The Impact of Emergency Department Overcrowding: Effect on Nursing Professional Practice and Patient Care
Emergency departments (ED) are essential as they offer immediate medical and surgical care to acutely ill or traumatic injury patients. Overcrowding at the ED can cause the nursing team to be overwhelmed, thus compromising patient care quality and negatively affecting treatment outcomes. Ideally, nurses should exhibit competency and offer quality input in their line of duty to avoid medical and medication errors that can be fatal. To achieve this, hospitals should have adequate staffing levels to ensure all departments, including the ED, have enough nurses to handle the patient influx. However, even with proper staffing levels for nurses, the ED can experience overcrowding that potentially leads to increased incidences of medication errors, nurses’ burnout, and mortality due to impaired emergency response.
First, patient numbers beyond the maximum capacity can precipitate confusion and mix-up during treatment due to the pressure on the nurses to deliver timely care to every patient. A study by Schroers et al. identified contextual factors that included frequent distractions, excessive workloads, inappropriate working conditions, and job-related pressure as the most frequently identified causes of medication errors (2020). When nurse-to-patient ratios decrease, the effect is a chaotic environment with more patients demanding attention. This situation can lead to medication errors that include a patient receiving the wrong medication, improper drug administration, or nurses administering the wrong dosage. As a result, ED overcrowding can impact nurses’ professional practice by presenting all the above contextual factors affecting patient care.
Secondly, the workload during overcrowding in the ED translates to increased fatigue among nurses. Burnout is a chronic job-related danger within the ED that affects many physicians and nurses alike (Schneider et al., 2019). Essentially, nurses’ burnout leads to suboptimal patient care. It is associated with mental exhaustion that impairs performance, lethargy that reduces their reaction time, and subsequent psychosocial pressure from perceived lack of support. Hence, burnout among nurses is hazardous to patient safety and compromises the care provider’s well-being. All the effects of burnout affect professionalism among nurses and threaten patient safety.
Lastly, overcrowding can impair emergency response when ambulance diversion is initiated at a congested ED, leading to increased mortality of critical care patients. Ambulance diversions are ineffectual and contribute to patient harm due to delayed care (Kelen et al., 2021). Notably, it denies patients timely interventions of their medical conditions, causing avoidable fatalities. The significant distress meted out on these patients during the long travels to alternative ED centers disproportionately increase morbidity and mortality rates. Moreover, when diversion occurs, the ambulances are not immediately available for other patients who may urgently require such services. In turn, more fatalities may arise from one diversion case.
In conclusion, ED overcrowding is a danger to patient safety and negatively affects nurses’ professional practice through the resulting workload. Hospitals should have well-structured action plans to protect patients and nurses from ED overcrowding. Therefore, investing in robust patient management systems at the ED and effective communication with ambulance services could reduce overcrowding and its consequences. Again, enacting favorable health policies that enable continuous and sustainable funding to hospitals for ED expansion and staffing can greatly improve the healthcare system.
Kelen, G.D., Wolfe, R., D’Onofrio, G., Mills, A.M., Diercks, D., Stern, S.A.,…Sokolove, PE (2021). Emergency department crowding: The canary in the health care system. Innovations in Care Delivery Journal, 3(1), 1-26. https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0217
Schneider, A., Wehler, M. & Weigl, M. (2019). Effects of work conditions on provider mental well-being and quality of care: A mixed-methods intervention study in the emergency department. BMC Emergency Medicine, 19(1), 1-12. https://doi.org/10.1186/s12873-018-0218-x
Schroers, G., Ross, J.G., & Moriarty, H. (2020). Nurses’ perceived causes of medication administration errors: A qualitative systematic review. The Joint Commission Journal on Quality and Patient Safety, 47(1), 38-53. https://doi.org/10.1016/j.jcjq.2020.09.010
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