allied health personnel, and teaches patients and families within a time-limited, high-pressured care environment.
Nursing interventions are accomplished interdependently, in consultation with or underthe direction of a licensed physician or nurse practitioner. The strengths of nursing andmedicine are complementary in an emergency situation. Appropriate nursing andmedical interventions are anticipated based on assessment data.
The emergency health care staff members work as a team in performing the highlytechnical, hands-on skills required to care for patients in an emergency situation.
The nursing process provides a logical framework for problem solving in thisenvironment. Patients in the ED have a wide variety of actual or potential problems, andtheir condition may change constantly. Therefore, nursing assessment must becontinuous,
and nursing diagnoses change with the patient‟s condition. Although a
patient may have several diagnoses at a given time, the focus is on the most life-threatening ones; often, both independent and interdependent nursing interventions arerequired.
LEGAL AND ETHICAL ISSUES IN EMERGENCY NURSINGA. LEGAL ISSUES1. FEDERAL ISSUEa.
Past federal legislation has mandated that any client who presents to an EDseeking treatment must be rendered aid regardless of financial ability to payfor services. Since the mid-1980s, additional specific legislation has beenenacted requiring ED personnel to stabilize the condemn of any clientconsidered medically unstable before transfer to another health care facility
the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 -andthe Omnibus Budget Reconciliation Act (OBRA) of 1990. This stabilization
mtist occur regardless of the client‟s financial ability to pay for services. ED
personnel who transfer clients to another institution without first providing thisinitial stabilization can incur substantial fines and penalties, as can thehospital administration.
Clients have continued to seek health care services in the ED, even with theproliferation of managed health care plans and gatekeeping policies. Thefinancial integrity of the ED has been challenged over the years due to thelegal obligations of the ED to provide service.
Retrospectively, financial reimbursement for rendered services has beendenied to EDs from managed health care plans following a determination that
the client‟s problem did not constitute a true emergency
Additional legislation was enacted (Emergency Medical Treatment and ActiveLabor Act EMTALA in 1988, 1989, 1990, and 1994) requiring that a medicalscreening examination be performed on all ED clients before solicitation ofinformation about ability to pay.3 This medical screening examination must