Emergency Department: Interview with Donovan Stewart, RN, MSN
Saving lives while boosting patient satisfaction
Tell us about your nursing career journey.
I’m originally from Canada and have been a nurse since 2003. I worked briefly in a Canadian ED and then came to Glendale Adventist while I was still in my first year. I was actually one of the first two Canadians that the hospital had ever recruited.Following my first stint with Glendale Adventist, I served as a manager and educator at Cedars-Sinai while completing my MSN in nursing administration at Cal State. After completing my MSN, I did a year at Providence Holy Cross as the trauma program manager. I loved that position and all that it offered, but Glendale aggressively recruited me to return in February 2017 for the ED director role. I’m thrilled to be here once again.
What are the parameters and highlights of your current role?
We’re a 39-bed ED, comprehensive stroke center, STEMI center and EDAP (emergency department approved for pediatrics). We see an average of 180–200 patients per day and can expand to 53 beds as needed. We’re not currently a trauma center, but we’re considering applying to become a Level II center in the future. I oversee a staff of 130, including two managers and 10 charge nurses. I’m in charge of operations, budget and hiring as well as collaborating with the managers on various initiatives and projects.
Under the auspices of the Throughput Committee, I also work closely with the inpatient team to ensure that patients move seamlessly through the hospital system. Meanwhile, we’re a base station, which means that we have 27 certified mobile intensive care nurses (MICNs) who field calls from paramedics responding to emergencies in the community. We use protocols overseen by a physician to guide the paramedics in both patient care and the routing of patients to appropriate facilities.
How did you become interested in nursing leadership?
I can safely say that I grew into being a leader. In my early nursing career, I was just excited to be an ED nurse and worked hard to become as efficient, competent and confident as I could. When I worked at Glendale the first time around, they promoted me to a night charge position. That was the stepping stone to subsequent leadership opportunities.
There’s definitely a learning curve in becoming a nurse leader. One of the things that I feel has contributed to my success as a leader is being humble, not feeling overconfident and being consistently unafraid to ask questions.
One of my greatest attributes is being a very calm person even when the place feels like a disaster zone. For me, the more chaotic it gets, the calmer I become. People often say they don’t understand how I can maintain my equanimity even in the worst situations, but it helps me help others to be calm and confident.
What do you love about What do you love about your work?
I love change and I love making things better for both patients and staff. I don’t do this alone — I see the vision and know where I need to go, but I need everyone on board in order for us to get there. Working 12 hours a day is tough on nurses, so I want my staff to enjoy being at work to the greatest extent possible. I can’t erase the natural stress of the ED, but I want it to be a positive work environment nonetheless. I like tapping into people‘s potential, discovering their strengths and boosting their confidence and natural ability.
Whenever I start a new job, I spend a great deal of time quietly observing. I like to get to know everyone, assess the workplace culture, ascertain strengths and weaknesses and work closely with the people who can get us to the next step in our evolution. I like to get everyone on the same page and move the department forward as a collective.
The greatest pet peeve of my nursing career is autocratic, dictator-style leadership that adheres to a hierarchical system and leaves little room for collaboration and individual creative input. Regardless of what level you are, every member of the staff should be working together and everyone should have a voice. Dictators don’t do well in healthcare.
What do you look for in ED staff?
I look at their energy and disposition. Are they open-minded? Are they able to take on whatever they’re handed and approach it with positivity? A good sense of humor is essential in such a stressful environment. Also, my staff must be warm and engaged when it comes to patient interaction. People who choose to work in the emergency department must be able to interact with many types of people. You have to be willing, open-minded and naturally collaborative. Technical skills are important, but if you don’t have the personality for it, you’ll never be truly successful.
I always have my eyes open for staff members who show natural leadership abilities. I like to give people the opportunity to try things out, so I ask myself who has the level of interest and the ability to be promoted. I’ve told my managers that they need to allow staff members to test-drive leadership in order to see the other side. Walking in someone else’s shoes can transform certain individuals into high performers once they gain some perspective and can understand the bigger picture from both sides of the equation.
What’s changing in the ED at this time in history?
One of the biggest changes in EDs is the fact that patients are no longer just patients — they’re savvy healthcare consumers. There’s this big focus on patient satisfaction, so nurses must remain aware that they’re potentially being scored on most every interaction. Even my goals as a director are all connected to patient satisfaction scores. It’s a different way of looking at healthcare, but simply essential in the 21st century healthcare marketplace.
I joke with my staff that how they’re treated when they order a burger is the same thing as the patient experience in the hospital: Were they greeted appropriately? Was the expected outcome reached in an efficient manner? Would they come back again? In the intense environment of the ED, staff say that saving patients’ lives should be enough, but I explain that patients are very informed; they read Yelp and other online reviews. Social media has altered the public’s perceptions of healthcare facilities and providers, so we have to go the extra mile.
Technology has also changed a lot. There are a lot more charting requirements and computer work these days, which won’t be decreasing any time soon. Staff struggle with that — they may not type quickly or have significant comfort with computers. We’re currently at a place where you must be very proficient with computers to function as a nurse. Computers have helped to improve things on some levels, but they’ve also taken away from overall nurse-patient engagement. It may seem sad to those who’ve been around a few decades, but you have to balance your time between computers and patients. It’s the new normal.
What do you recommend for nurses who want to work in the ED?
One of the biggest things is to keep learning and take as many courses as you can. Certification courses are a great way to gain knowledge and expertise. You can prepare as much as you can to work in emergency nursing, but there comes a point where you simply have to be in the ED to really understand it. We’ve brought new grads into the ED and provided an educator to get them off the ground and launched as solid emergency clinicians.
New ED nurses must understand that they’ll never be absolute experts. All of us are good at certain things, but we also need to keep learning and educating ourselves. None of us start out knowing everything about everything. None of us retire knowing it all either. One of the most exciting things about the emergency department is that you’ll constantly encounter conditions that you’ve never seen before. You’ll never get bored and the constant change will keep you on your toes.
When I first started out in the ED in Canada, I had a preceptor who said that seeing, experiencing and touching everything possible is a key to success. Is there a patient with a type of wound you’ve never seen? Get in there and provide care. Is there a new diagnosis being treated? Be a sponge and soak up as much knowledge and skill as you possibly can.
What are your future career plans?
I’m always interested in learning and I’ve toyed with the idea of earning a Ph.D. in the future. My ultimate goal is to seek higher-level management positions. Although my current role is very rewarding, I seek a role where I can have the ability to make the bigger decisions and lead the entire team. That would translate to a position as the CNO of a hospital. Adventist is very supportive of their leaders and tend to promote people and support their growth. I like the vision of empowering staff and helping them to grow in their careers. I love being a leader and I foresee a long career of empowering nurses to be the best that they can be.
Keith Carlson, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.
This article is from workingnurse.com.