Report Finds Underused Nurses Slowing Emergency Rooms Down

The Health Ministry report also claims safety procedures in emergency rooms are not being followed.

Nurses are not performing procedures they are authorized to carry out, making emergency rooms inefficient, a new Health Ministry report claims.

The report, which was submitted to the Health Ministry director general and is being published here for the first time, says that nurses could perform more procedures to reduce the time patients have to wait for certain tests.

The report points out differences among hospitals as to whether the head nurse in the emergency room has specific training in urgent care.

In government hospitals and hospitals owned by the Clalit Health Maintenance Organization, 90 percent of head nurses have undergone such training, which takes about a year. However, in the public hospitals surveyed, including Hadassah University Hospital and Shaare Zedek Medical Center in Jerusalem, Mayanei Hayeshua Medical Center in Bnei Brak and Laniado Hospital in Netanya, only 52 percent of head nurses have such training.

The survey, which was carred out in 2009, covered 27 general hospitals in Israel in which 1,948,613 patients were treated, about two years after new rules governing ER nursing care were instituted.

The report also claims safety procedures in emergency rooms are not being followed.

Only 10 ERs (37 percent of the total ) complied with requirements to have two nurses present when a blood transfusion is started, to reduce the chance of a mistake in blood type, the report says. The report revealed differences in procedures nurses are allowed to perform in various ERs. Only in 77 percent of ERs did nurses dispense over-the-counter drugs; the same amount of ERs allowed nurses insert a feeding tube in unconscious patients. In 7.5 percent of emergency rooms nurses removed catheters from large veins.

In 21 percent of ERs, nurses said ER policy dictated that procedures they are authorized to perform are carried out by a doctor, including attaching electrodes to a pacemaker and calibrating the breathing equipment to wean a patient off a respirator.

According to the report: "The main potential of the nurses is not being utilized to the fullest ... as a result of department policy. Removing these limitations and allowing nurses the option of carry out professional procedures could streamline emergency room work."

The report has been distributed over the past few days to the managements of hospitals throughout the country. They have been asked to submit reports on their urgent care departments to streamline nursing care.

The Health Ministry has also decided that ER work will be streamlined if nurses do not perform certain procedures that are rare, considering the extensive training they must undergo to do so, such as the removal of a central venous line, according to Dr. Shoshana Riba, head of the Health Ministry's nursing administration. "All actions nurses are allowed to perform require training and monetary investment. The findings of the survey will allow the learning process to become more efficient."

According to Riba, "In some hospitals doctors perform procedures nurses are allowed to do, and in some hospitals nurses don't want to perform certain procedures and they are not asked to. Considering the shortage in hospital beds and human resources, expanding the nurses' work would make it more efficient."

According to Riba, the report did not check waiting time for care in ERs, which she says do not depend only on the ER, but also on other departments such as X-ray and the hospital wards receiving the patient. However, changes to nursing care recommended by the report could reduce ER waiting time, she said.