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Recruitment, Retention, and Training:

A Busy Emergency Room Full of Patients, But Lacking in Experience

Daniel Scruggs

Bon Secours Memorial College of Nursing

Professional Role Development: Servant Leadership – NUR 4144 Dr. Ellcessor

March 27, 2018

“I Pledge”

Through working in the emergency department I have noticed there needs to be a change

in the process of which people are trained and retained. I can remember when I was new to the

unit, I noticed flaws within the training process. Now I have been there for over two years. I am

one of the senior staff members and I do training on new hires. Only being there two years is not

long at all. I can really see the problems with the process we currently have. There is no

consistency. People are being trained and released to do the job, and they are not ready. We are

a busy emergency room and if someone is not ready to be cut lose and do the job, there needs to

be additional training or counseling. Too many people are getting cleared off of orientation and

not able to properly do the job. This leads to incompetent nursing, and thus the more

experienced nurses are leaving due to not feeling comfortable in their surroundings. The

department is full of vastly inexperienced nurses. Only a few highly experienced nurses remain.

Some people have trouble with the job, and sometimes that can come down to lack of

experience. I have been an Emergency Medical Technician for about five years. I worked three

years on an ambulance in Henrico County, and worked two years as an emergency room

Technician in the hospital. I have seen my share of emergencies and medical problems.

However many of the newly hired employees do not have experience and are at times clueless.

This is something that really bothers me, because as medical professionals I expect things done

properly and this is putting people’s lives at stake.

This is a similar story in all emergency departments across America. There are too many

patients and not enough experienced providers. Nurses are being hired there without experience,

and many of the experienced nurses are leaving looking for other employment. These relatively

new nurses are left with no one to train them except for other new nurses who have a slightly bit

more experience.

Looking at the four domains of leadership from Lead Like Jesus (Blanchard, K. &

Hodges, P., 2005) we see that a leader should lead through his/her head, heart, hands, and habits.

These domains make up examples of what a good leader should do in any situation, and how to

bring the team together. Leaders also repair damage to the group or make the team move

forward with success.

A leader uses their head and creates a vision for the team. The leader should collaborate

with their staff to come up with a global vision for the department. Every person from the

manager to the cleaning staff should all have an equal say in the department vision. As the

manager, there needs to be a shared vision that includes all members, and has ideas of how to

keep staff and improve the training process. This will insure people are not poorly trained and

then leave after six months due to lack of support.

The heart of the leader should instill motivation in all the staff members. He/she works

with the staff to set goals and keep track of progress. There can be incentives for members

staying for a long time and reaching landmarks. The manager should be following them and

keep in contact with the staff to keep them focused on the goal of retention in the department.

The manager should always support the staff as needed and be available at all times.

The manager should never be afraid to get in dirt and do work. Never ask someone to do

something that you would not mind doing. The manager should step in if there is an open spot

on the schedule to be on the floor helping and supporting the nurses. The hands of the manager

are action driven. In this situation the manager should also meet with both day and night shifts

and pose the question, why can we not keep the department staffed? There needs to be feedback

created and ideas bounced around to define what the problem in the department is.

The leader’s habits are potentially the biggest part of his/her leadership style. This shows

their true character. Some people define character as to what you will do when nobody is

looking. A person’s character can say a lot about that person and can be driven by a person’s

habits. A person who is humbled, who is involved in prayer throughout their day, and has good

relationships with their coworkers/staff will have a strong since of character. This will help to

keep the manager focused on the project at hand.

Exemplary leadership skills can be used by all, not just appointed leaders. Through their

character they are to lead by example. This is them modeling the way. They live by the rules

they set upon others. Good managers always conduct themselves like they would like the entire

department to be conducted. They continue to inspire others to advance themselves. In a short

staffed unit they help nurse achieve their goals on the floor and outside of work. They create a

shared vision with the staff, and look for ways to inspire their team to explore ways to achieve it.

They lift other up and encourage others to learn and achieve more together as a whole unit.

Managers come in and challenge the process, and empower other to do the same. The process

can always be changed and questioned frequently. If there is another method of doing things,

then test it out and see if it is an improvement on the process. Through this they encourage and

empower others to act and help to lead the team. They encourage the hearts of the staff and

motivate each other to always do the right things for the benefit of the unit.

Managers need to check in with their staff and know that things are going well. They set

the tone for the culture of the department. The question is what kind of environment do they

what to provide for their team? Will the current morale of the department provide success for

the other nurses on the floor? Managers have to make these issues real, and question these very

things (Dellasege, C. & Volpe, R., 2013). At some point in our lives we have all had that

manager that was never there. If they are not there how can they focus on the issues? They need

to fix the negative by replacing it with positive. Too many people hold on to their negativity and

it will infect the entire department like a virus that cannot be stopped.

Many places are having trouble with staff retention, and now there are many new grad

nurses who have little to no experience. This was the problem for an emergency department in

the Netherlands (Ikkershiem, D. & van de Pas, H., 2012). The emergency department had very

few experienced physicians. This is similar to the standards we have today, with our quality

controls. We have to meet times, have certain criteria that patients have to meet. These are both

on a national standard and Bon Secours sets their own numbers. The managers post these and

can make people aware and hold them accountable. This new practice ensures quality measures

for all patients and helps with faster and proper patient care.

A study in Australia reported, “Employees in EDs report increasing role overload

because of critical staff shortages, budgetary cuts and increased patient numbers and acuity.”

(Johnston, A., Abraham, L., Greenslade, J., Thorn, O., Carolstorn, E., Wallis, M., & Crilly, J.,

2016). This is the same thing is all emergency departments around the globe. Nurses are

overworked and unappreciated. The job can be very stressful, there is no help when needed, if

you put together a group of inexperienced nurses it makes for an emergency department

nightmare. When people are the most vulnerable they come to the emergency room to get help.

There needs to be some experienced nurses there. Managers need to use tactics to draw in

seasoned nurses. Use pay incentives, signing bonuses, pull from travel agencies. The

emergency rooms need to be bursting at the seams with experienced healthcare providers.

Instead they are hanging on for dear life my new graduate nurses.

We have inexperienced nurses, and the number of staff nurses is low. We rely heavily on

travel nurses to complete staffing. There are always holes in the staffing sheets. There are

multiple positions listed for nurses to apply. Many are even offering sign-on bonuses for those

nurses who have emergency room experience. It is the responsibility of the nurse management

to make sure the department is properly staffed (Marquis, B. L. & Huston, C. J., 2017). Proper

staffing can help reduce safety events, and improve patient outcomes with more attention to the

patients. It can also improve times of door to discharge or admit.

With using things such as exit surveys for leaving staff, we can find areas of

improvement. Meetings can be held with current staff to openly talk about issues and find areas

for improvement. If a person is uncomfortable coming forward in a group setting, all members

will be encouraged to contact the nurse manager in private.

With addressing staffing issues, many problems will fix themselves. Travel nurses are

expensive. To use our own staff is cheaper and less time is spent for continuous training for each

new group. Nurses will feel more secure working there with a group of other nurses who have

their back if anything were to happen. It makes all the difference when a nurse feels supported

by the other staff and their manager. Having more experienced nurses would help to provide

more brains with higher knowledge and experience. Better patient outcomes would come about,

and improve the quality of care for patients seen in the emergency setting.


Blanchard, K. & Hodges, P. (2005). Lead like Jesus. Nashville, TN: Thomas Nelson.

Dellasege, C. & Volpe, R. (2013). Toxic nursing: managing bullying, bad attitudes, and total

turmoil. Indianapolis, IN: Sigma Theta Tau International.

Ikkershiem, D. & van de Pas, H. (2012). Improving the quality of emergency medicine care by

developing a quality requirement framework. International Journal of Emergency

Medicine 5:30. doi:10.1186/1865-1380-5-20.

Johnston, A., Abraham, L., Greenslade, J., Thorn, O., Carolstorn, E., Wallis, M., & Crilly, J.

(2016). Staff perception of the emergency department working environment. Emergency

Medicine Australia 28(1), 7-26. doi: 10.1111/1742-6723.12522.

Marquis, B. L. & Huston, C. J. (2017). Leadership roles and management functions in nursing:

Theory and application (9th ed). Philadelphia, PA: Wolters Kluwer.