The work of patient flow management: A grounded theory study of emergency nurses.

INTRODUCTION: The current crisis of emergency department overcrowding demands novel approaches. Despite a growing body of patient flow literature, there is little understanding of the work of emergency nurses. This study explored how emergency nurses perform patient flow management. METHODS: Constructivist grounded theory and situational analysis methodologies were used to examine the work of emergency nurses. Twenty-nine focus groups and interviews of 27 participants and 64 hours of participant observation across four emergency departments were conducted between August 2022 and February 2023. Data were analyzed using coding, constant comparative analysis, and memo-writing to identify emergent themes and develop a substantive theory. FINDINGS: Patient flow management is the work of balancing department resources and patient care to promote collective patient safety. Patient safety arises when care is ethical, efficient, and appropriately weighs care timeliness and comprehensiveness. Emergency nurses use numerous patient flow management strategies that can be organized into five tasks: information gathering, continuous triage, resource management, throughput management, and care oversight. CONCLUSION: Patient flow management is complex, cognitively demanding work. The central contribution of this paper is a theoretical model that reflects emergency nurses'conceptualizations, discourse, and priorities. This model lays the foundation for knowledge sharing, training, and practice improvement.

Empowerment Through Academia.

This is the sixth article in a series on nurse innovators, which focuses on nurse-engineer partnerships and outlines working, replicable models of collaboration between the two disciplines. In this installment, we describe the role of academia in building the next generation of nurse-engineers, highlighting three novel academic programs that have reimagined nursing and engineering education to promote interdisciplinary partnership and innovation.

Improving Bruise Detection in Patients with Dark Skin Tone.

This is the fifth article in a series on nurse innovators, which focuses whenever possible on nurse-engineer partnerships and outlines working, replicable models of collaboration between the two disciplines. In this installment, we profile Katherine N. Scafide, a forensic nurse and researcher, who has partnered with engineers over many years to improve bruise detection in patients with dark skin tone.

"Nurses are every bit of the flow:" Emergency department nurses' conceptualization of patient flow management.

AIM: To validate and refine Benjamin and Jacelon's 2021 definition of patient flow management using the experience and knowledge of practicing emergency department nurses. BACKGROUND: Patient flow requires complex, real-time decision-making to match patients to limited resources and facilitate their movement through care processes. A literature-based concept analysis of patient flow management was first performed in 2021, but the voice of nurses is largely absent from existing patient flow research. DESIGN: This study employed an expanded concept analysis methodology, as articulated by Kathleen Cowles. DATA SOURCE: Focus groups of nine emergency nurses were conducted. RESULTS: Emergency nurses' conceptualization of patient flow management differs from the definition as it has emerged through patient flow literature. Patient flow management is a nurse-driven process that relies on nursing knowledge and the work of all emergency nurses, including bedside nurses. Emergency nurses perceive the ultimate goal of patient flow management to be the collective safety of patients, and they work to promote patient safety within their own scope of responsibility. CONCLUSION: Understanding patient flow management as a nurse-driven process emphasizes the importance of nurse training and capacity to effective patient flow. Future research should explore the role of emergency nurses as active directors, rather than passive components, of patient flow. More work is needed to investigate this complex nursing task.

INNOVATE: Preparing Nurses to Be Health Care Innovation Leaders.

A new certificate program has been designed that augments the traditional undergraduate nursing education with a curriculum of innovation and entrepreneurship. The goal of the Integrated Innovation & Entrepreneurship Certificate in Nursing Program (INNOVATE) is to empower nurses to collaboratively solve health care challenges and become thought leaders in health care products, technologies, and processes, as well as service and delivery methods, with a particular focus on the needs of vulnerable populations. Toward this goal, INNOVATE is built on an integrative, immersive curriculum, experiential learning, intentional cohort building, peer and faculty support, real-world connections, and the prioritization of diversity, inclusivity, and equity to build of a cohort of nursing students ready for careers in clinical and health care innovation. In this article, we provide the outline for the proposed curriculum, program strategies, anticipated outcomes, and evaluation criteria that we believe can serve as a national model for innovation and entrepreneurship in undergraduate nursing education.

An analysis of the concept of patient flow management.

AIM: To analyze the concept of patient flow management. BACKGROUND: Patient flow has a significant impact on the provision of patient care. The term "patient flow" is widely used, but the related concept of "patient flow management" has been poorly defined. The ability to differentiate and clarify the term patient flow management has implications on strategies to improve patient flow. DESIGN: Rodgers evolutionary method of concept analysis. DATA SOURCE: Literature published between 2000 and 2021 in the PubMed, CINAHL, and Business Source databases. REVIEW METHODS: Inductive analysis of the literature was performed to identify the usage and features of the concept. RESULTS: Patient flow management is defined as the application of holistic perspectives, dynamic data, and complex considerations of multiple priorities to enable timely, efficient, and high-quality patient care. Patient flow management requires the identification of a patient, care processes, a flow manager, and frontline staff. It has profound consequences on patient, staff, and hospital system outcomes. CONCLUSIONS: Literature should more carefully delineate between "patient flow" and "patient flow management." Effective patient flow management increases the speed and quality of patient care, improves employee satisfaction, and reduces healthcare costs. Strategies to improve patient flow management should focus on understanding the role and interventions of flow management nurses.

Understanding the work and decision-making strategies of bed management nurses: a systematic review.

The need for hospital-wide solutions to improve patient flow is broadly recognised. Bed management nurses are integral to patient flow processes, and recognition of their strengths and skills is crucial in implementing effective solutions, yet there is limited research describing their role. This article details a systematic review of the literature on bed management nurses. Six themes were identified: complexity in a context of scarcity; dealing with external pressures and conflicting priorities; need for multiple decision-making strategies; uncertainty; need for training; and unrecognised yet important work. The findings could assist nurse managers and hospital leaders to promote communication, teamwork and coordination between hospital staff and bed management nurses.