Debra J. Paulson

Q Methodology: A New Way of Assessing Employee Satisfaction

As yet another nursing shortage faces the country, the issue of the satisfaction of nurses again becomes of critical concern to nursing managers in the interest of staff retention. The authors describe the use of the statistical technique Q methodology to assess the needs of nurses and other medical staff at a level one, tertiary care emergency department in the United States. Using the Q method, the authors were able to identify different, unique viewpoints concerning employee needs among the study population, as well as commonly shared views. This level of detail, not obtainable using more traditional statistical techniques, can aid in the design of more effective strategies aimed at fulfilling the needs of an organization’s staff to increase their satisfaction.

The Emergency Department Log as a Simple Injury-Surveillance Tool

STUDY OBJECTIVE To describe the development of an injury-surveillance system based on the emergency department log. SETTING An ED with 40,000 visits annually, tertiary care center. PARTICIPANTS All patients to our ED during a 6-month period. ED logs are used to collect basic information such as demographics, chief complaint, mode of arrival, and disposition. Our log was modified for collection of injury-related information such as whether the ED visit was because of an injury and, if so, the mechanism of injury. A list of 16 mechanism-of-injury codes was developed on the basis of review of existing literature and on a 1-month review of injuries in our population. The ED log data were entered into a database, and descriptive analysis was performed. RESULTS A list of mechanisms of injury was developed that, when implemented, was successful in coding 93% of injured patients in our ED population. The expansion of the ED log for collection of injury data required minimal training and cost. An example of the data obtained is presented to demonstrate the type of information available. Of the 18,742 patients, the ED log identified 5,067 patients (27%) as having been injured. Most were male (2,972 of 5,067 [59%]), and most were between 15 and 40 years of age (2,857 of 5,067 [61%]). Common mechanisms of injury included falls (907 of 5,067 [19%]), transportation (706 of 5,067 [15%]), cuts or punctures (332 of 5,067 [7%]), sports (323 of 5,067 [7%]), and assaults (245 of 5,067 [5%]). CONCLUSION With minimal training and cost, the ED log can be adapted for collection of injury data on all patients seen in the ED.

Using Q methodology to assess the needs of Emergency Medicine support staff employees

The support staff members of any Department of Emergency Medicine perform a plethora of tasks that are crucial to the productivity of both individual physicians and the department as a whole. It is important to ensure that the personal and professional needs of the support staff are being met. This report describes the use of a relatively new statistical technique, Q methodology, to elucidate the needs of the support staff. This method allowed the investigators to quantitatively reveal the presence of two distinct viewpoints on employee needs among the support staff. Additionally, opinions that were held by the employees concerning their needs were identified. These results allowed for strategies to be tailored to both the individual and the group. The results indicate that Q methodology can have widespread application in the relatively new area of health care quality research.

A rural outreach program for emergency nurses

Nurses practicing in a rural setting play a vital role in providing and improving rural emergency care. 1 In many small rural hospitals nurses manage the initial care of critically ill patients, a 3 However, the nurse who works in the rural emergency department often has several other duties, such as hospital shift supervisor, critical care unit staff member, or provider of obstetric coverage, and there is limited opportunity to obtain continuing education within rural communities.i, 5 In addition, economic pressures have forced many rural hospitals to adopt ED staffing patterns that allow little time for staff education. Travel times from the rural community to a course given in an urban setting can take 2 to 4 hours in West Virginia; a 1-hour course can become a full-day project. The Emergency Nurses Partnership Program (ENPP) of West Virginia University was created to provide an opportunity for continuing education to be presented at rural hospitals, to encourage interaction between the rural emergency nurses and the ENPP teaching staff, and to allow for a precepted experience at a tertiary care facility. The partnership program resulted from the use of Partners in Health Care hospitals as the source of survey information and as the initial target audience. It also resulted from the partnership of the rural nurse with a tertiary care staff nurse during the clinical portion of the program. The program was specifically targeted for full-time and parttime nurses who work in the emergency department. However, any health care provider at the hospital was welcome to participate.