Introduction
Emergency nursing involves the treatment of patients in emergency situations. Such patients could be experiencing trauma or injury. The emergency departments where these services take place are usually at the front doors of hospitals. Over the years patients have come to develop their perception of the overall healthcare experience during emergency situations. With the rapidly changing healthcare system and the high demand placed on hospitals to produce quality results, strong nursing leadership is vital. Nursing Leadership in the Emergency Department must exhibit 5 important components; Effective communication, efficient operation, constant collaboration, active participation, and persistent dedication. The maintenance of a happy and motivated workforce at the emergency department is also important in the achievement of exemplary results.
Leadership and managerial processes, skills, and attributes for emergency responses
Effective leadership in nursing places emphasis and value on the most important assets to any healthcare institution - nurses. Nursing leaders practice rounding – or the proactive leadership practice where leaders spend about 10 minutes on a one-on-one with each of the employees that reports to them on a daily basis. The Studer Group (2010) identified this as a vital and transformative leadership style. Nursing leaders who practice such styles are able to access and respond to the concerns of their nursing teams thereby maintaining a productive and motivated workforce.
The development of effective communication at healthcare facilities is the first leadership and managerial process that needs to be undertaken in order to have an effective nursing leadership. Ineffective communication systems, procedures and information gaps are a leading cause of medical malpractices (Baker, 2009; Jost et al, 2009). The ripple effect of such malpractices and errors usually causes exacerbation of simple medical conditions and at times even death. Grimm (2008) urges nurse leaders to prioritize making physician-nurse communication effective in order to minimize diagnosis-related errors.
Nursing Leaders should provide essential information to fellow nurses, other medical professionals, patients, relatives and any other stakeholders. This is based on the Studer Group Model (2010) which advocates for patient/family rounding, patient rounding and staff rounding. Effective nursing leadership especially in emergency nursing requires the regular rounding in order to increase satisfaction levels in all the parties affected or responding to an emergency. This is especially crucial in nurse leaders entrusted with leading teams to respond to emergencies. Effective nursing leadership entails ensuring that all nurses are adept in staff rounding to ensure that changes are implemented and also to remove any barriers to implantation of changes.
Nursing leadership should be adept in overseeing training of staff on rounding and effective communication with patient, the people who initially reacted to a given emergency situation as well as someone who has known the patient in question for some time (Grimm, 2008). Such people should explain important issues such as some brief medial history of the patient, information on the first aid given, the cause of the injuries sustained or cause of trauma among other information (Gullatte, 2005). In this regard, the nursing leadership at each hospital operating an ED should develop a set of questions to be directed to the patient (if in a position to talk), others to the people who bring the patient to the ED and others to immediate family members.
Baker (2009) recommends the following three strategies as the most effective ways to improve communication by nursing leaders; designing of structured communication events, staff development and education and thirdly, operational and organizational change. Nurse and physician leaders should develop a structured communication strategy. Nurses and physicians should have their designated roles well communicated. Each set of professionals should also share critical information such as patient medical history, development of abnormal vital signs, intended responses or therapy, changes in bed capacity, capacity and patient flow, number of cases to be attended to among other aspects crucial in responding to an emergency effectively (Studer Group, 2010). Staff at the ED should be trained to hone their verbal and non-verbal communication skills while organizational changes should see the communication protocols enhanced to enhance service delivery.
Efficient operation is the second pillar of an effective nursing leadership. According to the Controlled Risk Insurance Companies (CRICO) and the Risk Management Foundation (RMF), missed or delayed diagnoses in the emergency situation are the leading cause of malpractice liabilities in Emergency Medicine (Sullivan, 2012). The minimization of wastage of unnecessary delays and work at the ED is critical to making EDs more efficient. Nursing leaders can borrow from the five LEAN manufacturing principles organized as; identification of value, mapping of the value system, creation of flow, establishing a pull and seeking perfection (Smith, 2011). In this regard, processes in emergency nursing should be standardized as much as possible in order to save lives and eliminate errors. Staff at the ED should be guided, taught and skilled in eschewing from any work, procedure or process deemed unnecessary and that does not add value to the patient care (Smith, 2011).
The third aspect critical to nursing leadership is enhancing collaboration between nurses, physicians and any other medical professional or supporting staff. While communication is central to enhancing collaboration, nursing leadership should develop long-term collaboration measures for all stakeholders. Collaboration should involve clear division of labor and evaluating the personalities of physicians and nurses for compatibility prior to placing them as a team in charge of emergencies (Borkowski, 2009). Nursing leaders should select a team that reflects diversity in age, gender, experience and where possible ethnic and cultural diversity. According to Borkowski (2009) nursing teams that bear diversity in the above aspects are able to respond to emergencies that have stumbling barriers such as language, age, gender, cultural practices among others. For instance, an emergency team in which there is a nurse or doctor who is multilingual would be more suited to respond to an emergency than one without such a nurse. Nurses and physician leaders should collaborate and bring together professionals from diverse backgrounds in order to enhance their capacity to handle diverse emergencies and also non-emergency situations. Smith (2011) warns nursing leaders to be careful in the composition of any nursing team in order to avoid having a team so diversified that it becomes counterproductive.
Nurses should inspire and motivate their teams. Though the Hippocratic Oath unconditionally urges all medical professionals to act in the best interest of the patients, hospital managements and nurse leaders have huge effects on the dedication levels of their staff members. Jean Watson’s theory of nursing or human caring (1985) stresses that nurses serve as mediators for illness experiences in interactions with patients. According to Watson, nurses serving in whichever department should help patients increase harmony of the mind-body and souls thereby increasing a patient’s self-knowledge, self-healing, self-reverence and self-care. This nursing theory also asserts that nurses should love and care for themselves as a requisite to caring for others. Nursing leaders should develop systems to increase the dedication of nurses to their work through proper managerial and supervisory systems. Nursing leaders and other management staff should refrain from demeaning or harassing nurses as this has a direct negative impact on their level dedication to their work (Borkowski, 2009). Instead, nurses should be adequately remunerated, treated with dignity and promoted as ways to enhance their levels of dedication and responsibility in key healthcare provision areas such as the Emergency Department.
In order for nursing leaders to guide their team to effective emergency responses they should apply the findings of some researchers. Figley (1999) explained how the empathy and emotional energy are the leading forces that enable a nurse to deliver effective responses in stressing and traumatic emergency situations. Figley (1999) asserts that nurses should be offered avenues to release stresses and shocks from handling horrific emergency injuries and traumatizing conditions. Hans Selye’s theory (1956) on the stress among nurses responding to traumatizing emergencies states that compassion fatigue among such nurses can lead them to disregard medical ethics resulting in decreased benevolence and concern for the patient. Some of the things that nursing leaders can do to prevent compassion fatigue include favorable shift changes, regular leaves, counseling services, fun and games activities among other means of disengagement all targeted at minimizing compassion stress among nurses.
Elements of effective communication for nursing leaders
Communication has emerged as a central pillar to increasing efficiency in healthcare institutions and especially in emergency nursing. Some of the elements to effective communication include improving verbal communication skills, employing active listening skills, voice management, developing non-verbal communication skills, cultural awareness and clarity in written communication (Jost et al, 2006).
In regard to improving verbal communication skills, nurses and other medical staff should collectively be aware of language (colloquialisms and euphemisms) commonly used by patients. The care givers should be in a position to interpret and understand patients and each other’s verbal expressions to increase the levels of comfort especially when applying medical terminologies. Nursing leaders should guide nurses in understanding non-verbal communications (such as expressions of anger, sadness, pain etc) that they are bound to use in with other medical professionals. Nurses should also uphold active listening as a cardinal element of effective communication. They need to pay attention when obtaining instructions from physicians, patients, the management as well as nursing leaders. In addition, nurses should practice voice management as an element of effective communication. According to Baker (2009) nurses should ensure accurate pronunciation as well as appropriate pitch and intonation. Nursing leaders should identify nurses with difficulties in voice management and train them on the same. This is essential especially in hospitals operating in complex multicultural societies (Gullatte, 2005). Proper voice management ensures that messages are relayed and obtained as intended with minimal misinterpretations. It is also important to train nurses on cultural sensitivity to enhance their communication skills. Training nurses on about other cultures helps them overcome cultural stereotyping about language and communication thereby “breaking the ice” for nurses in multicultural settings to communicate effectively (Smith, 2011). This is crucial to new nurses especially when they face complex emergency situations such as accident victims resulting from massive natural calamities like hurricanes or floods.
Current and future trends in healthcare impact on nursing leadership
Transformational leaders are inspirational leaders who are able to use tools and skills to manage teams and respond to challenges in timely and satisfactory manners. Transformational leadership in emergency nursing entails rounding as stated by the Studer Group. In this regard, nurse leaders talk to their staff, the patient and the patient’s family members to increase their satisfaction levels, and gather more information crucial in the provision of care. This is especially important in emergency nursing. Current and future trends in healthcare impact the roles of nursing leaders. Currently many healthcare centers have limited numbers of staff, bed capacity and medical supplies. Effective nurse leaders manage available resources in order to save on cost and yet provide quality healthcare even in emergency situations. Whenever massive catastrophes occur, many hospitals get overcrowded and emergency responses are stretched leading to the possibility of compromised healthcare. Effective nurse leaders crate highly effective teams by training their staff on how to respond to emergency as well as non-emergency situations. It would also be advisable to retrain old nurses on the same in order to keep all nurses abreast with emerging technologies and methods in nursing. Nursing leaders should press for the recruitment of more nurses as well as adoption of modern technology and methods in their facilities in order to respond to increased demand for quality medical services. Going into the future, the demand for quality healthcare is bound to be overwhelming and excellence might be hard to achieve. However, in the words of Baker (2009), “where there is a will and a team of passionate and caring staff members; there is definitely a way.” Establishment of dedicated teams of nurses should be the hallmark of modern nursing leadership.
References
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Borkowski, N. (2009). Organizational behavior, theory, and design in health care. Sudbury, Mass.: Jones and Bartlett Publishers.
Figley, C. (1999). Compassion fatigue: Toward a new understanding of the costs of caring. In B.H. Stamm (Ed.) Secondary traumatic stress: Self-care issues forclinicians, researchers, and educators (2nd ed.), Lutherville, MD: Sidran Press.
Grimm, J. (2008). Effective Leadership: Making The Difference. Journal of Emergency Nursing, 27, 23-28.
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Jost, K., Celia, C. A., Vose, C., Natale, G., & Micucci, K. D. (2006). Leadership Development For The Front Line. Journal of Emergency Nursing, 32(1), 10-11.
Smith M. A., (2011) Are you a transformational leader? Starkville Orthopedic Clinic, Starkville, MI, USA. Nursing management 09/2011; 42(9):44-50
Studer Group (Firm). (2010). The nurse leader handbook: The art and science of nurse leadership. Gulf Breeze, FL: Fire Starter Pub.
Sullivan, E. J. (2012). Effective leadership and management in nursing (8th ed.). Boston: Pearson.
Watson, J. (1985). Nursing: The philosophy and science of caring. Colorado: University Press of Colorado.
