Busy emergency hospital room corridor

Emergency Nursing in 2021: What Has Changed, What Hasn’t

Emergency departments (EDs) have become busier again, with COVID-19 cases dropping in highly vaccinated states. The need for emergency room (ER) nurses has also been on the rise.

“We have had a nonCOVID volume increase,” said Ron Kraus, MSN, RN, EMT, CEN, ACNS-BC, TCRN, president of the Emergency Nurses Association (ENA). “We’re seeing what appears to be higher acuity and bigger volumes.”

A study from the Epic Health Research Network in February 2021, found ED volume dropped by half early in the pandemic and rebounded to about 75 percent of predicted volume. Those patients presenting to the ED tended to have more serious conditions, such as myocardial infarction or stroke, rather than low-acuity issues like conjunctivitis or dermatitis.

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Boarding and Overcrowding Remain Problems

All that volume leads to overcrowding, and if throughput of inpatients lags, patients end up waiting, sometimes for long periods in the ED.

Boarding patients in the emergency department while they wait for a bed in the hospital presents challenges for the ED and emergency nurses, who are now dealing with some seriously ill patients, some receiving mechanical ventilation or resting in the hallway, while also trying to keep up with the influx of patients arriving who need care.

“That is a big dissatisfier in the emergency department,” Kraus said. “It leads to a nonhealthy work environment.”

Patients boarding in the ED and their families often become frustrated and angry and might take it out on the emergency nurses. It can even be a trigger for workplace violence.

Workplace Violence Affecting Emergency Nurses

“The workplace violence is not new, but I believe that there is more awareness,” Kraus said. “I don’t know why that behavior for so many years has been allowed to happen.”

Authors of a qualitative study involving ED nurses and physicians reported in Annals of Emergency Medicine in June 2021 that verbal and physical abuse frequently occurs in a U.S. emergency department. One-third of emergency nurses and others working in the emergency setting had experienced physical assaults and nearly all of the healthcare workers had been verbally abused. Yet, few had formally filed reports. 

Kraus encourages ER nurses to report incidents of violence and fill out incident reports. He said that leads to a healthy work environment, a big priority for ENA.

The Joint Commission has released new workplace violence standards, effective January 1, 2022, which it hopes will guide hospitals in developing prevention systems, reporting mechanisms, and post-incident strategies.

Priorities for Emergency Nurses

Kraus has made COVID-19 vaccinations a priority of his ENA presidency. In April 2021, he urged everyone to become fully vaccinated, for nurses to educate others, and announced the #EducateToVaccinate campaign. Some EDs are administering COVID-19 vaccines to patients, he said.

“We highly encourage nurses to be informed, look at the evidence, and be a role model,” Kraus said.

ENA has developed a geriatric emergency nursing education course to help ER nurses better meet the needs of older adults.

“It’s another educational resource for our members and other ED nurses who care for a vulnerable population and an increasing number [of patients],” Kraus said.

ENA also launched a firearms injury prevention educational program, including tools and information to help identify patients at risk for firearm injuries and teach them how to reduce their chance of harm.  

“We encourage safe handling and safe storage of firearms,” Kraus explained. “It impacts all of us to see the violence, changing a whole community.”

The Emergency Nursing 2021 conference, sponsored by ENA, will present an opportunity to network in Orlando in September. The hybrid virtual and in-person event helps ER nurses network, learn new information and debrief.

“A lot of nurses come to recharge their batteries,” Kraus said. “We have a lot to debrief on over the last 18 months.”

Last year, ENA released “ED Nurses on the COVID-19 Front Line,” a video series, which offers a glimpse at the realities of emergency nursing during the pandemic.

With “the high acuity of people coming in and put on ventilators and the rapidly changing information, you could see the look of fear in everybody’s lives,” Kraus said. “When we all started getting vaccinated, you could see a relief around the department and a collective sigh. At least there is a little hope that we are getting to the end of this.”

Plentiful Emergency Nursing Jobs

If you’re looking for emergency nursing position, you are in luck. The job site Indeed.com currently lists thousands of ER nurse jobs across the United States, and AMN Healthcare has hundreds of ER travel nurse jobs available to nurses who are ready to take their experience on the road. Just like permanent staff, ER travel nurses care for patients suffering from trauma, strokes, heart conditions and other acute issues in a fast-paced environment.

AMN Healthcare travel ER nurses must have at least one year of hospital experience in emergency nursing; some assignments will require more. Many facilities will also require certain life support credentials.

Employers set the salary rate for ER travel assignments, which will vary based on location and other factors, but ER nurse travelers can earn up to $2,400 or more per week. As part of their compensation package, travel nurses receive housing and a per-diem stipend.

Although emergency nursing jobs may be high-stress, days off allow traveling nurses to explore different parts of the country, visit family and friends, gain a fresh perspective, and find new ways to decompress. ER travel nurses can have the best of both worlds, with assignments that offer both professional and personal perks.

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