|Files in This Item:|
|Title: ||Enhanced nursing practice in emergency departments|
|Publisher: ||National Council for the Professional Development of Nursing and Midwifery|
|Issue Date: ||Apr-2008 |
|Type: ||Working Paper|
|Description: ||The National Council for the Professional Development of Nursing and Midwifery (National Council) supports the
development of enhanced nursing roles in Emergency Departments (EDs) and believes that such roles will greatly
improve the service offered to patients/clients.
Approximately 1.2 million patients attend the Health Service Executive’s (HSE) EDs each year, which is an average of
3,000 people per day. Studies have shown that satisfaction with this service is high (HSE 2006); however, EDs still
experience delays, and there are variations in bed capacity, level and availability of clinical decision-making, and
internal control processes (HSE 2007).
The Emergency Department Task Force Report published in 2007 recommended a number of innovations to increase
capability within the EDs (HSE 2007). This paper details current and future ED nursing role developments to help
support improvements in the care pathway for ED patients and the implementation of the recommendations of the
Task Force. For example the Task Force identified that Advanced Nurse Practitioners (ANPs) working in EDs supported
the efficient management and effective patient flow of particular patient groups, particularly less urgent and elderly
patients. It also identified that the success of the ANP role would be augmented with the introduction of nurse
The National Council has shown its support for the development of enhanced practice in emergency nursing by
developing frameworks for the establishment of Clinical Nurse Specialist (CNS) and ANP posts, conducting a review of
nurse-led care (NCNM 2005a) and providing continuing education funding for innovation and development.
Presently, 1,971 CNS/CMS and 105 ANP posts have been approved by the National Council, of which 80 are based in
EDs. There are 46 ANP posts (Adult and Paediatric), which provide caseload management for minor injuries/ambulatory
care. Table 1 provides examples of current CNS/ANP roles.
In addition to CNS and ANP roles there are varying degrees of enhanced nursing roles in place in a number of EDs
throughout the country. The range of activities in these expanded roles extends from early assessment of patients
following triage, and performing venepuncture and intravenous cannulation to carrying out physical examination,
initiating tests, administering immediate care and requesting diagnostic tests, which may include radiology. The use of
medication management protocols also allows for more timely administration of medications for pain management and
early intervention in the immediate management of acute illness such as myocardial infarction and medical emergencies.
Initiatives such as these should be considered for replication throughout the country. In addition other groups of
patients, for example those with acute and chronic medical conditions, stroke care and older persons, present to the
ED with specific needs that could be managed by enhanced nursing roles and further development of CNS and ANP
roles. It is now time to build capacity around all enhanced nursing roles; this will contribute significantly to increased
efficiencies in the management of patients in the ED and improve patient flow through departments.
Evidence Supporting Enhanced Nursing Roles in the ED
Internationally EDs have over time developed many strategies to improve services and develop clinical skills in order to
match local service need. Examples of such service initiatives are the introduction of nurse-led care, dedicated minor
injury services and medical emergency teams (Galhotra et al 2006).
Specific roles such as chest pain assessment, respiratory care and mental health liaison have also emerged with such
roles becoming mainstream in many countries. A review of current ED research found a number of benefits to
enhanced nursing roles. These benefits are outlined in Table 2.
Table 1 Current CNS and ANP roles in the ED in Ireland|
|Keywords: ||EMERGENCY MEDICAL CARE|
|Series/Report no.: ||Position Paper|
|Appears in Collections: ||National Council for the Professional Development of Nursing and Midwifery|
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