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MENA is the Maine state council of the Emergency Nurses Association. We are a not-for-profit organization and our main purpose is education.

Our vision is to define the future of emergency nursing and emergency care through advocacy, expertise, innovation, and leadership.

National ENA Organization

ENA is the specialty nursing association serving the emergency nursing profession through research, publications, professional development, and injury prevention. Since 1970, when Judith Kelleher and Anita Dorr founded the Association, ENA has grown larger, stronger and more influential each year.

The National ENA website has a great deal of information related to its mission, vision, values and ideas for today and tomorrow.

President’s Message - Summer, 2009

Challenges in Emergency Nursing

I had already begun to write this article when 42 of us gathered at Miles Memorial Hospital for the Maine ENA Spring Education Day.  Part of the program in the afternoon was moving from room to room having round table discussions on “Hot Topics”.  One of the topics was improving ED throughput and the problem of boarding patients in the ED.

Not surprisingly, we all had identified the same problems and obstacles.  We also had improved most of the issues that we had control over, but all continue to struggle with the ones that depend upon the cooperation and buy in from other departments, such as actually getting our patients who need to be admitted into their inpatient beds.

One of the things that many of us have done is to move patients from the waiting room to an exam room as soon as possible.  If triage is backed up and there are empty rooms, we bring patients back and triage them there. At my ED on the night shift, when census is usually at its lowest, we pull the triage nurse and place a tech at triage.  Every patient who comes in is brought back immediately.  Patients who come in through triage get a “Quick Reg” and then full registration is done at the bedside.

If the admitting physician takes more than one hour to come in to see the patient, our ED providers write holding orders and we take the patient to the floor.

When we get a bed assignment, we call to give report and if the nurse is busy or otherwise not available, we can sometimes give report to the charge nurse.

The creation of a position for a day supervisor, or “Bed Czar”, has been very valuable for shortening the time for bed assignments by coordinating admissions and bed placement through out the hospital.

All the work has been very rewarding with increased patient satisfaction as well as the improvements in decreased time to provider and ED length of stay. Identifying obstacles is, of course, the easy part.  Changing practices and old habits is the most difficult part.

Our hospital, like many others, has recently done some restructuring and down sizing.  We have 21 beds less than we had a year ago and in the ED we are definitely feeling the impact of this.  We have suddenly begun to board some of our admitted patients for several hours.  We continue to meet regularly and work on solutions to our problems. One thing we have done is to identify areas in the hospital that may occasionally have extra beds that we can move patients from the ED into.  If these are not available, we have three rooms designated in the ED to hold admitted patients.  Developing a list of float nurses who will take care of these admitted patients has been a priority.

This process is not easy, but necessary, and we continue to strive to make constant improvements to the systems we have in place.

Respectfully Submitted,
Carol Minis, RN, CEN
President Maine ENA