The NurseGrid team is heading to Emergency Nursing 2016 in Los Angeles on September 14th. We’ll be sponsoring a booth in the Exhibit Hall, and we can’t wait to connect with ED nurses and nurse leaders from around the country to talk about their priorities and challenges. Let us know if you’ll be there at email@example.com, or swing by our booth and say hi! We’ll have fun NurseGrid swag and giveaways for nurses and managers, interactive demos of our NurseGrid Manager platform, and team members who’ll be there to chat and answer any of your questions!
In honor of this event, I sat down with our Founder and CEO Joe Novello, a former ED nurse himself, to relive some of his best--and worst--times in the ED.
Me: Can you catch us up on your ED nursing experience (where you worked and what you did) real quick?
Joe: Ha, I’m not sure it will be real quick! I started off young, as an ED tech and unit clerk in a hospital in my hometown of Newport, OR in 1997. I graduated from the University of Portland School of Nursing in 2004 and headed to the Nursing ED Residency Program at UCSF. After that, I spent about three years as an agency nurse for EDs all around Oregon and California, and eventually landed back in the Bay Area at Alta Bates Summit Medical Center as a staff ED nurse and then a full-time charge nurse.
Me: When would you say the idea for NurseGrid really started to solidify?
Joe: I think the need for more efficient administrative processes--for nurses, nursing departments, and facilities--really became clear when I worked as an agency nurse. I was exposed to the processes in so many different EDs, and I never encountered one with super efficient operating procedures. And I definitely never encountered one where nurses were happy with the way things, like requesting schedule changes or having access to the department schedule as it changed, were handled. Things were so manual and wasted so much time for everyone. And we had important work to do!
Me: Give me some examples of these inefficiencies that drove you and your fellow nurses crazy.
Joe: Oh I have so many. I remember one facility when I was an agency nurse where we had 120 nurses in the ED, and we were submitting work availability by paper--every month you’d have to submit when you were and were not available to work outside your regular shifts ahead of time on paper! So much valuable time was wasted with this manual process. Then there was the way swaps were handled at nearly every facility I worked at. Both nurses would have to walk into the manager’s office, drop off a piece of paper, wait maybe days to get a response (which they had to be at the hospital to receive), and then both the master and daily paper schedules were updated. We all also used to send and receive mass text messages at all times looking for people to cover open shifts--even if those people were already scheduled to work or unavailable. You’d start to ignore the texts because they frequently just didn’t apply to you.
Me: What were some key challenges you experienced as a charge nurse that you think are particularly common in EDs?
Joe: EDs move really fast, and have more real-time fluctuations in census and acuity than just about any other type of nursing department. So trying to match staffing levels to needs in real time was really challenging. First of all, we didn’t have good real-time data to help inform those decisions--I never knew who had indicated their availability to work, for instance, so I’d know who to contact. We were constantly running 3-5 nurses short, and we didn’t have enough time for the phone trees needed to bring more people in. From a facility perspective, we were losing revenue because of a lack of nursing resources. The LWBS rate would increase in the winter, and we’d be on ambulance diversion to keep people alive, but the higher-ups would get mad at us.
So the other big problem was patient throughput--we’d have multiple admits all at once, and the nurses upstairs were stretched too thin to receive our patients. So you’d have ED nurses taking care of patients who should be med-surg patients, which wasn’t ideal for those patients and lost revenue from not getting those patients into inpatient departments, which wasn’t ideal for facilities. And across all this, when a department or multiple departments are short-staffed, there are just not enough nurses to take care of all the things you want to do for a patient; we were all trying to do our best for them, but there just weren’t enough hours and resources to go around. Every day someone would be complaining about scheduling or staffing; I experienced firsthand and witnessed the downsides of short-staffing departments, nurse burnout, and the impact on patient safety. It could often feel like a lose-lose-lose situation: nurses, patients, facilities--it didn’t feel like it was working quite right for anyone.
Me: But it can’t have been all bad. You stuck with it for so many years!
Joe: I know us nurses can make it sound like it’s all bad sometimes--and the challenges really do eat away at you--but there’s also something about ED nursing I just loved and still love, and I don’t think I’ll ever give it up entirely. ED nursing is so challenging, in a way I liked: You get acute patients, you have to figure out what’s going on and how to handle it so fast. It’s challenging, uncertain, exciting. There was also a lot of autonomy in ED nursing; I was so frequently operating at the top of my scope of practice. Too many facilities and departments these days are using nurses below their scope of practice--and nurses make everything in healthcare work! We should be used to our full potential!
And you got so close to your fellow nurses in the ED--we were like a family. We’d travel together, hang out on off days together. This is part of why some of the first features I knew I wanted in our mobile app were the ability to see who you were working with each shift and share schedules for planning.
Me: OK, you knew it was coming. What’s the craziest day you ever had in the ED?
Joe: Ha! I can’t answer that on our blog. It was crazy every day! I’ve seen absolutely everything coming out of every kind of orifice…
Me: OK! TMI!
Don’t forget to shoot us a note at firstname.lastname@example.org or swing by our booth if you’re heading to Emergency Nursing 2016 in Los Angeles! We can’t wait to see you!