Introduction

Complex adaptive systems, including the Emergency Department, are prevalent in various practice areas. In considering my current and future practice as a registered nurse and aspiring Advanced Practice Nurse (APN) in the emergency department, I have identified a critical concern: the underappreciation and burnout of emergency room nurses. This issue affects multiple system levels, including the macro, mesa, and micro. To address this concern effectively, it is essential to implement solutions that promote interprofessional collaboration and positively impact all levels of the system.

The emergency department operates as an interprofessional practice model, where each healthcare provider functions independently within their scope of practice but collaborates with other team members in the patient’s care. This model ensures high-quality and cost-effective healthcare delivery. For instance, when a patient arrives with a heart attack, the physician or APN assesses the patient and calls for a cardiologist. At the same time, the nurse follows through with orders, seeking assistance from other healthcare professionals like nurse assistants, chaplains, dietitians, or social workers. This collaboration ensures comprehensive and efficient care for the patient.

The emergency department faces the challenge of managing constantly changing dynamics at the boundaries of the department and integrating services from other departments and units within the hospital. The department acts as the integrated care site, connecting the community’s primary care to the hospital’s secondary and tertiary care. This complexity requires a comprehensive understanding of the care provided by different clinicians, the services offered by the emergency department, and the diverse needs of the patients across the spectrum of care.

NR 500 NP Week 5 Discussion Systems Theory and Practice Issues in the Emergency Department

Unfortunately, society often underappreciates the emergency department and its nurses, despite being a critical access point for many patients. While intensive care and floor nurses receive recognition, emergency room nurses tend to be overlooked. This lack of appreciation has been an ongoing complaint throughout my career but has become even more pronounced over the last 18 months due to the pandemic. Society often fails to acknowledge that when patients arrive at the hospital in an ambulance, their first destination is the emergency room. These nurses are continuously exposed to high workloads, resulting in burnout and increased staff turnover rates.

The concern of nurse burnout and underappreciation can be attributed to the microsystem, mesosystem, and microsystem levels. Addressing these concerns requires a multi-faceted approach that involves all stakeholders in the system: Microsystem: The hospital’s chief executive officer, president, and chief nursing officer are aware of nurse burnout as they witness it daily and review call-off data or instances of nurses quitting. To address this issue, the organization should genuinely appreciate the nursing staff. Beyond superficial gestures like pizza or ice cream, offering extra paid days off or bonuses can demonstrate a sincere recognition of their dedication and motivate them to stay.

NR 500 NP Week 5 Discussion Systems Theory and Practice Issues in the Emergency Department

Mesosystem: Nurse Managers play a crucial role in the mesosystem. To promote a positive work environment, nurse managers should actively support and advocate for the staff nurses, especially when short-staffed and stressed. By standing by their team during challenging times, nurse managers can foster a sense of unity and appreciation, which may improve staff retention and overall satisfaction.

Microsystem: The microsystem encompasses direct care providers, including bedside nurses, physicians, and APNs. Finding solutions at this level is particularly challenging due to the “trickle-down” effect from higher levels. However, addressing the concerns at the microsystem and mesosystem levels can alleviate the burden on the microsystem. Creating an environment of support, teamwork, and recognition throughout the system can reduce burnout and improve job satisfaction among direct care providers. Interprofessional collaboration is crucial in resolving these issues. By engaging in collaborative decision

References

DeNisco, S.M. & Barker, A. M. (2015). Advanced practice nursing: Essential knowledge for the

Profession (3rd Ed.). Jones & Bartlett Learning. Nugus, P., Carroll, K., Hewett, D. G., Short, A., Forero, R., & Braithwaite, J. (2010). Integrated care in the emergency department: A complex adaptive systems perspective. Social Science & Medicine (1982), 71(11), 1997–2004.

https://doi.org/10.1016/j.socscimed.2010.08.013.

The American Institute of Stress. (2020, February 26) Stress Management for The Emergency Room Nurse.

https://www.stress.org/stress-management-for-the-emergency-room-nurse.

 Retrieved September 18, 2021