Can Education and Staff-based Participatory Research Change Nursing Practice in an Era of ED Overcrowding? A Focus Group Study

Abstract

In our facility an operational process intervention was implemented to decrease overcrowding. The intervention consisted of implementing criteria (developed from a series of 8 interactive workshops led by the investigators with all charge and staff nurses) describing when we should "close the waiting room." The purpose of this study was to explore the charge nurses' perceptions of the intervention and their experiences with implementation several months after the operational change began. All charge nurses were invited to attend 1 of 2 focus groups that elicited participants' knowledge of the closing criteria as well as their use and perceptions of the criteria. Participants were asked to identify how often they had been able to close the waiting room or keep it closed and to note whether they used the developed criteria. Barriers and facilitators to closing the waiting room were also discussed. Charge nurses had internalized the criteria and reported that most of the time the waiting room was often closed between the hours of 3 and 9 am. Evening charge nurses, in particular, reported feeling a positive impact from waiting room closure during these hours earlier in the day. Facilitators included charge nurses receiving positive feedback from patients and perceiving an improvement in patient safety as fewer patients were waiting. Specific barriers included negative staff attitudes and hospital overcrowding. Feedback from focus group analysis with charge nurses responsible for closing the ED waiting room suggests that the operational change has been positive because of the staff-based participatory research methodology used to create the intervention.