Keeping Your Cool Amid the Chaos in the ED

Posted on Wed, Jun 29, 2016
Keeping Your Cool Amid the Chaos in the ED

By Ginger Wirth, RN

I’ve written about leading by example, and recently I had the opportunity to watch a fairly new leader do not only that but also lead from the front. I thought that I understood what that meant, but when I watched this medical director in action, it became even clearer to me.

I was observing processes in an emergency department and when I walked in at 10 a.m., things were clearly beyond the “norm.” I looked at the tracker and noted that names, numbers, different colors and flags filled the whole screen. There was nary a blank space to be seen. In the 24-bed department, the tracker told me that there were 18 patients waiting to be admitted and 11 of them were waiting for critical care beds. There also was a critical patient awaiting transfer. All of the other beds were filled with regular ED patients, and EMS was bringing more in the back door. I failed to mention that four of the critical care patients had been in the ED for more than 24 hours.

I saw the staff hurrying around the department, some looking more stressed than normal, while others maintained a smile despite the chaos. The medical director and I met in the ED at the same time. Without saying a word, she looked at me and I knew that she needed to fully assess the situation to determine the best way to help.

I watched her and was impressed. As many of us who have worked in emergency medicine know it’s frequently easiest to just grab the next chart and start seeing patients, go give the medication or provide the treatment. This medical director resisted that urge and she began making calls, activated the provider surge protocol, and assisted the facility and nursing leadership in implementing their capacity plan. The doctor remained in the middle of the nurses’ station directing the team, assisting advanced practice providers with reviewing discharges and turning over the low-acuity patients safely and rapidly. She also facilitated getting additional help for the hospitalists upstairs. They were able to get another hospitalist to come in and assist from the direction and notification from the ED SMD. She also made sure that the entire team was aware of the resources that were mobilized and what the plan was.

That entire scenario is exactly what I mean by “leading from the front.” Because of her leadership, providers and nursing staff were able to continue providing hands-on care to patients – and that’s exactly where we want them. The team felt comfortable knowing that the “administrative” stuff was being handled by the site medical director. By having the medical director there in the middle of the ED making calls, providing direction and supporting the staff, the team knew exactly what was happening and they were confident that relief was coming and beds would be found. While those calls could have been made in an office outside the ED, when action happens “outside” the chaos, many assume that nothing is happening. This frequently leads to dissatisfaction and low morale, and can have a negative impact on the care being provided.

On this day the team felt fully supported by the medical leadership in the ED. There was strong collaboration with nursing as well as the inpatient and administrative leaders. Frontline staff was able to focus on communicating with patients and their families about the delays and the plan going forward rather than making calls, assumptions and getting frustrated with the situation.

I know that this incident is nothing unique and there are EDs all over the country facing the same or similar days. I hope that they have nursing and physician leaders who can not only lead by example but also lead their departments and practices from the front.

Leadership requires collaboration, organization, planning and structure. It’s also important to be able to demonstrate the ability to stay calm in the face of stress, manage emotions – not only yours but at times the emotions of those around you – and to support and motivate the team. Be out there with your team, not only making sure that they believe you can do the things they are expected to do, but that you also are out there “in the trenches” with them.

“A true leader has the confidence to stand alone, the courage to make tough decisions, and the compassion to listen to the needs of others. He does not set out to be a leader, but becomes one by the equality of his actions and the integrity of his intent.”
-General Douglas MacArthur

Ginger Wirth

Ginger Wirth, RN, joined EmCare in 2013 as a Divisional Director of Clinical Services for the Alliance Group. Her goal is to make positive changes in healthcare by helping others focus on quality, excellence, and the overall patient experience. Wirth regards her role as Director of Clinical Services as the ideal opportunity to partner with nursing, physician and facility leaders to make positive changes to the entire patient care experience. Her 20-plus year nursing career has been dedicated to quality and excellence, promoting overall positive outcomes and safety for patients.

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