Open Forum for Change

I mentioned in a previous blog, "The RSV Blues," the pediatric emergency department has had a very busy winter. The adult area is even worse. One day last month, we had over 90 patients registered and being cared for in our 31-bed unit. How can this happen? It seems the more room we make in the hospital, the more patients we have waiting to be admitted. Luckily, our management responded and the hospital decided to declare Plan D-a disaster situation. It has since happened again.

What is Plan D? It is when our emergency room is so overwhelmed with patients that the entire hospital becomes involved in patient care. Staff can be pulled from anywhere to attend to the needs of patients, more staff is called in, and working staff is required to stay until the demand has decreased. Typically this would occur due to a large number of traumas, e.g. an explosion at a factory. In this situation, our medical director, nurse manager and director of ambulatory services rolled up their sleeves and dove in to help. They pushed stretchers, answered phone calls, did what had to be done. They also called on other managers to open units not typically used for inpatient beds.

As one can imagine, a tremendous amount of resources and energy was required to make all of this happen. An already exhausted staff was pushed beyond their limits with no end in sight. The promise of a hospital addition dangles in front of us, teasing us with hopes of a brighter future we may not survive to see. Just about everyone is miserable. Complaints roll off tongues far more regularly these days; smiles are few and far between.

Our management has responded to us with the best of their abilities. Once the unrest was palpable, open forums were scheduled for all staff to attend. This differs from general staff meetings in that the leaders have no agenda except to hear our needs. Issues and concerns can be verbalized without fear of repercussions. True problem solving begins with honest discussion.

Response was mixed, with only a few attendees at each meeting. I made it a point to go, even though I didn't truly believe anything would change. I figured I had no right to continue complaining if I didn't offer my opinion on the situation. I am a valid member of this community and complacency can only do more harm than good.

I was filled with pride the morning I went to that meeting. My co-workers did more than just whine and cry. Solutions were offered and discussed. Brainstorming brought about goals that have been washed away in our continuing tide of patients. But most of all, we made ourselves heard and our leaders listened.

To date, I have seen a number of small improvements, a few minor changes. It's still chaos, don't get me wrong, but a few small baby steps can lead to so much more if we just give it time. Being a person who thrives on instant gratification, it can be hard to hear that a plan is ‘in the works'.

I cannot say if others have noticed; I've been too busy to ask. But hostility seems a little lighter; more ideas are forming each day on how to care for admissions waiting for a bed. We now have two on call plans-one for overflow and one for general ER patients. The response has been fairly positive, and I look forward to figuring out how I can participate.

So, for all of you out there who believe that open forums are for whiners and don't really accomplish anything anyway, it may be time to change your mind. Situations can only get better if an effort is made. Yes, both leaders and participants need to be responsive but you can start by setting the example. We, the staff nurses, are not powerless. We are front-line defenders of life in general. Why not make that work for our entire unit as well?