Roles and Responsibilities in Leadership and Management
Grand Canyon University:
Purpose and Background
This proposal is requesting the consideration of bringing a designated triage nurse onto the ED team. Current scenarios have recently surfaced with a few critical patients that were not triaged appropriately or treated quick enough. Both patients were at risk for declining rapidly in the waiting room and left unrecognized. A designated triage nurse would have prevented this from occurring by improving the speed of care and stabilization. Currently the ED nursing staff caring for patients are expected to “meet and greet” patients as they come in the lobby and make a quick assessment while providing rapid care in the next room for patients. Trying to watch out for patients entering the lobby, while providing care in the next room is challenging and risky. If the ED nurse does not come out and assess quickly enough, or accurately enough the patient may be at risk for demise. Additionally, there is currently no “priority list” in how the patients are brought back. When the rooms are full, and a critical patient comes in, quick action and recognition of the situation needs to be done. Without a triage nurse there is more delay in assessing, communicating with the physician, and providing immediate care for those in critical physical condition.
By definition; a triage nurse is a trained professional who is required to prioritize patient care and provide a safe environment for those who enter the ED hospital doors. Certain qualifications are deemed necessary such as length of experience, communication skills, critical thinking, accurate decision making and educational programs like PALS, ALS, ENPC, and TNCC (“Role Descriptions of Triage Nurse in Emergency Department: A Delphi Study,” n.d.). With the increased population base and growing needs for healthcare nationwide, the emergency room is often an overcrowded and chaotic place. Most emergency rooms have limited resources with one or two physicians to 60 patients (, n.d.). Providing excellent care and attention to existing patients can be consuming and challenging depending on the acuity and physical condition of the patient. Trying to break away and leave the room for triaging is not the most effective use of time or expertise. Current ED nursing staff are often busy and overwhelmed already. Its not fair to the new patients who walk in and need assessment, or the patients in the back-ED rooms. A designated triage nurse could solve this problem.
The target population effected by the proposal are anyone who comes into the emergency room for treatment. Men and women of all age categories and ethnicities, and with all levels of physical ailments. Those most effected are the patients with serious medical emergencies, who if not assessed accurately and promptly may be compromised.
Benefits of the Project
The benefit of having a designated triage nurse are better patient outcomes and shorter wait times. Currently there is a ratio of three patients to one nurse, with the ED nurse taking the role of triage when patients enter the admitting bay. The benefits of hiring a designated triage nurse would be that the ED nurses could take another patient and focus entirely on those rather than having the additional responsibility of triaging people. Benefits claimed by designating an assigned triage nurse in the Emergency Room are better patient outcomes, through skilled clinical assessment, and reaching those in greatest need as a priority (“Nurse triage in theory and in practice,” n.d.).
Cost and Budget Justification
By hiring a designated “Triage “nurse, the other ED nursing staff could take an additional patient. The patient to nurse ratio would still meet the standard of four to one and more exclusive focus could be given to patient care in the ED, expediting the flow and increasing patient outcomes. By acquiring an additional experienced nurse who is designated for “Triage”, would mean they take the responsibility for assessments, questions at entry and prioritization, leaving the ED nurses with more time to take an additional patient. The patient flow would increase, and more patients could be seen. This would increase efficiency and revenue which would cover the cost of the additional employee. Other advantages to having a designated “Nurse Triage” in place are defining the actual need of care, which can lower claims and wasted costs for simple or non-necessary visits to the ED. According to research, patients that are not triaged accurately run the risk of long wait times in the waiting room, without being reassessed or monitored. Often, they walk out without being cared for. (“Evidence-Based Practice: Decreasing ED Walkouts with Waiting Room Rounding – CEP America,” n.d.). Leaving without care shows:
(“Evidence-Based Practice: Decreasing ED Walkouts With Waiting Room Rounding – CEP America,” n.d.)
- Decreased safety of the patient.
- Decreased patient satisfaction.
- Lost revenue for the hospital.
- Increased liability for the hospital.
The proposal will be evaluated based on several things including patient feedback and satisfaction, length of stay in the ED, and increased revenue. Data will be collected from the follow up surveys following patient care, showing success outcomes, average length of time spent in the ED, and overall increased ED revenue. The data collected will encourage or negate the proposed concept of hiring a designated triage nurse. Confidence in this proposal will likely prove the need for accepting and approving funds for this proposal.
The ED is a busy place which carries an enormous responsibility. The community and local population base depend on the resources within the environment of the ED in which they may obtain emergent assessment and stabilization, as well as medical care. People with medical needs rely on healthcare professionals to make responsible choices for them in their time of need. This is a serious undertaking and should be valued. An experienced and designated triage nurse can expedite those needs creating better patient outcomes and overall success rates for the hospital.
Retrieved from http://www.nursetheory.com/triage-nurse/
Evidence-Based Practice: Decreasing ED Walkouts With Waiting Room Rounding – CEP America. (n.d.). Retrieved from http://www.cepamerica.com/news-resources/perspectives-on-the-acute-care-continuum/2015-december/evidence-based-practice
Nurse triage in theory and in practice. (n.d.). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1285993/
Nurse Triage Programs Can Help with Workers? Compensation Cost Containment. (2015, February 17). Retrieved from https://www.owendunn.com/enterprise-risk-management-blog/nurse-triage-programs-can-help-with-workers-compensation-cost-containment/
The Role Descriptions of Triage Nurse in Emergency Department: A Delphi Study. (2016, June 13). Retrieved from https://www.hindawi.com/journals/scientifica/2016/5269815/
What is a Triage Nurse? (n.d.). Retrieved from https://www.bestmasterofscienceinnursing.com/faq/what-is-a-triage-nurse/