1. Section Editor(s): Raso, Rosanne MS, RN, NEA-BC

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By the time you read this editorial, I hope the flu season is almost over for our patients and staff. EDs all over the country have been inundated with this year's flu pandemic, as well as other countries worldwide. Many have died, including the heartbreak of succumbed children. This year it's H3N2, next year it may be something else, and we certainly haven't had a dearth of community emergencies and mass casualty incidents leading to surging ED volumes. Our colleagues in the ED need our support, and that means from every angle-incoming, outgoing, and even advocacy.

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Emergency nurses often deal with overcrowding, and it's obviously much worse during a flu pandemic. EDs have surge protocols that iterate over time and by situation; however, we know this isn't just a "downstairs" problem. It takes multiple stakeholders to make it work, including staffing support, throughput escalation, supply enhancements, diagnostic timeliness, and much more. We all have a role, including those on the continuum of care outside of the hospital who can possibly prevent ED visits through their care. We can't sit on our haunches as the ED struggles to provide care to current and incoming patients. Yes, when the ED is busy so is everyone else, and it's infinitely more controllable outside of the ED. The tension of "upstairs-downstairs" relationships must be mitigated and managed-that's what good leaders do.


The American College of Emergency Physicians' website states that there should be an "end to the practice of boarding admitted patients in the ED when no inpatient beds are available." If only it were that easy. I don't know about your patient care environment, but despite using hallways on inpatient units and opening every bed, the number of patients without a bed assignment remains very high at times like this. Stretchers with inpatients line every ED corridor, and each ED bay is doubled. Sound familiar? I worry about these patients and you should, too.


In general, most nurse leaders are affected by the flu in all care environments and can influence patient care and public health. Although the vaccine hasn't been 100% effective against all strains this year, it's still imperative that we be unrelenting in promoting vaccination for staff, patients, and the public. Nurse-driven protocols, state regulations, professional advice whether random or planned, and many more strategies help.


Another preventive measure is simply staying home when you're sick and encouraging others to do the same. Nurses are notably bad at this, especially when staffing is short during high volume times. Sick adults are able to infect others 1 day before symptoms appear and at least several days after they become ill; children even longer. We must ensure that infection control precautions, such as masks and hand washing, are always utilized. The virus can survive on hard surfaces for 24 hours and also for several hours as droplets. No wonder it spreads so quickly.


Flu pandemics are a call to arms for public health and acute care. Don't forego your advocacy role. There are always lessons to be learned after these situations. Debrief often and improve for next time because, unfortunately, there's always a next time.


Announcing Pathway to Excellence(R) partnership

Nursing Management has been named the official journal for the American Nurses Credentialing Center's Pathway to Excellence(R) Program. This partnership recognizes our mutual, and important, goals for positive practice environments. Read Dr. Jeffrey Doucette's article on page 13 to learn more about this exciting news.



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