Emergency nursing care provided despite problems with Emergency Department access

There has been considerable media attention given to the difficulties of providing care to
patients in overcrowded emergency departments. In particular, concerns have been raised
regarding the increased demands for emergency care services resulting in ambulance
patients being transferred to trolleys in emergency department corridors and perceptions
about the care that they then receive.

The College of Emergency Nursing Australasia (CENA) deems that caring for patients on
trolleys in emergency department corridors and in unapproved treatment spaces is
unacceptable. Hospitals and health services should view the inability to allocate a patient to
staffed, equipped treatment spaces within the emergency department as a serious adverse
event.

CENA reassures the public that specialist emergency nurses assess every patient who
attends the emergency department through the triage process, and that emergency nurses
provide assessment and care to all patients, irrespective of their location within the
emergency department.

“Emergency nurses are committed to providing safe and high quality emergency care, and
typically do so in challenging working conditions. Equity of access to emergency care is
fundamental to emergency nursing. Nursing resources are distributed according to patient
needs, not where the patient happens to be physically located within the emergency
department” said CENA Executive Director, Lee Trenning. “The College and its members
work collaboratively with our medical and paramedic peers to facilitate appropriate care for
patients presenting to emergency department by ambulance, including those patients for
who there is a delay in accessing the emergency department”.

CENA encourages the public to continue to lobby Governments for timely access to
emergency care and for an integrated health system where ambulance, emergency and
inpatient services can provide the best possible care to the communities that they serve

National Health Performance Authority Update Report on Time in Emergency Departments.

The College of Emergency Nursing Australasia (CENA) is pleased to acknowledge the publication of
the National Health Performance Authority’s Update Report Time patients spent in emergency
departments in 2012 and 2013(1).

The Report tracks hospital performance for the percentage of patients leaving emergency
departments within four hours of arrival (known as the National Emergency Access Target). The
findings in the Report reveal there has been marked improvement in the percentage of patients
departing emergency departments within four hours, particularly in major metropolitan hospitals,
and to a lesser extent in major regional hospitals.

The National Emergency Access Target was established in 2011 under the National Partnership
Agreement on Improving Public Hospital Services2. Individual annual targets were established for
each state and territory with a final target of 90 per cent to be achieved by 2015. The College
supports the implementation of the target, as outlined in the Position Statement on the National
Emergency Access Target(3).

CENA congratulates all clinicians contributing to the reform and redesign efforts necessary to
achieve the improvements in access to care through emergency departments. “The improvement in
timely access to emergency departments requires engagement at all levels to achieve change across
the health system and it is positive to see the achievements in many Australian public hospitals” said
CENA Executive Director, Lee Trenning

“However, the College is concerned that the removal of reward funding associated with National
Emergency Access Target, announced earlier this month by the Australian Government in the 2014
Budget, will create a disincentive to further improvement in this area” said Lee Trenning.

Without the resources and incentives allocated to these health reforms, health services will struggle
to meet the growing demand for emergency department services. Meeting this need requires a
focus on improving patient care, through advancing models of care and streamlining the delivery of
timely emergency care.

The College of Emergency Nursing Australasia (CENA) is the peak professional association representing emergency nurses across
Australasia. CENA represents nurses from small regional and rural hospitals through to large metropolitan emergency departments.
CENA urges the Minister for Health Peter Dutton to meet with representatives from CENA and other
professional bodies to discuss ways to lead sustained improvements in access to emergency
departments and acute care.

(1) www.nhpa.gov.au
(2) http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/npa-improvingpublichospitalsagreement/$File/National%20Partnership%20Agreement%20on%20Improving%20Public%20Hospital%20Services.pdf
(3) http://cena.org.au/CENA_Mer/Resources/Position_Statements/CENA_Mer/Resources/Position_Statements.aspx?hkey=54413819-e458-4a2d-942a-7ff17571366fCollege of Emergency Nursing Australasia

ENDS

Released: 29 May 2014
Contact: Lee Trenning
Executive Director- College of Emergency Nursing Australasia
College of Emergency Nursing Australasia
Email: national@cena.org.au
Web: www.cena.org.au
Tel: +61 03 9895 4433

GP co-payments a real concern for Emergency Departments

The Federal Treasurer last night handed down the Budget which included co-payments for visits to a General
Practitioner, out-of-hospital pathology and imaging.

The College of Emergency Nursing Australasia (CENA) is disappointed in the decision to implement a copayment
system for the following reasons:

CENA supports health policy that reduces inequities in health care provision and ensures accessible and
equitable health services for all. “As Emergency nurses we see that there are vulnerable people in the
community who experience multiple barriers to accessing primary health care services. A number of these
people have significant health care needs and less capacity to pay for services. The introduction of a copayment
system will create another barrier to accessing health care leading to poorer health outcomes”, said
emergency nurse and CENA Executive Director, Lee Trenning.

The implementation of a co-payment system will result in patients delaying accessing health care or seeking it
from the wrong part of the system, putting extra burden on public hospital emergency departments that are
already under immense pressure and overcrowded. CENA opposes the Australian Government
recommendation for states to introduce an emergency department fee for ‘GP type patients’. This policy risks
those patients who are unable to afford the payment having nowhere to go, and has the potential for
significant adverse patient outcomes.

CENA does not support a policy that erodes appropriate and timely access to emergency care, or the
additional administrative burden that such policy would create.

CENA considers that the provision of Universal Access to Health Care for All is our greatest priority irrespective
of the ability to pay a fee for service. CENA would welcome opportunities to work with other professional
bodies and the Australian Government to create a more effective and sustainable health system.

ENDS
Released: 14th May 2014
Contact: Lee Trenning
Executive Director- College of Emergency Nursing Australasia
College of Emergency Nursing Australasia
Email: national@cena.org
Web: www.cena.org.au
Tel: +61 7 3735 5406
Fax: +61 7 3735 5431

College of Emergency Nursing Australasia
The College of Emergency Nursing Australasia (CENA) is the peak professional association representing emergency nurses
across Australasia. CENA represents over 1200 nurses nationally and internationally from small regional and rural hospitals
through to large metropolitan emergency departments.

CENA supports Victorian Ambulance Transfer Taskforce recommendation

The Victorian Ambulance Transfer Taskforce has recently recommended that hospitals accept
immediate responsibility from ambulance paramedics for patients transferred to the emergency
department. This recommendation aims to reduce the excessive time spent by paramedics in
emergency departments before handing over care of their patient to ED clinicians and this goal is
supported by the College of Emergency Nursing, Australasia (CENA).

Paramedics play an important role in commencing emergency care and delivering patients to the
emergency department. It is vital that these clinicians do not continue to spend excessive periods of
time ramped in emergency departments if they are to provide an effective community based
emergency service. It is in the interests of patients to have them back on the road.

To make it possible for EDs to release paramedics, the ED must be in a position to assume
responsibility for these patients. College Executive Director and Victorian Branch President,Di Crellin
highlights that frequent ramping of patients in EDsis clear evidence of a system that is overstretched
and unable to provide appropriate levels of service to meet the community’s needs.

‘It is our concern that our EDs are not currently adequately resourced to apply this recommendation
regardless of its merit’ she says. ‘We often don’t have a bed or a staff member in our EDs to care for
a newly arrived patient. We rely heavily on our paramedic colleagues to ensure patient safety.’

The College of Emergency Nursing Australasia considers the provision of safe and effective care to
emergency patients to be our greatest priority and call on the Victorian government to support the
Taskforces important recommendation with provision of sufficient resources to hospitals and their
EDs to match the demand for service.

For more information contact:

Di Crellin
CENA Executive Director and Victorian Branch President
0401 314 339
di.crellin@gmail.com
Date released: Tuesday 12 November 2013

Experts debate the future of emergency department care

There has been a 20% increase in the number of patients attending emergency
departments over the last 5 years and the numbers continue to grow. Australian emergency
departments now manage over 6 million attendances per year. Reform isn’t just desirable,
it’s a necessity.” according to eminent Australian emergency physician Professor Gerald
FitzGerald.

The countdown is on.
On 12th October 2012, experts from around the world will debate the future of emergency
department care in Australia when they meet at the 10th International Conference for
Emergency Nurses in Hobart Like many other countries, Australian EDs are struggling with
increasing demand for emergency healthcare services, overcrowding and lack of access to
hospital beds. Emergency department staff face daily challenges of providing high quality
care for critically ill patients while handicapped by lack of hospital beds and emergency
department overcrowding.

Key questions include:

  • is the traditional way emergency departments function obsolete in 2012?
  • what new roles can emergency nurses play in emergency care delivery?
  • how to measure quality and safety of emergency care?

Some of the other panel experts include:

  • Dr Rosemary Bryant, President of the International Council of Nurses and Australian Commonwealth Nursing and Midwifery Officer
  • Peggy Lee, President of the Emergency Nurses Association
  • Dianne Crellin, Executive Director, College of Emergency Nursing Australasia and Emergency Nurse Practitioner

Dianne Crellin, Executive Director of the College of Emergency Nursing Australasian says “it is important that emergency nurses understand the social, political and clinical influences on emergency care. As the largest workforce in emergency departments, emergency nurses
need to make informed decisions about how to best care for their patients and have an active role in emergency care reforms.”

ABC Journalist Jane Hutcheon will drive debate as panel members challenge existing thinking and propose radial solutions to managing the growing demand for emergency healthcare into the next decade.

For more information, contact:

  • ICEN Scientific Co-convenor Associate Professor Julie Considine at
    julie.considine@nh.org.au / 0409354133
  • ICEN Scientific Co-convenor Associate Professor Ramon Shaban at
    r.shaban@griffith.edu.au / 0417600544
  • ICEN Conference Convenor Tony Bradley at tony.bradley@dhhs.tas.gov.au / 0439
    241 217

AHPRA to apologise to health practitioners

A report by the Senate Finance and Public Administration References
Committee details the findings of their inquiry into the management of
health practitioner registration by the Australian Health practitioner
Registration Agency (AHPRA) who have recommended that AHPRA
apologise to practitioners who were deregistered as a result of deficits in
AHPRA’s management of registration. The inquiry received submissions
from a number of groups representing the 11 health professions which
are now registered with AHPRA, highlighting the considerable number of
problems that occurred during the transition from State registration to
National registration.

Nurses applying for nurse practitioner endorsement have been
particularly disadvantaged by AHPRA. Emergency employs the largest
number of nurse practitioners and they provide a valuable service to
patients who otherwise wait for long periods of time in emergency
departments before being seen. ‘We have nurses who applied for
authorisation to work as nurse practitioners last year who have still not
received a decision from AHPRA.’ said Ms Di Crellin the Executive
Director of The College of Emergency Nursing Australasia (CENA). ‘This
limits the care that can be provided to patients in emergency
departments.’

‘CENA members welcome a national health practitioner registration
system. However, it seems obvious that moving health practitioners from
State registration to national was a huge job and not enough resource
has been allocated to be able to do this properly.’

We are pleased that the Senate inquiry has highlighted some of the
problems and made recommendations to ensure that they are fixed
quickly so that health practitioners, including nurses, can get back to
caring for patients.

The inquiry recommendations are as follows:

1. AHPRA should issue a letter of apology to practitioners who were
deregistered because of the problems revealed by the inquiry and, where
it is established a lapse or delay in registration took place, AHPRA
should reimburse practitioners for any loss of direct Medicare payments

2. AHPRA should rectify any situation where a practitioner is left liable
due to their professional indemnity insurance lapsing, or being voided,
during a period where they were deregistered by AHPRA’s administrative
failings.

3. The federal government should seek the support of the Australian
Health Workforce Ministerial Council to undertake a regular review of the
registration of overseas trained health practitioners.

4. Key Performance Indicators should be established in relation to the
registration of overseas trained health practitioners and AHPRA provide
detailed information on this matter in its annual report.

5. Complaints processing within AHPRA to be reviewed to ensure more
accurate reporting of notifications and to reduce the impact of vexatious
complaints on health practitioners.

6. The federal government should seek the support of the Australian
Health Workforce Ministerial Council to identify and establish
mechanisms to improve the accountability of AHPRA to the parliaments
of all jurisdictions and the Australian public.

7. AHPRA, as a matter of urgency, should establish consultative groups
with professional organisations and health providers.

8. The National Law to be amended to provide AHPRA with the
discretion to grant a grace period where a health practitioner faces
deregistration as a result of administrative error by AHPRA.

9. The Australian Health Workforce Ministerial Council to amend the
National Law to provide further practicing classifications for practitioners
in academic institutions and for those who practise in a limited manner.

10. The Australian Health Workforce Ministerial Council to implement a
review of the mandatory notifications requirements and in particular take
into account the Western Australia model of mandatory reporting.

The complete report can be viewed at this link
http://www.aph.gov.au/senate/committee/fapa_ctte/health_practitioner_registration/report/index.htm

New funding is a win for emergency nurses and their patients

Lee Thomas, federal secretary of the Australian Nursing Federation, said new funding for emergency nurses will provide a more highly skilled workforce in emergency departments.

“It is imperative that we encourage more people into nursing and then continue to develop their skills throughout their working life so patients receive the best possible care.”

Ms Thomas said the funding demonstrated the government had taken nurses and their patients concerns seriously and made an announcement for a further investment in nurses and support staff so that the community would benefit from more timely care and experienced staff.

“Not only will the funding help patients but it will free nurses from administration duties so they can focus on their job.”

“Nurses also have well founded concerns about administrative duties taking up their time – we welcome theGovernment’s announcement of $600,000 to fund about 100 scholarships a year for clerical and non-clinical support staff so that nurses can get on with the job of looking after patients.”

“There will be $15 million to educate more emergency department nurses. This includes 100 additional scholarships for nurse practitioners to work in emergency. Nurse practitioners are experts with the ability to provide very high quality healthcare. “That’s why we are very happy the funding will provide for about 100 additional postgraduate scholarships in emergency nursing a year and about 100 additional scholarships in continuing professional development opportunities.”

“Importantly, clinical placements and graduate nurse places will provide well supported clinical supervision for students and nurse graduates. This continues to be an issue with some sectors lacking educators to help nurses transition.”

“This is a well thought out package that not only provides training opportunities for existing nurses in ED but also experience and mentoring for new graduates, all of which ultimately assist nurses to provide timely care.

Media Contact
Eleni Hale, Media Advisor, 0458 892 999

RESEARCH GRANT SUCCESS – H1N1 INFLUENZA 09 MEDICAL RESEARCH PROJECTS FAST-TRACKED

The College of Emergency Nursing Australasia is delighted to advise that a national research
study entitled ‘Emergency Department impact and patient profile of H1N1 Influenza 09
outbreak in Australia: A national survey’ has been successful in receiving a grant of
$106,136.

Emergency Departments (EDs) are at the forefront of Australia’s health disaster response;
providing immediate patient care and system wide patient facilitation. The recent outbreak
of H1N1 Influenza 09 has demonstrated the diversity of roles of EDs in disease containment
and management but also provides an opportunity to describe the extended clinical impact of
pandemic disease. The outbreak has had a significant impact on EDs with large numbers of
patients presenting with flu-like illness. This impact has occurred at a time when EDs
confront continual problems of overcrowding associated with Access Block and growing
demand. The survey of emergency departments will be completed within six months.
Emergency Departments will be asked about how they managed the people with flu-like
symptoms when they arrived, in terms of masks, quarantine and the impact on staff, so that
this information can inform future policy, planning and response management for pandemic.

This project is highly significant for developing Australia’s management of pandemics. A
clearer understanding of the full impact of the disease on Emergency Departments and the
strategies taken by EDs to manage the outbreak is essential to better inform health system
policy, planning and preparedness. The extension of this pandemic into the northern
hemisphere winter is likely to have a significant impact on community health as well as on
health services. A detailed understanding of the broader burden of the disease, along with
the response strategies required within EDs, will help prepare health systems to cope with
the potential impact.

Under the leadership of Professor Gerry FitzGerald, the study is a collaborative endeavour of
three universities (Queensland University of Technology, Griffith University and James Cook
University) and the three peak emergency medicine and nursing Colleges in Australia, the
College of Emergency Nursing Australasia (CENA), the Australasian College for Emergency
Medicine (ACEM), and the Australian College of Emergency Nursing (ACEN). The College of
Emergency Nursing Australasia would like to acknowledge Mr Ramon Shaban, one of the
Chief Investigators, for his role in initiating the development of this study. The grant was one of 41 Australian research projects that will help ensure the Australian

Government’s response to the evolving threat of H1N1 is based on the most up-to-date
information available, and help the Government tailor its response to the spread and nature of
the disease, and better equip the Government to help those most at risk. $7 million has been
provided for these projects from the National Health and Medical Research Council
(NHMRC). NHMRC has fast-tracked a robust international peer review of applications for
medical research grants to identify the critical projects that would best shed more light on
H1N1. This process can normally take many months, however NHMRC achieved this within
one week through involvement of highly experienced researchers from Australia, Singapore,
New Zealand and the United Kingdom. The quick, collaborative international response seeks
to take advantage of the current Australian flu season to learn much more about the virus. The
results will be shared internationally, and will be particularly valuable for those countries who
are currently preparing for their coming flu season. Researches will report their findings at a
symposium in December 2009 attended by the Chief Medical Officers of Australia and each
state and territory, as well as public health experts(1).

Media contacts: Julie Finucane OAM, Executive Director CENA – 0418 758 661

(1) NHMRC Media Release dated 8th July 2009. http://www.nhmrc.gov.au/media/media/rel09/090708-h1n1-fast-track.htm

Resources in Emergency Departments (NSW Branch)

The College of Emergency Nursing Australasia Ltd. (CENA) is the peak national nursingspecialty organisation representing emergency nurses.

The NSW Branch of the College of Emergency Nursing Australasia Ltd. responded to media reports
surrounding issues relating to a woman who miscarried in the waiting room toilets of the Emergency
Department of Royal North Shore Hospital, Sydney.

The state government announced an inquiry into the treatment of “patients presenting with
miscarriages or threatened miscarriages” in the public health system yesterday.
NSW President and National Director Toni McCallum Pardey said: “The fact is there are insufficient
resources in Emergency Departments throughout NSW. Emergency Departments lack adequate
levels of human, educational, technological, facility and ancillary resources. There is insufficient
funding for nursing staff levels to meet the needs of emergency patients.”

Nurses, in particular Triage Nurses, who are the front-line in emergency departments, are exposed on
a daily basis to abuse from exasperated and irate patients, their family members or friends, whose
expectations for prompt, quality care are unable to be met, Ms McCallum Pardey said.
“The recognition that resources are grossly overstretched is not new, nursing and medical staff having
been highlighting their concerns for many years” Ms McCallum Pardey said.

“Emergency Nurses have worked hard to improve services they provide to patients in an effort to
streamline treatment and decrease waiting times. The Scope of Practice for emergency nurses has
extended significantly in recent years.

Yet by extending the Scope of Practice, compounded by ever increasing demand for service, the
problem of unreasonably heavy workloads for emergency nurses has worsened.”
“International evidence clearly demonstrates that an inadequate number of university educated
registered nurses is associated with significantly higher risks of adverse outcomes for patients,
including death,”1,2 Ms McCallum Pardey said.

“There is no Emergency Nursing workforce tool used in NSW to establish appropriate nursing staff
numbers. Nurses are forced to work with inadequate staffing levels in an attempt to meet the needs of
patients.

In response to media reports that the inquiry will be conducted, CENAs position is clear: any review of
patient care must include an appropriately qualified nurse,” Ms McCallum Pardey said.

References
1 Needleman, J., et al. Nurse staffing levels and the quality of care in hospitals, New England Journal of
Medicine, 2002, 346:22, pp.1715-1722.

2 Cho, S., et al. The effect of nurse staffing on adverse events, morbidity, mortality, and medical costs, Nursing
Research, 2003, 52:2, pp. 71-79.

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