The ED tends to attract certain personality traits, Massingale says. "These people are fairly self-confident, action-oriented, and willing to risk being wrong for the sheer pleasure of knowing that most of the time they are right." Generally speaking, ED clinicians thrive on the energy of a frenetic pace, hate being bored and don't necessarily know what to do with downtime. Unlike in other areas of the hospital where the ups and downs of patient flow are fairly predictable, staffing an emergency department's downs can be just as challenging as maintaining its ups, Massingale says.
NMMC-Tupelo changed its ED process to involve all caregivers all the time, dividing the patient load more evenly, and triaging patients at the bedside. "When I arrived, everybody came in the front door the same, everybody talked to one person--the nurses in the back were hanging around. We had nurses at the back with empty beds and 20 people in the lobby trying to get through one nurse," Della-Calce remembers.
Not all staff agreed with NMMC-Tupelo's change to patient-centered care; the hospital lost 17 nurses through the ED transition and brought in a new physician leadership team this summer. "It was made clear that you have to be on board with this," Stokes says.
Part of an ED's culture depends on how patients and families are treated from the moment they walk in the front door. Families were something that NMMC-Tupelo's ED had neglected before Della-Calce came on board. Prominently placed signs listed strict visitation policies, and patients were limited to just two visitors. The patients, many of them from rural areas outside of Tupelo, did not have access to telephones to contact their loved ones. This changed the whole atmosphere of the department.
"The environment was real loud when I got here because families were calling to the registration out front and they were constantly paging families to come to the phone," Della-Calce says.