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The success or failure of an emergency department (ED) is based largely on patient satisfaction with its services. Consumers make judgments primarily on the basis of their interactions with staff during their ED visit. The human interaction between staff and patients is clearly a strong final component of patient satisfaction.

Balancing staff demands with patient care needs is the challenge of every ED manager. Often, wide fluctuations in patient acuity and census bring additional dimensions to the challenge of maintaining appropriate staffing levels. Nationwide, ED managers stretch staffing resources to cover the day-to-day schedule while expending time and effort on recruitment and retention of staff. The cycle continues: a new nurse begins orientation and an experienced nurse leaves. The ED manager, through the use of ingenuity, commitment, and proactive planning, can minimize the effect of this cycle on the delivery of quality care to the patient. This chapter reviews several emergency nurse recruitment strategies, discusses nurse credentialing, and provides an overview of orientation concepts for the ED setting.

Before discussion of ED nurse recruitment strategies, it is important to understand some of the issues that have affected the nursing profession in general, as well as the ED nurse specifically. The nursing shortage has waxed and waned since the early 1980s. Although a chronic shortage has existed nationwide, registered nurses (RNs) have been plentiful in one region while severe shortages exist in another.

Historically, the ED has escaped the effects of the nursing shortage because emergency nursing has been viewed by some nurses as an advancement opportunity. The overall nursing shortage impacts the ED indirectly as inpatients are increasingly boarded in the ED. EDs with flight medical units may have a greater attraction for nurses who aspire to become members of the flight team. Increased opportunities for education and professional advancement attract nurses to university hospitals due to the academic center reputation. Despite any potential draws, the hospital ED often has vacancies.

Movement of nurses in and out of the ED is a common occurrence. In the past, nurses who made frequent job changes may have been avoided by managers. However, managers also seek nurses who possess a variety of experiences and nursing expertise. The negative stigma of frequent job changes has been replaced with the belief that nurses who have made frequent job changes tend to be flexible and bring valuable experience to the department.

Although turnover is accepted and considered normal in the ED, it is important that managers do not become complacent and stop questioning reasons for vacancies. The danger is that managers may view turnover as beyond their control and inevitable. High turnover can quickly result in a dysfunctional department and decreased patient safety. Valuable information for recruitment can be gained by a thorough evaluation of frequent job changes. The top 3 professional reasons a new nurse leaves a position are poor management, stressful work, and wanting experience in ...

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