What does "safe staffing" actually mean? We talk about safe staffing all the time, but is it simply a nurse-to-patient ratio? In the emergency department, where volume, acuity, and workload can change in minutes, the answer is so much more complicated. In this episode, Kevin and Dr. Wolf dig into the science of ED staffing and Lisa's latest research, on safe staffing in the emergency department. The conversation takes on one of the most common assumptions about staffing: that safety comes down to counting how many nurses are on the schedule. We all know two shifts can have the same numbers and go completely differently depending on experience, skill mix, teamwork, patient acuity, workload, and the systems backing up the team. Dr. Wolf's study asked more than 1,000 emergency nurses what actually makes an ED safe. Nurses identified 14 indicators of safety, but only eight were considered measurable, and what is worse is only three were routinely being measured in most emergency departments. So how can we claim to be "staffing safely" if we aren't measuring safety? Safe staffing is more complicated than filling holes on a schedule, but it may also be much more measurable and solvable than we think. Links to the staffing studies.  1. Educational Levels of Hospital Nurses and Surgical Patient Mortality https://pmc.ncbi.nlm.nih.gov/articles/PMC3077115/ Free full text — PubMed Central 2. Implications of the California Nurse Staffing Mandate for Other States https://pmc.ncbi.nlm.nih.gov/articles/PMC2908200/ Free full text — PubMed Central 3. Effects of Nurse Staffing and Nurse Education on Patient Deaths in Hospitals With Different Nurse Work Environments (Medical Care, 2011) https://pmc.ncbi.nlm.nih.gov/articles/PMC3217062/ Free full text — PubMed Central 4. Effects of Hospital Care Environment on Patient Mortality and Nurse Outcomes https://pmc.ncbi.nlm.nih.gov/articles/PMC2586978/ Free full text — PubMed Central 5. Effects of Nurse Staffing and Nurse Education on Patient Deaths in Hospitals With Different Nurse Work Environments (JONA, 2012) https://pmc.ncbi.nlm.nih.gov/articles/PMC6764437/ Free full text — PubMed Central 6. On the Threshold of Safety: A Qualitative Exploration of Nurses' Perceptions of Factors Involved in Safe Staffing Levels in Emergency Departments https://www.sciencedirect.com/science/article/pii/S0099176716302136 Journal of Emergency Nursing — ScienceDirect 7. Perceived Relationships Between Emergency Department Staffing Patterns and Missed Care, Missed Decompensation, and Delays in Care https://www.sciencedirect.com/science/article/pii/S0099176725002843Complimentary access — ScienceDirect 8. The Meaning of Safety in the Emergency Department: A Survey Study https://www.sciencedirect.com/science/article/pii/S0099176726001650Journal of Emergency Nursing — ScienceDirect   Follow us on: Facebook: https://www.facebook.com/Art-of-Emergency-Nursing-276898616569046/  YouTube: https://www.youtube.com/channel/UCJTnz4phtCTjojTIDJo2afA?view_as=subscriber  Twitter: @AoenPodcast Instagram: https://www.instagram.com/artofemergencynursing/  To support the show: Leave an honest review on iTunes. Your ratings and reviews greatly contribute to the success of the podcast, and I appreciate each and every one of them. Subscribe on Apple Podcasts, Google Podcasts, or your preferred podcast platform to never miss an episode.

How do you create a drama-free shift? Start by recognizing patient deterioration before it becomes a code. In this episode, Kevin and Dr. Lisa Wolf discuss how patients often show signs of deterioration hours before cardiac arrest—and why those warning signs are too easily missed, minimized, or handed off to the next shift. From subtle changes in mental status and relative hypotension to rising respiratory rates, delayed interventions, and the high-acuity patient hiding in a low-acuity setting, they break down what nurses should be watching for. They also discuss the importance of trending vital signs, completing a real assessment, preparing the patient's environment, escalating concerns, and asking for another set of experienced eyes when something just does not look right. Because the best code is the one that never happens—and hope is not a plan. Link to the Trigger Values study https://pubmed.ncbi.nlm.nih.gov/21521399/ Follow us on: Facebook: https://www.facebook.com/Art-of-Emergency-Nursing-276898616569046/  YouTube: https://www.youtube.com/channel/UCJTnz4phtCTjojTIDJo2afA?view_as=subscriber  Twitter: @AoenPodcast Instagram: https://www.instagram.com/artofemergencynursing/  To support the show: Leave an honest review on iTunes. Your ratings and reviews greatly contribute to the success of the podcast, and I appreciate each and every one of them. Subscribe on Apple Podcasts, Google Podcasts, or your preferred podcast platform to never miss an episode.

In this episode, Kevin and Dr. Wolf tackle a listener question about hourly rounding, and the conversation quickly evolves into a larger discussion about how healthcare systems often implement sweeping changes with little to no evidence behind them. From "check-the-box" tasks to reactionary policies created after adverse events, they explore how well-intentioned interventions can become burdensome, ineffective, and sometimes even counterproductive. Along the way, they discuss the importance of evidence-based practice, critical thinking, and asking the simple but important question: "What problem are we actually trying to solve?"

We've all heard, "Pain is whatever the patient says it is." But do we actually practice that way? In this episode, Kevin and Lisa dive into a fascinating mixed-methods study exploring how nurses think about pain and how those beliefs change when real clinical decisions are made in triage. Dr. Wolf unpacks research examining nurses' attitudes, behaviors, and hidden biases surrounding pain assessment and triage decision-making. The results are uncomfortable and important. This conversation isn't about blaming nurses; it's about understanding how systems, cognition, and culture shape practice, and how awareness can help us deliver safer, more compassionate care. Here is a link to the full article.  https://www.sciencedirect.com/science/article/pii/S0099176726000048?dgcid=author Want to watch the video on Youtube? https://youtu.be/FkCvwME19eE      Follow us on: Facebook: https://www.facebook.com/Art-of-Emergency-Nursing-276898616569046/  YouTube: https://www.youtube.com/channel/UCJTnz4phtCTjojTIDJo2afA?view_as=subscriber  Twitter: @AoenPodcast Instagram: https://www.instagram.com/artofemergencynursing/  To support the show: Leave an honest review on iTunes. Your ratings and reviews greatly contribute to the success of the podcast, and I appreciate each and every one of them. Subscribe on Apple Podcasts, Google Podcasts, or your preferred podcast platform to never miss an episode. Thank you for being a part of our AOEN community!    

Vaccines are one of public health's greatest success stories—but what happens when people start saying no? In this episode, Kevin and Dr. Lisa Wolf dig into the rising tide of vaccine refusal, what's fueling it, and how it's already impacting what we see in the emergency department.  If you've ever struggled to explain vaccine science to a skeptical patient, this episode is essential listening. Resources mentioned: ·       American Academy of Pediatrics vaccination recommendations ·       American College of Obstetricians and Gynecologists vaccine guidelines ·       Studies on shingles vaccine and dementia reduction ·       HPV vaccine and cervical cancer elimination in Scotland ·       Vaccination in the emergency department study Follow us on: Facebook: https://www.facebook.com/Art-of-Emergency-Nursing-276898616569046/  YouTube: https://www.youtube.com/channel/UCJTnz4phtCTjojTIDJo2afA?view_as=subscriber  Twitter: @AoenPodcast Instagram: https://www.instagram.com/artofemergencynursing/  To support the show: Leave an honest review on iTunes. Your ratings and reviews greatly contribute to the success of the podcast, and I appreciate each and every one of them. Subscribe on Apple Podcasts, Google Podcasts, or your preferred podcast platform to never miss an episode. Thank you for being a part of our AOEN community!

Fluid and electrolyte emergencies are the silent killers you might not notice until your patient crashes. In this episode, Kevin and Dr. Lisa Wolf break down the classic (and not-so-classic) presentations of hypo/hypernatremia, hypokalemia, hyperkalemia, and calcium derangements—and how they impact perfusion, mental status, and cardiac rhythm. Follow us on: Facebook: https://www.facebook.com/Art-of-Emergency-Nursing-276898616569046/  YouTube: https://www.youtube.com/channel/UCJTnz4phtCTjojTIDJo2afA?view_as=subscriber  Twitter: @AoenPodcast Instagram: https://www.instagram.com/artofemergencynursing/  To support the show: Leave an honest review on iTunes. Your ratings and reviews greatly contribute to the success of the podcast, and I appreciate each and every one of them. Subscribe on Apple Podcasts, Google Podcasts, or your preferred podcast platform to never miss an episode. Thank you for being a part of our AOEN community!

What happens when you're not the one about to make the mistake, but you're see someone about to make an error?  In this episode, Kevin and Dr. Lisa Wolf tackle one of the toughest ethical and professional dilemmas in healthcare: how to intervene when a colleague is on the verge of harming a patient. From quiet cues to full-on halts, theydive into the art of the interruption.  You'll also hear why modeling behavior matters, how burnout can blind providers, and why letting a mistake slide is more than just dangerous, it's bullying. If you've ever asked yourself, "How do I say something without causing a scene?" this one's for you. Key Takeaways: Your first loyalty is to the patient There's an art to interrupting mistakes Focus fatigue and burnout cause errors If you don't stop it, you're complicit Modeling matters Letting someone fail is a form of bullying Follow us on: Facebook: https://www.facebook.com/Art-of-Emergency-Nursing-276898616569046/  YouTube: https://www.youtube.com/channel/UCJTnz4phtCTjojTIDJo2afA?view_as=subscriber  Twitter: @AoenPodcast Instagram: https://www.instagram.com/artofemergencynursing/  To support the show: Leave an honest review on iTunes. Your ratings and reviews greatly contribute to the success of the podcast, and I appreciate each and every one of them. Subscribe on Apple Podcasts, Google Podcasts, or your preferred podcast platform to never miss an episode. Thank you for being a part of our AOEN community!

In this episode, Kevin and Dr. Lisa Wolf tackle the critical issue of intimate partner violence (IPV) and its implications for emergency nursing. They break down why IPV is often missed, how it can present in ED, and the subtle red flags that signal deeper concerns. From the limitations of triage screening to the importance of private conversations, they share strategies to identify and respond to intimate partner violence Links to articles Warning Signs of Partner Abuse in Intimate Relationships Intimate Partner Violence and Human Trafficking Investigating the prevalence of intimate partner violence victimisation in women presenting to the emergency department in suicidal crisis Follow us on: Facebook: https://www.facebook.com/Art-of-Emergency-Nursing-276898616569046/  YouTube: https://www.youtube.com/channel/UCJTnz4phtCTjojTIDJo2afA?view_as=subscriber  Twitter: @AoenPodcast Instagram: https://www.instagram.com/artofemergencynursing/  To support the show: Leave an honest review on iTunes. Your ratings and reviews greatly contribute to the success of the podcast, and I appreciate each and every one of them. Subscribe on Apple Podcasts, Google Podcasts, or your preferred podcast platform to never miss an episode. Thank you for being a part of our AOEN community!

In this episode, Kevin and Dr. Lisa Wolf dive into the ethical principles that shape nursing practice.  Nursing ethics are not just in crisis situations, but in the everyday decisions nurses make every single shift. From returning the bladder scanner to honoring patient autonomy, we explore how small actions reflect deep ethical commitments. Follow us on: Facebook: https://www.facebook.com/Art-of-Emergency-Nursing-276898616569046/  YouTube: https://www.youtube.com/channel/UCJTnz4phtCTjojTIDJo2afA?view_as=subscriber  Twitter: @AoenPodcast Instagram: https://www.instagram.com/artofemergencynursing/  To support the show: Leave an honest review on iTunes. Your ratings and reviews greatly contribute to the success of the podcast, and I appreciate each and every one of them. Subscribe on Apple Podcasts, Google Podcasts, or your preferred podcast platform to never miss an episode. Thank you for being a part of our AOEN community!

In this episode, Kevin and Dr. Wolf dive deep into the under-discussed but critically important world of renal and urologic emergencies. From the agony of kidney stones to the subtleties of urinary retention.  They discuss the dangers of delayed diagnosis, unpack key presentations, triage considerations, and red flags that emergency nurses must recognize. Urine color chart Click here https://www.medicalnewstoday.com/articles/urine-color-chart  Follow us on: Facebook: https://www.facebook.com/Art-of-Emergency-Nursing-276898616569046/  YouTube: https://www.youtube.com/channel/UCJTnz4phtCTjojTIDJo2afA?view_as=subscriber  Twitter: @AoenPodcast Instagram: https://www.instagram.com/artofemergencynursing/  To support the show: Leave an honest review on iTunes. Your ratings and reviews greatly contribute to the success of the podcast, and I appreciate each and every one of them. Subscribe on Apple Podcasts, Google Podcasts, or your preferred podcast platform to never miss an episode. Thank you for being a part of our AOEN community!