Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN, Wilmington, DE


hope that those of you who have been reading my editorials this year have picked up on my passion for patient safety and our opportunity as individual nurses to have a significant positive impact when delivering safe patient care. One day, regardless of what emergency department you are standing in, who your teammates are on the shift, which physician is working, or how busy it is, care will be error free. Until we get there, we must commit to a culture of continuous improvement. We must not be afraid of trying something new, turning ED flow and throughput on its ear, and constantly measuring and reevaluating what works and where the opportunities lie to deliver better, safer, patient care. One of the incredible opportunities I have had while serving on the ENA Board of Directors has been to visit emergency departments in other countries. I have had the privilege of visiting emergency departments in Mexico, Australia, Cuba, and Abu Dhabi, as well as meeting with ED nurses from the United Kingdom, Costa Rica, Brazil, Canada, Barbados, The Netherlands, Ireland, Israel, the Philippines, and many other countries. The more places I visit and the more ED nurses I meet, the more I begin to understand the similarities in emergency nursing practice. When I walked into the emergency department in Al Rabha hospital in Abu Dhabi, United Arab Emirates, the

Deena Brecher is President of the Emergency Nurses Association. For correspondence, write: Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN, Emergency Nurses Association, 915 Lee St, Des Plaines, IL 60016; E-mail: [email protected] J Emerg Nurs 2014;40:297. 0099-1767 Copyright © 2014 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

July 2014


first thing I noticed was a large electronic dashboard. On it were the current door-to-physician time, the number of patients waiting to see a provider, and the daily averages for the two metrics. They were practicing immediate bedding, provider in triage, and split flow. All around the department were messages about patient safety, hand washing, performance improvement metrics, and professional nursing development. It was exactly what I observed when I was in Australia. As a matter of fact, each time I have the opportunity to chat with an ED nurse from another country, I find far more commonalities in our practice than I find differences. The issues of crowding and throughput are always at the top of our minds, and similarities exist in our approaches to managing these issues. Patient safety and performance improvement follow closely, with a focus on processes and procedures to enhance patient and staff safety. Sadly, workplace violence and bullying are also high on the list. It is easy for each of us to work in our own emergency departments and think that the issues, problems, opportunities, and solutions are unique to our own locations. It is also easy to feel as if the changes and solutions being presented, while they may have worked at the hospital down the street, are not going to be successful in “my house.” I am here to tell you that we are all in this together. Continuous improvement and the drive for zero errors are not unique to the United States, nor are they unique to your emergency department. Sometimes, stepping outside of your place of work provides the opportunity to see the bigger picture. Innovation is happening in departments all over the world, and if I would guess, in your own back yard. We can do a better job of sharing what works and being open to new possibilities, and stop engaging in behaviors and actions that sabotage these new processes. It is through my involvement with ENA that I have learned just how similar emergency nursing practices can be. Journals like this one provide the opportunity for sharing of new knowledge and innovation. Take these new ideas and try them in your own department. If you have successfully implemented new processes, then it’s up to you to share the ideas, processes, and learning you have gained with the global emergency nursing community. One of my favorite things about the profession of emergency nursing is that each of us brings a unique set of skills and experiences to our practice. Sharing ideas, successes, and lessons learned will make our profession that much stronger. Our patients are counting on us!



We are all in this together.

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