RN as Scholar

a specialist in a particular branch of study

By Originally posted SRNA News Bulletin

Posted: January 31st, 2019


RN as Scholar: Joan Wagner

A sense of curiosity is what led Dr. Joan Wagner, PhD and RN, into the field of research. Upon earning her nursing undergraduate degree in 1973, she worked as a direct care provider in both hospital and community settings until entering the formal teaching realm when she completed her PhD in 2010. “I am a very curious person, and, as a critical thinker, who is also a care provider, it is natural that I ask a lot of questions about health care,” says Wagner. “These questions led me to research.”

Her most recent research project, “Synergy in the ER: Improving Emergency Department Care and Provider and Patient Outcomes Using a Synergy Tool Website:,” spawned from a policy direction of the Government of Saskatchewan’s Ministry of Health. In 2016, the Saskatchewan Ministry of Health put forth a goal to reduce emergency department patient wait times by 60 percent, and to overall improve patient flow within the department, reducing patient length of stay. Emergency departments across the country are frequently congested, so exploring emergency departments and management of patient care delivery and staff workloads can uncover significant systems issues, benefiting an entire organization. Wagner notes that the issues are cyclical and can impede patient outcomes.

“Congestion increases a patient’s time to be seen by nurses and doctors. Patients get frustrated and leave, resulting in unnecessary, adverse outcomes. Patient overcrowding is associated with increased patient morbidity and mortality.” Wagner goes on to explain that emergency department congestion and overcrowding is also associated with health care provider dissatisfaction and turnover. “Nurses and physicians experience undue moral distress from their inability to provide safe, quality care.”

With the 60 percent reduction target in mind, Wagner, in collaboration with the Saskatchewan Health Authority executive and clinical emergency department leadership, the Saskatchewan Union of Nurses and nurse researchers from the University of Regina, the University of Saskatchewan, the University of Manitoba and the University of British Columbia, began to investigate the impact of the synergy tool, a real-time staffing tool on patient care delivery and nurse workload management, within two Regina hospital emergency departments. The synergy tool itself has been implemented in acute care, community health care, residential care and mental health care settings across Canada and the United States but, Wagner notes, has never been implemented in an emergency department. Eager to improve the experience in Saskatchewan emergency departments, the research team set out to evaluate the impact of the synergy tool with respect to describing patient outcomes, describing organizational outcomes (including human resource utilization, such as nurse overtime, absenteeism and turnover), quantifying patient care requirements (including determining alternate services that can be provided in a more appropriate and less costly environment), identifying nurse perceptions of quality, safe care delivery and team work, and disseminating findings to improve patient wait times and patient flows to other emergency departments in the Canadian health care system as a whole.

With a keen interest in developing healthy workplaces in health care practices, Wagner’s research “holds promise as a means for emergency department clinical leadership and nurses to determine patient priority needs in real time. It is a patient-centered model focusing on patient care.” Although the research is still ongoing, the potential impact thus far is encouraging— Wagner notes that the synergy tool has encouraged nurses to look at the patient in a more holistic manner, enabling care providers to better assess required resources than some diagnoses initially suggest. As the research unfolds and results are interpreted, Wagner will work with her research partners to incorporate this knowledge into health care practice in Saskatchewan.