Abstract
The research shows that Emergency Departments (EDs) in many regions of the country are short-staffed, and this fact influences the patient experiences significantly. The shortages in the nurse staff affect the waiting time for patients, and as a result, the level of patient satisfaction. In 2006, the average waiting time associated with the number of available staff in the ED was about 37 minutes when the standard time was no more than 15 minutes, and these numbers tend to increase because of inadequate staffing in most EDs of the country (Aiken, Cimiotti, & Sloane, 2011; Horwitz, 2010). Researches indicate that nurse staff shortages in the EDs are associated with the low-standard care caused by the extended waiting time and disproportionally high numbers of patients in the EDs (Aiken & Sermeus, 2012). The evidence-based solution to the problem of short staffing in the ED and decreased levels of patient satisfaction is self-scheduling which is an alternative to traditional methods of signing up for nursing shifts (Dent, 2015; Oredsson, Jonsson, Rognes, & Lind, 2011). While implementing the electronic tool for self-scheduling in the ED, it is possible to expect full staffing for all shifts and, as a consequence, positive changes in the patient experiences. In this context, the implementation of the self-scheduling system in the EDs can be discussed as an effective solution to the problem of short staffing associated with nursing staff shortages. The proposed intervention is also efficient to change the patients’ experiences while influencing the level of their satisfaction.
Introduction
Short staffing in EDs in comparison with full staffing can be discussed as a problem that affects the levels of patient satisfaction. The implementation of the self-scheduling system in the EDs as the solution to the problem of short staffing oriented to changing the patient experiences and attitudes can be discussed as an effective strategy, and the proposal aims to present the problem statement, to describe the solution, to analyze the aspects of the implementation plan, and to propose the guidelines for the project evaluation and dissemination of results.
Problem Description
The main difference between the short-staffed and fully-staffed EDs is the waiting time for patients and the quality of the provided care. The long waiting time is associated with the fact that one nurse needs to examine more patients because of the staff shortages, and long waiting times often result in patients’ complaints (Karaca, Erbil, & Özmen, 2011, p. 1). The quality of the care is also affected because the staff density and optimization lead to increased levels of stress and higher rates of medical errors. Emergency Departments (EDs) in hospitals are often overcrowded, and it can lead to the problem of patient dissatisfaction if the department is short-staffed (Chan, Killeen, & Vilke, 2012, p. 547). According to the study conducted by Sayah and the group of researchers, in 2010, only 48% of EDs provided patients with the necessary care within 6 hours (Sayah, Rogers, Devarajan, Kingsley-Rocker, & Lobon, 2014, p. 1). This percentage demonstrates that EDs across the country are currently short-staffed, and the provided care is highly inefficient with the focus on long waiting times.
To overcome the problem, leaders in EDs need to choose an efficient solution from the limited number of strategies that can increase the workload and the overall level of the patients’ satisfaction. Still, the problem is in the fact that such solutions are usually associated with the staff optimization model, and they are rather costly. From this point, staff shortages in EDs usually cause the high levels of patients’ dissatisfaction because persons do not receive the necessary and appropriate assistance in time, and this issue should be addressed with the focus on changes in the number of nurses in the shift (Horwitz, 2010, p. 134). As a result, it is possible to assume that nurses in fully staffed EDs and facilities can provide patients with more effective care than nurses in short-staffed ED rooms, while causing different levels of satisfaction in patients (Burström, Starrin, Engström, & Thulesius, 2013).
If the ED is short-staffed, the nurse-patient ratio is not correlated with the ED requirements in order to guarantee the effective delivery of care for patients. The level of patient satisfaction in such ED can be discussed as low in comparison with the data for the periods when the ED was fully staffed (Dahlen, Westin, & Adolfsson, 2012, p. 2). Thus, it is possible to speak about the association between staff shortages and patient satisfaction in EDs (Wang, 2013, p. 3). If the scheduling used in the ED is highly regulated and rule-based, it affects the quality of decisions associated with nurses’ signing up for shifts. The change in the ED staff scheduling can address the identified problem.
Solution Description
The solution to overcome the problem of short staffing in the ED is based on changing the approach to nurse staff scheduling. Thus, it is important to change the rule-based scheduling with the self-scheduling (Dent, 2015, p. 44). The procedure will depend on using the online scheduling tool by nurses who have authorized access to the schedule planning file and can make changes in it. In order to avoid short staffing during different shifts, nurses are expected to sign up for the desired number of 12-hour shifts during the four-week period. The nurses will be able to plan their schedules independently while addressing the regulations, parameters, and rules and guaranteeing flexibility (Duclay, Hardouin, & Anthoine, 2014, p. 4). In spite of the hour limits for the shift, nurses will be able to control their time during a week and sign up for the extra shifts according to their capacity. The system will allow controlling nurse-patient ratios to avoid short staffing and long waiting times.
The focus on self-scheduling is an effective approach to overcome staff shortages in the ED. While planning their shifts individually and placing the preferable number of shifts and dates to the organization’s scheduling system, nurses have the opportunity to sign up for the open shifts while covering the number of available shifts and agree to sign up for the extra shifts. As a result, the problem of short-staffed shifts will be overcome because of the focus on more flexible and predictable schedules. In order to guarantee patient satisfaction in EDs and reductions in waiting times, the number of nurses in the EDs needs to be adequate (Oredsson, Jonsson, Rognes, & Lind, 2011, p. 44). Self-scheduling is effective to guarantee the presence of full staff in the shift, as a result, the level of absenteeism decreases along with the waiting time for patients (Dent, 2015, p. 44). In addition, self-scheduling is appropriate to prevent extended work shifts that cause fatigue in the staff. Furthermore, self-scheduling can be discussed as the least expensive strategy to guarantee the presence of the full staff in EDs in order to increase the quality of care and reduce the waiting time (McHugh, Berez, & Small, 2013, p. 1741; Stimpfel, Sloane, & Aiken, 2012). The reason is that the self-scheduling online system can be integrated into the current electronic system used by administrators to set shifts according to parameters (Wang, 2013, p. 4). The positive result of such an approach is the improved nurse staffing and appropriate ratios of patients to nurses in the ED.
Implementation Plan
The statistical theory is important to be used for providing the background for the implementation of the solution because its principles need to be used at the stages of testing and evaluation of the deployed tools for self-scheduling. The statistical theory provides the framework for the data analysis to make decisions regarding the effectiveness of the integrated solution at all stages of the implementation. The justification for selecting the theory is based on its capacity to provide the methods of statistical analysis to conclude the progress during the project implementation. While using statistical procedures, it is possible to find why certain categories of staff can react to the changes in the scheduling system more positively than others and how staffing ratios can change with references to the comparison of data for short-staffed and fully-staffed EDs (Aiken, Cimiotti, & Sloane, 2011; Aiken & Sermeus, 2012). Furthermore, referring to the statistical tools, it is also possible to understand how various staffing ratios typical for short-staffed and fully-staffed EDs can influence the level of patient satisfaction during their visits in the rooms of EDs.
Referring to the aspects of the statistical theory as the background, it is possible to identify the stages of the solution implementation plan. The first stage is the planning of the self-scheduling system integration as a pilot. The details of the integration need to be discussed with the administrators of the ED. At this one-week-long stage, the system requirements are determined in cooperation with Nurse Administrator. The third stage is Integration and Configuration of the System (Wiler, 2010). At this stage, Nurse Administrator determines the information that needs to be included in the scheduling protocol, specifies staffing and scheduling parameters on which the self-scheduling will be based, and determines regulatory parameters. IT Specialist is responsible for integrating these parameters and protocols in the Intranet system currently used in the hospital in order to provide all the nurses with equal access to the electronic scheduling tool. Training of the nurse staff on the use of a self-scheduling tool is expected to be conducted by Nurse Administrator during the third week of the project implementation when the tool is tested by IT Specialists.
The next stage is Deployment, during which nurses are planned to actively use self-scheduling to set shifts. This stage will last four weeks. Nurse Administrator and Emergency Department Manager are planned to be responsible for monitoring this stage in order to report possible weaknesses in the system. The overall implementation process will be overseen by the Emergency Department Manager who is responsible for the evaluation of the implemented solution at the final stage of the project development (Table 1).
Table 1. Timeframe for the Project Integration
Focusing on the nature of solution and on the proposed implementation plan, it is possible to determine the human and material resources required for the effective implementation of the self-scheduling tool in the ED. The staff required for the effective implementation of the online self-scheduling tool includes IT Specialists for integrating software and guaranteeing the interoperability of the systems’ components. The participation of Nurse Administrator is also an important condition to ensure that the requirements of the ED are met and all the necessary parameters are addressed. Furthermore, the Nurse Administrator is responsible for conducting training sessions for the ED nursing staff.
Educational materials for training sessions include PowerPoint presentations describing the challenges of short staffing in the ED in association with patient satisfaction and handouts providing the step-by-step instructions for using the online scheduling tool and making changes in the schedule according to the parameters and within the set timeframe. Assessment tools will include questionnaires separately developed for nurses and patients. Questionnaires for nurses will examine the situation before the intervention and then assess changes in the nurse staff’s experiences about work and life balance, flexibility, job satisfaction, productivity, burnout, and performance. Questionnaires for patients will aim to represent patients’ visions of efficiency of the nurse care in the ED before and after the intervention to compare the results for the short-staffed and fully-staffed settings.
The technology required for the solution integration is the software for online self-scheduling. The program should guarantee the authorized access for the nurse staff to the schedule and allow them to correct the schedule. The necessary hardware includes two additional tablet computers for the ED in order to allow nurses to fix changes in the schedule in cases when personal computers or laptops in the Nurse Office or at Nurse Stations are not available. The project will be funded by the hospital authorities as to the part of the management program. The overall costs will include costs of technology and costs of educating the nurse staff (Table 2). Nurse Administrators and Emergency Department managers are expected to be responsible for overseeing and evaluating the change in the ED.
Table 2. Planned Costs
The proposed solution aims to overcome the problem of short staffing in the ED in order to affect patient satisfaction levels. The implementation of the self-scheduling approach and tool will be effective to examine the relationship between the factors of short staffing and full staffing as influential for changes in the patient satisfaction. The focus on gathering the data before and after the intervention is important to guarantee the collection of the appropriate information to conclude the possible correlation. The used approach to implementing the steps of the project is supported with the principles of the statistical theory.
Evaluation Plan
The effectiveness of the project implementation and proposed solution for the concrete facility depends on the outcomes of the intervention. In this context, it is important to determine approaches that are appropriate to evaluate the project’s results. The solution to the problem of short-staffing in the Emergency Department (ED) is based on integrating the self-scheduling system for the nursing staff to guarantee the flexibility in schedules and possibilities to set full day and night shifts without being limited by the overall number of nurses working at the ED during a certain period of time. Therefore, to study the effectiveness of the self-scheduling system to overcome the problem of short staffing, it is necessary to conduct the staff survey and compare the nurse attitudes, perceptions, and experiences regarding the work and life balance, flexibility, job satisfaction, productivity, burnout, and performance before and after the intervention. It is also important to study how this intervention can influence the aspect of the patient satisfaction; to conduct the survey for patients, and to compare the results of the survey regarding the patients’ visions and perceptions of efficiency of the nurse care in the ED before and after the intervention with the focus on the aspect of satisfaction. The final step is to analyze the results for the short-staffed (before the intervention) and fully-staffed (after the intervention) ED settings based on the overall comparison of findings in their relation to patient satisfaction.
The purpose of three proposed methods for the project evaluation is to study how the intervention strategy can influence changes in such two variables as (1) the nurse staff’s attitudes, perceptions, and experiences and (2) patient satisfaction. In this context, changes in the nurse staff’s attitudes and perceptions are examined in order to conclude about the effectiveness of the solution to resolve the problem of short staffing at the ED. In its turn, the focus on studying the changes in patient satisfaction is the priority because of the necessity to examine how patients react to changes in the number of nurses available at the ED as a result of the implemented solution. Assessing the changes in patient satisfaction, it will be possible to find how short staffing and full staffing in ED can influence the patients’ perceptions.
The materials necessary to educate the nurse staff on the problem of short staffing and aspects of self-scheduling during the training sessions include the PowerPoint presentation and handouts. The slides of the PowerPoint presentation are intended to describe the specific challenges of short staffing in the ED and the impact of short-staffed settings on patient satisfaction (Appendix A). In order to educate the nursing staff on the effective use of the self-scheduling tool, it is necessary to provide the personnel with the step-by-step instructions developed for using the integrated online scheduling tool and for making changes in the proposed schedule according to the parameters indicated by Nurse Administrator and within the set timeframe (Appendix B).
The assessment tools that are necessary to evaluate the outcomes of the self-scheduling system implementation are questionnaires for nurses and patients that are provided for the participants of the project before and after the intervention. The questionnaire for nurses is developed to examine the same staff’s perceptions and experiences before and after the intervention in order to assess possible changes in the nurse staff’s experiences and visions of their work and life balance, flexibility, job satisfaction, productivity, burnout, and performance (Appendix C). The questionnaire for patients is oriented to be divided into two parts, where the first part of the questionnaire is delivered to the patients at the ED before the intervention when the setting is discussed as short-staffed. The second part of the questionnaire is delivered to the patients at the ED additionally to the first part after the solution is implemented, when the setting can be discussed as full-staffed (number of nurses in shifts is additionally controlled by Nurse Administrator) because of the changes in the approaches to scheduling. The questionnaire results will be used to analyze changes in patient satisfaction before and after the intervention (Appendix D).
Dissemination Plan
The process of disseminating findings and results associated with the intervention in the Emergency Department (ED) of the determined facility should include two stages. The first stage is connected with disseminating the findings to Emergency Department Manager, Nurse Administrator, and to the facility’s staff. The second stage is associated with demonstrating the significance of the intervention to the large nursing community while referring to the findings and important positive outcomes.
The first approach is to present the results of the project to the stakeholders in the formal structured report on the project completion and outcomes. The formal report provided to the Emergency Department Manager and Nurse Administrator as supervisors of the project is expected to include the overview of the project steps and summary of the results with the focus on their practical significance. The informal report of the results to the other stakeholders, such as the ED staff participating and assisting in the project, should be based on demonstrating the PowerPoint presentation which overviews the stages of the intervention and presents the results in the form of tables, graphs, and figures in order to support conclusions with the help of the visual material.
When the results of the project are disseminated to the stakeholders involved in the solution implementation, it is necessary to present the findings and discuss the significance of the outcomes in the format that is accessible by the large nursing community. To disseminate the project’s findings and accentuate the importance of the outcomes in an appropriate form, it is important to prepare posters for placing them in the community’s clinics and hospitals. This information will be available not only to the nurses but also to the physicians as well as potential patients of the Emergency Department.
In addition to placing posters in the medical facilities of the community, it is also important to focus on publishing the results of the project in different professional or peer-reviewed journals. In this context, it is possible to combine the results of the project with the other interventions’ results that were previously conducted in the ED and related to the research question. Thus, the article on the association between staffing and patient satisfaction in the ED can be written in cooperation with the nursing leaders and researchers in the medical center. Moreover, the results of the project can be provided to the nursing community’s leaders for further use in seminars and conferences. In this case, the preliminary discussion of the results with the leaders of the local nursing community should be organized.
Conclusion
Emergency Departments in most facilities of the country are often described as understaffed, and this situation also affects the problem of patient satisfaction. The problem is in the fact that the long waiting times, as well as the lack of adequate care, make patients feel dissatisfied, and they often associate this problem with short-staffed settings in contrast to fully staffed EDs. As a result, the management teams in EDs face the problem of addressing the nurse staff shortages in order to increase the level of patient satisfaction. The cost-efficient solution to the problem of short staffing in EDs is the integration of the self-scheduling system for the nursing staff. When nurses have the opportunity to sign up for shifts independently, the problem of short staffing can be discussed as overcome because nurses focus on controlling their schedule, they can avoid burnout, and the set of flexible shifts in the ED becomes possible. In addition, the proposed solution can be integrated within the user system for online scheduling, and it can be discussed as cost-efficient. The evaluation of the solution implementation results with the help of the questionnaires and statistical tools is important to support the conclusions regarding the intervention’s effectiveness.
Review of Literature
Aiken, L., Cimiotti, J., & Sloane, D. (2011). Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Medical Care, 49(12), 1047-1053.
The researchers aimed to study how the hospital nurse staffing could influence patient mortality. Aiken, Cimiotti, and Sloane concluded that the relationship between staffing and patient outcomes can be different in various hospitals. Aiken et al. (2011) studied the aspects of staffing in 665 hospitals and compared the results with the data on inpatient mortality. Thus, the findings can be discussed as representative. The researchers found that appropriate patient-to-nurse ratios can improve patient outcomes, decrease mortality, and add to patient satisfaction. The findings are important to focus more on hospital nurse staffing in order to reduce hospital mortality. The results are valid to represent the connection between staff shortages and patient outcomes.
Aiken, L., & Sermeus, W. (2012). Patient safety, satisfaction, and quality of hospital care: Cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ, 344(1), e1717-e1732.
The researchers examined how improved nurse staffing could affect patient care and satisfaction. Aiken and Sermeus chose a cross-sectional study design that is effective to provide credible data on the large population in the European and US countries to discuss the tendency. The researchers found that the relationship between safety, quality of care, and satisfaction was great. The research results are relevant to be applied in the hospital settings in the USA because the researchers proved the fact that full staffing and avoidance of shortages represent the effective low-cost strategy to improve patient satisfaction.
Burström, L., Starrin, B., Engström, M., & Thulesius, H. (2013). Waiting management at the emergency department – a grounded theory study. BMC Health Services Research, 13(1), 95-102.
The researchers focused on examining the quality of the care observed in emergency departments and on the factors that could influence the care, such as staff shortages. Concentrating on collecting the data on the patient experience and satisfaction, the researchers conducted the qualitative study based on focus group interviews and supported it with collecting the quantitative data. The appropriate research design allowed discovering the factors that influenced patient satisfaction. The participants focused on the long waiting time and the lack of appropriate staff behavior or care. The study is significant to provide the support for discussing the correlation between the waiting time in ED and patient satisfaction in terms of the staff shortages causing patient frustration and inadequate care.
Chan, T., Killeen, J., & Vilke, G. (2012). Effect of mandated nurse–patient ratios on patient wait time and care time in the emergency department. AEM, 17(5), 546-572.
Chan, Killeen, and Vilke examined the relationship between mandated nurse-patient ratios and the patient flow and satisfaction in emergency departments. The researchers chose to use the modern technologies to collect the data and focused on conducting the information with the help of electronic medical records and electronic systems used in two hospitals. Chan et al. (2012) found that the staffing directly influenced the patient wait time. The results are applicable for hospital environments when staffing decisions are made while ignoring state-mandated levels and standards.
Dahlen, D., Westin, L., & Adolfsson, A. (2012). Experience of being a low priority patient during waiting time at an emergency department. Psychology Research and Behavior Management, 5(2), 1–9.
The researchers focused on examining the experience of patients who could be prioritized according to the priority rating. Low priority patients were discussed as having the longest waiting time in ED. To study the problem, Dahlen, Westin, and Adolfsson adopted the phenomenological method and interviewed patients in ED. The method was selected effectively because it provided the opportunity to focus on the aspects of experience and satisfaction. It was found that lower priority patients felt dissatisfaction because of the lack of care and attention. The study is significant to propose focusing on lower priority patients’ experience in ED to improve the overall quality of care and patient flow in hospitals.
Dent, B. (2015). Nine principles for improved nurse staffing. Nursing Economics, 33(1), 41-45.
Dent reviewed the researches on the problem of nurse staffing and formulated principles for improving the work organization in hospitals. Based on the literature review, Dent was able to examine the issue in detail in order to propose effective principles for improving the staff. Therefore, such variables as skill mix and number of nurses were discussed as important to influence clinical management. The article is important to provide guidelines for the effective organization of staff work in order to prevent burnout and shortages.
Duclay, E., Hardouin, J., & Anthoine, E. (2014). Exploring the impact of staff absenteeism on patient satisfaction using routine databases in a university hospital. Journal of Nursing Management, 3(2), 1-9.
The researchers examined how staff absenteeism could lead to changes in the patient satisfaction and focused on the concept of burnout. To research the problem, the authors chose to conduct the multilevel analysis and examine staff databases. The situation in only one hospital in France was examined. It was found that nurse absenteeism could influence patient satisfaction significantly. The study is important to affect the approaches in working with the staff in hospitals to avoid absenteeism or shortages and increase patient satisfaction.
Horwitz, L. (2010). US emergency department performance on wait time and length of visit. AEM, 55(2), 133-141.
Horwitz aimed to study the relationship between the staff performance in emergency departments, wait time, and patient outcomes. A retrospective cross-sectional study was chosen as a method. This design allowed focusing on a large number of patient visits to conclude about the relationship. Horwitz found that the percentage of hospitals that follow the recommended wait time in ED is rather low, and that fact influenced the quality of the care. These results need to be referred to while organizing the work of ED to avoid long wait times and staff shortages.
Karaca, M., Erbil, B., & Ă–zmen, M. (2011). Waiting in the emergency room: Patient and attendant satisfaction and perception. EJSS, 2(1), 1-4.
The researchers reviewed the tendencies in the sphere of emergency services with the focus on the waiting time and patient satisfaction. Karaca, Erbil, and Ă–zmen provided their conclusions referring to the literature review results. The authors concluded that the patient satisfaction directly depends on the wait time, and this factor is based on the staff organization. The article provides important notes on the connection between insufficient care in ED, long waiting time, and patient dissatisfaction.
McHugh, M., Berez, J., & Small, D. (2013). Hospitals with higher nurse staffing had lower odds of readmissions penalties than hospitals with lower staffing. Health Affairs 32(10), 1740–1747.
The researchers reviewed the connection of high staffing and low staffing with the effective work of the whole hospital system. McHugh, Berez, and Small identified the policies and the legal framework in the context of which it was important to discuss the problem of staffing. The effect of staffing on the system’s work was measured. It was stated that high staffing was a necessary requirement for the effective work of hospitals according to policies. The conclusions are significant to revise the staff norms and policies in hospitals to meet requirements.
Oredsson, S., Jonsson, H., Rognes, J., & Lind, L. (2011). A systematic review of triage-related interventions to improve patient flow in emergency departments. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 19(2), 43-52.
The researchers found that overcrowding in emergency rooms can influence patient satisfaction, and these situations are directly associated with staffing. The authors reviewed interventions in hospitals to improve the situation in emergency rooms with the focus on the systematic literature review. The researchers followed strict criteria to choose the most appropriate studies for reviewing. The examined interventions were analyzed and grouped to choose the most effective ones. The proposed interventions can reduce waiting for time and length of stay, improve the staff work, and increase patient satisfaction.
Sayah, A., Rogers, L., Devarajan, D., Kingsley-Rocker, L., & Lobon, L. (2014). Minimizing ED waiting times and improving patient flow and experience of care. Emergency Medicine International, 2(1), 1-9.
The article proposed interventions and improvements of the ED waiting time to influence the patient experience. The research is valid because it includes both pre-and post-intervention data analysis. The study results are comprehensive to propose interventions that could address staffing issues in ED directly. The article is important to support the idea of improving the emergency patients’ experience with references to new interventions on high staffing and workload.
Stimpfel, A., Sloane, D., & Aiken, L. (2012). The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Affairs, 31(11), 2501-2509.
Stimpfel, Sloane, and Aiken focused on discussing how long work shifts associated with staff shortages could influence the quality of care and the level of patient satisfaction. The researchers conducted the analysis of cross-sectional data for the period of 2005-2008 and related to the organization of the staff work. Focusing on the aspects of burnout, shift length, and staff shortages, the researchers concluded about the role of shift lengths for quality of care and staff attitudes. The research is important to link extended work shifts with burnout caused by staff shortages, and then, with patient dissatisfaction.
Wang, X. (2013). Emergency department staffing: A separated continuous linear programming approach. Mathematical Problems in Engineering, 2(3), 1-9.
Wang proposed the model for estimating the effective number of staff for emergency departments to guarantee or increase patient satisfaction. The strategy to design a model was effectively chosen by the author to address the typical challenges associated with the work in emergency departments. The outcome was the model to address ED overcrowding and low staffing. The proposed staff work optimization model can be effectively used in hospitals to resolve the problem of low staffing and decreased patient satisfaction.
Wiler, J. (2010). Optimizing emergency department front-end operations. Annals of Emergency Medicine, 55(2), 142-162.
Wiler presented the review of the scholar literature on the available interventions to improve the work of emergency departments. The literature review was chosen as an effective tool to provide the qualitative information on the issue. The outcomes included the selection of interventions effective to improve the work of the staff, cope with staff shortages, manage the services, and add to patient satisfaction. The article is important to assess interventions that can be effective to address the problem of staff shortage in ED.
References
Aiken, L., Cimiotti, J., & Sloane, D. (2011). Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Medical Care, 49(12), 1047-1053.
Aiken, L., & Sermeus, W. (2012). Patient safety, satisfaction, and quality of hospital care: Cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ, 344(1), e1717-e1732.
Burström, L., Starrin, B., Engström, M., & Thulesius, H. (2013). Waiting management at the emergency department – a grounded theory study. BMC Health Services Research, 13(1), 95-102.
Chan, T., Killeen, J., & Vilke, G. (2012). Effect of mandated nurse–patient ratios on patient wait time and care time in the emergency department. AEM, 17(5), 546-572.
Dahlen, D., Westin, L., & Adolfsson, A. (2012). Experience of being a low priority patient during waiting time at an emergency department. Psychology Research and Behavior Management, 5(2), 1–9.
Dent, B. (2015). Nine principles for improved nurse staffing. Nursing Economics, 33(1), 41-45.
Duclay, E., Hardouin, J., & Anthoine, E. (2014). Exploring the impact of staff absenteeism on patient satisfaction using routine databases in a university hospital. Journal of Nursing Management, 3(2), 1-9.
Horwitz, L. (2010). US emergency department performance on wait time and length of visit. AEM, 55(2), 133-141.
Karaca, M., Erbil, B., & Ă–zmen, M. (2011). Waiting in the emergency room: Patient and attendant satisfaction and perception. EJSS, 2(1), 1-4.
McHugh, M., Berez, J., & Small, D. (2013). Hospitals with higher nurse staffing had lower odds of readmissions penalties than hospitals with lower staffing. Health Affairs 32(10), 1740–1747.
Oredsson, S., Jonsson, H., Rognes, J., & Lind, L. (2011). A systematic review of triage-related interventions to improve patient flow in emergency departments. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 19(2), 43-52.
Sayah, A., Rogers, L., Devarajan, D., Kingsley-Rocker, L., & Lobon, L. (2014). Minimizing ED waiting times and improving patient flow and experience of care. Emergency Medicine International, 2(1), 1-9.
Stimpfel, A., Sloane, D., & Aiken, L. (2012). The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Affairs, 31(11), 2501-2509.
Wang, X. (2013). Emergency department staffing: A separated continuous linear programming approach. Mathematical Problems in Engineering, 2(3), 1-9.
Wiler, J. (2010). Optimizing emergency department front-end operations. Annals of Emergency Medicine, 55(2), 142-162.
Appendix A: Example of the Slide for the PowerPoint Presentation
Appendix B: Handout for Using the Self-Schedule Tool
- Double-click on Member Entrance.
- Enter the Login information and Password for authorization.
- Double-click on the “Schedules” button.
- Click on the “Self-Schedule for ED Nurses” button.
- The schedule for the next four weeks will appear. Click on the available day or night shifts to sign up for these shifts and add your name and position.
- Click on the “Parameters” button to automatically check your workload and number of available shifts.
- Sign up for extra shifts if you wish and your workload is according to parameters “No more than 60 hours in a 7-day period”.
Appendix C: Questionnaire for Nurses
Appendix D: Questionnaire for Patients
