The impact of overcrowding on the practice environment for emergency department nurses

Overcrowding in the Emergency Department (ED) occurs when there is an imbalance between resource supply and demand. In other words, the ED is challenged to provide quality care within acceptable time frames. Overcrowding literature illustrates that ED overcrowding has become so common that it is now considered normal, which begs the question: are terms such as "overcrowded" still pertinent to the current context of the ED environment in which overcrowding is a normal state? A recent and growing body of Canadian literature describes negative workplace environments in acute care facilities, but there is as yet no literature that examines overcrowding in relation to workplace environments in the ED. This interpretive descriptive study examines the relationship of overcrowding to the practice environment of emergency departments. Data were collected over six months and included in-depth interviews with ten experienced emergency department nurses. These data illustrate the negative impact of overcrowding on the emergency department environment. Emergency department overcrowding has occurred in parallel with fundamental restructuring of the health care system, creating a new era environment. This new environment is characterized by chronic overcrowding and an equally chronic shortage of resources. Within this environment nurses face several new challenges, such as understanding the discourse of overcrowding, reconciling conflicting values, and navigating the cycles of tension that arise from this new situation. Many of the changes to the ED have resulted from changes imposed elsewhere in the system, such as the closure of acute care beds. EDs are consequently in a state of transition as health care providers attempt to put the pieces back together. Within this new era environment many challenges have emerged and data analysis suggests that new era EDs support negative workplace environments. It is crucial that policy makers be well informed when making decisions that impact EDs. In order to be able to influence policy makers it is essential that nurses be proactive and involved in charting the course for the future. It is also necessary for organizations to invest in leadership by creating appropriate positions at appropriate levels so that leaders can be visible and available to create vision and help nurses through the transition to the new era environment. This study argues for the need to create an increased body of research that will inform policy makers about how ED overcrowding negatively affects the practice environment.Applied Science, Faculty ofNursing, School ofGraduat