Determining Emergency Severity Index Acuity: Key Triage Elements Identified by Emergency Nurses.

Introduction: The conflation of mandated screening question data collection with patient assessment at the initial triage encounter challenges the ability of the emergency nurse to identify patients at risk for deterioration rapidly and accurately. Further, inexperienced triage nurses are generally challenged in differentiating between questions that establish stability and questions that meet other requirements. The aims of the study included exploration of how triage nurses identified critical data elements to facilitate more rapid and accurate patient triage and Emergency Severity Index acuity assignment, perceptions of appropriate location of assessment elements, and identifying common triage processes.

Establishing Triage Competencies and Verification Processes: A Survey Study.

Introduction: Although the ED triage function is a critical means of ensuring patient safety, core competencies for ED triage are not well defined in the literature. The purpose of the study was to identify and validate emergency triage nursing competencies and to develop a competency verification process.

Methods: A sample of 1181 emergency nurses evenly divided between roles with oversight of triage training and competency assessment (manager-level and staff nurses performing triage) completed an online survey evaluating competency elements that comprised the following in terms of frequency and importance, training modalities, and evaluation methods: expert assessment, clinical judgment, management of medical resources, communication, and timely decisions.

Validation of Emergency Nurse Practitioner Competencies: Patient Complexity and Clinical Decision Making.

Introduction: Over the past 15 years, the emergency nurse practitioner has been recognized as a nursing specialty role with dedicated scope and standards of practice. However, a paucity of objective data exists to validate the actual practice of emergency nurse practitioners in the emergency care setting. The purpose of this pilot study was to describe the initial acuity of patients assigned to emergency nurse practitioners, actions, decisional complexity, and disposition decisions of advanced practice nurses as they function in emergency departments in a single system.

Elements of an Advanced Trauma Education Program for Emergency Nurses: A Modified Delphi Approach.

Background: Basic trauma education for emergency department (ED) staff is available, but there are currently no advanced trauma nursing practice standards for ED nurses.

Objective: The purpose of this study was to identify consensus-based elements of an advanced trauma nursing program for ED nurses.

Methods: We used a modified Delphi process with three rounds of online survey data collection to ensure a large group of geographically diverse experts.

Ensuring Throughput: Development and Validation of Charge Nurse Competencies for United States Emergency Care Settings.

Introduction: Charge nurses are shift leaders whose role includes managing nursing resources and facilitating appropriate patient care; in emergency departments, the charge nurse role requires both clinical and leadership skills to facilitate the flow of patients, while ensuring patient and staff safety. Literature on orientation and specific training is notably sparse. This study aimed to evaluate the content and process of core competency training and identify evaluation and implementation strategies necessary to improve charge nurse performance in United States emergency departments.

Individual Attributes and Environmental Conditions of Registered Nurses Working in Freestanding Emergency Departments in the United States: A Descriptive Exploratory Study.

Introduction: Freestanding emergency departments (FSEDs) are emergency facilities not connected to inpatient services. The percentage of FSEDs of all EDs grew from 1% in 2001 to 12% in 2017, making FSEDs a substantial subset of US emergency care. The purpose of this study was to describe the individual attributes and environmental conditions of registered nurses working in FSEDs in the US.

Emergency nurses' perceptions of the utility, adaptability and feasibility of the emergency nursing framework HIRAID for practice change in US: An exploratory study.

Background: Patient assessment is a core component of nursing practice and underpins safe, high-quality patient care. HIRAID an evidence-informed emergency nursing framework, provides nurses with a structured approach to patient assessment and management post triage. In Australia, HIRAID resulted in significant improvements to nurse-led communication and reduced adverse patient events.

The Effect of Mandatory Triage Questions on Triage Processes: A Qualitative Exploratory Study.

Introduction: The study purpose was to obtain an understanding of both the types of questions mandated for the triage encounter in emergency departments across the United States and how emergency nurses perceive the relevance of these questions to the triage process.

Methods: A qualitative descriptive exploratory study using focus group data was used. Data were collected at an in-person emergency nursing conference held in September 2022.

Current Practice and Practice Competencies of Clinical Nurse Specialists Working in US Emergency Care Settings: A Survey Study.

Purpose/aims: The aim of this study was to investigate the current practice of clinical nurse specialists working in US emergency care settings to (1) explicate the application of the Emergency Nurses Association core competencies and define the specialized clinical nurse specialist role in emergency care and (2) align current clinical nurse specialist practice in emergency settings with the National Association of Clinical Nurse Specialists core competencies and the identified substantive areas of clinical nurse specialist practice.

Design: This study used a quantitative exploratory descriptive approach using survey data.

Methods: A purposive convenience sample was recruited from the Emergency Nurses Association and the National Association of Clinical Nurse Specialists.

The Experiences of United States Emergency Nurses Related to Witnessed and Experienced Bias: A Mixed-Methods Study.

Introduction: The purpose of this study was to obtain a broad view of the knowledge, attitudes, beliefs, and lived experiences of emergency nurses regarding implicit and explicit bias.

Methods: An exploratory, descriptive, sequential mixed-methods approach using online surveys and focus groups to generate study data. Two validated instruments were incorporated into the survey to evaluate experiences of microaggression in the workplace and ethnocultural empathy.

Role and Training of Emergency Department Charge Nurses: A Mixed Methods Analysis of Processes, Needs, and Expectations.

Introduction: Charge nurses (CNs) are shift leaders who manage resources and facilitate patient care, yet CNs in EDs receive minimal training, with implications for patient safety and emergency nursing practice. The purpose of the study was to describe the experiences of emergency nurses related to training, preparation, and function of the CN role.

Methods: An explanatory sequential mixed methods design using survey data (n = 2579) and focus group data (n = 49) from both CN and staff nurse perspectives.

Development of Nurse-Sensitive, Emergency Department-Specific Quality Indicators Using a Modified Delphi Technique.

Background: There is no identified set of nursing-sensitive, emergency department (ED)-specific quality indicators.

Purpose: The purpose of this study was to address the gap in quality indicators specific to the emergency care environment and identify a list of nursing-sensitive, ED-specific quality indicators across ED populations and phases of the ED visit for further development and testing.

Methods: A modified Delphi technique was used to reach initial consensus.

Educational Needs of U.S. Emergency Nurses Related to Forensic Nursing Processes.

Background: Forensic nursing is a specialty deployed in patient care areas, including emergency departments, intensive care units, labor and delivery suites, and psychiatric units treating persons who have suffered trauma from a violent or criminal act. The recognition of violence-related injuries in patients presenting to health care facilities is critical to an appropriate care trajectory. These patients require specialized resources beyond the treatment of physical injuries to include psychosocial and legal care that supports patient recovery and pursuit of criminal justice.

Validation of a grounded theory of nurse bullying in emergency department settings.

Background: Workplace bullying in health care settings, including emergency departments (EDs), is a significant and negative factor in the dynamics of patient care, nursing work culture, and nurse retention. Specifically, workplace bullying has a significant and negative effect on patient care, with both direct (errors and substandard care) and indirect sequelae (high turnover and inexperienced nursing staff hired to replace those nurses who have left to escape bullying behavior). The purpose of this study was to determine the theoretical coherence of the ENA model of nurse bullying in emergency department and its impact on emergency nurses' intent to leave their job.

Triage Decisions Involving Pregnancy-Capable Patients: Educational Deficits and Emergency Nurses' Perceptions of Risk.

Background: In areas where obstetric services are not available, emergency departments often become the default for unplanned obstetric care, yet emergency nurses are not universally trained in the identification and treatment of obstetric emergencies. The purpose of this study was to explore emergency nurses' perception of acuity in the triage of pregnant or postpartum patients presenting to the emergency department with high-risk complaints and to identify facilitators and challenges to the accurate identification and treatment of these patients.

Method: A mixed-methods study was conducted using chart review data (N = 12,766) and focus group data (N = 39) from five emergency departments in the eastern United States.