Every day in life, we face conflict and change; whether it is large in its impact or small. Generally, change is often perceived as something that is negative, or at least does not come with great ease. Many of us are creatures of habit, and it can be difficult to change our ways, or our work ways; even if it is ultimately for the better. During the past several years, the 27 bed emergency department that I have been working in has gone through some major changes relating to the record increase patient numbers. Because of the shocking spike in the patient numbers, the department had to come up with a new plan on how to handle the patient flow through the small department. At first, it was a huge adjustment and several changes were taking place at once. Looking back now, the changes made were extremely beneficial; not only to the flow of patients, but this also increased our patient satisfaction scores in the process. The Reason(S) For The Change
The department I work in is considerably small. Staff and valuable resources are limited. The facts that our ED contains 27 patient rooms and was presented with a patient visit record of about 150 patients seen on day shift, created quite a few problems. Several ideas for change took place; including modifying the triage process and utilizing a separate room just outside the department for patients to move to while awaiting test procedures. It was understood by everyone on staff that a change to be made, but the several ideas presented resulted in a myriad of opinions and reactions. Inevitably, the changes were going to take place, it was the process and adjustment process that was trying at times to experience.
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The Change That Caused The Conflict
The change that occurred had taken place in two different areas: triage and mid-diagnostic phases. The change made in triage was to put another triage nurse out in the side triage room with a physician’s assistant to see the patients who could not go right into a room. The primary triage nurse would perform initial vitals, height and weight, and discover what the chief complaint and allergies were. The second triage nurse would find out medical history, surgeries, home medications, perform a quick head to toe assessment, and initiate protocols based on standing protocols or what the physician assistant would pre-order. This frustrated many of the secondary triage nurses because they believed they were doing much of the work (with the exception of medication administration) and then have to do it all over again with the next patient. It also upset several physician assistants because they were seeing every patient who came through triage if there were no patient beds available. In fact, they would even be required to see some of the ambulance patients if there was a long wait in the ambulance offload and no beds to place these patients.
The second change made was within the mid-diagnostic phase. Management decided to pull patients from rooms who were awaiting test results. Such patients included those who did not have an infectious or contagious process, and ones who did not need to be on a monitor. From their rooms, they would move the patient into a room that would be called the results waiting room (“RWR”).
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In the results waiting room, they set up a bunch of chairs and recliners, a big screen television, and put a registered nurse to monitor these patients. There were several problems that arose. One of those problems was the nurse reaction to the patient movement. Many of them were upset because they had triaged, started diagnostic tests, administered medications, assessed, and monitored these patients for a good amount of time.
Moving a patient from the nurse’s room mean that he or she would just get another patient and either have to do it all over again. In some cases, the nurse would then receive a very difficult new patient (i.e. intensive care candidate, psych patient, or unreasonable alcoholic).
The other dilemma that was faced was the act of moving the patient and when to do so. Some patients did not want to move to another area because it was believed that they were not going to be as well cared for, and therefore not considered as important as other patients. Because new patients would come into the rooms at such a fast rate and some tests would be pre-ordered in triage; they would often be off in a diagnostic test and not be seen by the doctor yet. This caused in the delay of flow and thus times for patient results as well as stalling additive tests and medications ordered by the future physician.
The Reasons For The Change
The surge in patient numbers forced an action and change to be taken place within the emergency department. Management had to figure out how to deal with the large number of patients coming in through triage and ambulance offload, and figure out how to get them seen by the doctor/initiate protocols within a reasonable time frame. The problem was that all of the patient rooms were filled. The issue was figuring out what to do with these patients and to somehow keep them satisfied, after all; the emergency room was still a business and patient satisfaction was a high on the priority list. In addition, making such changes involved considering the nurses feelings and efforts to keep them relatively happy in their work environment. Employee satisfaction was yet another priority with the management.
The Reason the Change Caused Conflict
One reason that the change caused conflict was because the change occurred rapidly and without detailed information and feedback involving the nurses. It would have been preferred by my fellow nurses that their input mattered prior to all the changes being taken place. Thankfully, during the process, management decided to include their input when modifying and adjusting the change process. The other reason for why the change caused conflict was that some nurses were building up animosity toward others because of the nurse zone assignment. Management originally had decided that they would keep each nurse in the same zone for the course of the first few months so that he or she could get a handle of each zone properly. It turned out that some nurses would get an easier zone than others and this was perceived as unfair to many.
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The Manifestations Of The Conflict
Given that fairness, equality, and input was so important to each of the staff, management started organizing weekly meetings on how the new process could be adjusted or improved. In addition, management would go around and speak with patients and get their input as well. Considering the needs of the staff as well as the patient, became significant in the ED’s success.
The Outcomes Of The Conflict
Several changes took place with the input of the staff. Two rooms were freed up so that the physician assistant and nurse could work together in comfort with readily available resources. In addition, a paramedic and a technician were added to the triage process in which they would aid in starting IV’s, performing electrocardiograms, and facilitate patient movement to results waiting room or to a patient room. Also a technician was assigned to results waiting room to help the nurse with vitals, aid in the movement of the patients to and from this room, and to help the nurse meet further needs of the patient (i.e. blankets, food/drink for families, updating patient information and wait times).
Other changes that took place were that the managers placed more nurses on staff. Having extra help aided in the reported stress and feelings of being overwhelmed. In addition, all the nurses were moved around in different zones every shift. The variety of assignment seemed to make the nurses happier and more willing to work harder.
Conclusion
Change is an ever-occurring fact in today’s world. Despite preexisting feelings on change, the best approach is to embrace change. Effective communication of ideas and input can create limitless possibilities. Change is an adjustment, however; positive outcomes are highly possible with the right attitude and effort. The moral of my personal story is that working together as a team made such a difference. When management realized how imperative it was not only to understand the patient’s perception but also the staffs’, wonderful changes were made. Everyone’s input was and is important. Once management made the decision to encourage staff to express their ideas, it helped people believe that they were truly validated. Without validation, I believe one lacks a true feeling of worthiness and contribution to what one feels is important in their lives. The consideration of patient, management, and staff ideas and needs created a positive change within our work environment. This was a steppingstone for my colleagues, and it gives me great joy and hope for the future.
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