Nurse's Station

How to Destroy a Great ER: A Step by Step Guide


3. When the ER is showing signs of distress, address it by creating more administrative positions. The wait times are long, the patients are angry, and the staff is overwhelmed. Conventional wisdom would argue that increasing clinical FTEs is a reasonable first step. Ignore conventional wisdom. True geniuses “think outside the box.” What that struggling ER really needs is another layer of administrators to right the ship. It would be best to promote a few of the exceptional clinical nurses who haven’t yet left to these new administrative positions, where they can truly shine.

4. Automatically turn down any request from clinical staff in the name of saving money. It’s great that all employees see your multi-million dollar administrator salary which increases on a yearly basis. What better way to create a culture of honesty, generosity, and respect? Your organization is a non-profit, so your employees know already that you’re a great humanitarian.

5. No one knows the unique struggles, challenges, and problems that your emergency department faces like an outside consultant. These consultants are professionals, and are well worth the price tag. They can show up, flip through a few spreadsheets, and instantly tell you what to correct. Nothing improves staff morale like a mandatory meeting with a stranger telling them all the ways they are doing their job wrong.

6. Make sure your EM physicians are constantly reminded that they have no negotiating power. You have the say on whether their contract is renewed. There are two ways they can choose to do it: your way or the highway. A collegial relationship with your physicians is terribly overrated.

7. All of the many EDs in your system are doing exactly the same thing, so it is fair to directly compare them to each other. Sure, there may be vast differences in patient volume, staffing levels, acuity, EMS arrivals, admission percentage, available hospital beds, payer mix, patient age and education level, etc. across your emergency departments. All of these factors even out. It is perfectly reasonable to compare the satisfaction scores and wait times of a low-volume free-standing ER in an affluent area with the ED of a tertiary referral hospital which is crushed by volume and acuity on a daily basis. Make it easy on yourself by keeping the spreadsheet simple.

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