Challenges Confronting the Future of Emergency Nursing

In 1981 only 1% of hospitals nationwide reported that they were unable to fill emergency nursing positions.1 Moreover, hospitals in selected areas report the existence of 12- to 18-month waiting lists for nurses in emergency departments. [...]the 60,000 emergency nurses practicing today2 appear to be sufficient to meet the demand in the approximately 6,500 acute care facilities in which they are employed. [...]only 5% of visits to hospital emergency departments at present are made for life-threatening problems; the proportion is, of course, much higher in shock-trauma centers and many teaching hospitals.6 On a national scale approximately 15% to 20% of all ED visits are for urgent problems, with the remaining 75% to 80% of total visits for nonurgent problems.6,7 The end result is a health facility that is used extensively, inefficiently, and expensively.National Challenges to Emergency Nursing Practice Table 1 presents the five major challenges that will influence the future role and scope of emergency nursing. [...]the population aged 65 years and over will double in the next 50 years. Three states—New York, Maryland, and Massachusetts—operate their own prospective hospital payment systems and are currently exempt from DRG requirements, and three other states—Alaska, Connecticut, and Michigan—are attempting to establish hospital reimbursement systems using DRGs for all non-Medicare third-party payers.15 (New Jersey, the state with the prospective payment system that served as the model for the Medicare DRG program, has had its waiver terminated effective December 31 unless the Health Care Financing Administration reverses its decision.)16 In addition, in at least 25 states private insurance companies are participating in some type of medical cost containment program, many switching their reimbursements from retrospective to prospective.17 One impact that cost-containment programs have had on hospitals has been the trend to cut services in various departments.