specific knowledge and skills on the provision of care. The patients with particular disease conditions are directed to particular groups with the needed knowledge for their condition. Also, there will be the use of the pivot nurses at the ED to help direct the patients upon consultation to the right treatment area, and this will facilitate the faster provision of medical services. Also, the research the recommends the establishment of steering committees charged with the facilitation of any changes in the ED to include the nursing staff who should take chances to be part of the community to ensure that they get updated on how to handle different cases with the changes in the ED and to help tackle the emergencies in the form of the pandemic such as the Coronavirus that has claimed numerous lives all over the world.
Burt, C. W., & McCaig, L. F. (2006). Staffing, capacity, and ambulance diversion in emergency departments, United States, 2003-04.
Chan, P., & Stackhouse, S. (2014). Improving Patient Safety and Quality of Care in a
Community Department by Incorporating Evidence into Practice: Using a Pivot Nurse to
Improve Access to the Appropriate Level of Care. Vancouver Coastal Health.
Derlet, R. W., Richards, J. R., & Kravitz, R. L. (2001). Frequent overcrowding in US emergency departments. Academic Emergency Medicine8(2), 151-155.
Herron, K. (2017). Improve Emergency Department Efficiency | Webinars | Intelligent Insights. Retrieved from: › Events & Webinar
Jarvis, P. R. E. (2016). Improving emergency department patient flow. Clinical and experimental emergency medicine3(2), 63.
Johnson, K. D., & Winkelman, C. (2011). The effect of emergency department crowding on patient outcomes: a literature review. Advanced Emergency Nursing Journal33(1), 39-54.
Regional One Hospital. (2016). Mission Statements. Retrieved from:



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