Innovations in Emergency Nursing: Adapting Patient Flow Management to Emergency Department Overcrowding

Introduction: The coronavirus disease-2019 pandemic brought greater attention to nurses’ innovation and adaptability. Emergency nurses continue to adjust their patient flow management strategies in response to high levels of overcrowding, but this work has been poorly described. Methods: This paper describes findings from a grounded theory study that included 29 focus groups and interviews with emergency nurses. Data was also collected through 64 hours of participant observation across 4 emergency departments. Results: Two themes emerged to capture how emergency nurses manage patient flow in overcrowded departments. First, emergency nurses creatively adapt their resource use, staffing roles, and patient care processes to expand patient care capacity and expedite throughput. Second, nurses demonstrate cognitive adaptability by modifying their attention and focus. As crowding increases, nurses become more highly engaged in the work of patient flow management until excessive overcrowding may lead to disengagement. Nurses also shift their focus away from proactive and retrospective patient flow management strategies to become more attentive to meeting current patient care needs. Discussion: The ability of emergency departments to care for high patient volumes depends upon nurses' cognitive and organizational labor. Innovation and adaptability are essential components of emergency nursing work. Although emergency nurses have demonstrated great ingenuity, more work is needed to ensure that emergency patient flow management strategies are evidence-based.