Barriers and enablers to nurse-initiated care in emergency departments: An embedded mixed methods survey study.

Background: Increased demand, wait times and length of stay have seen many emergency departments implement nurse-initiated protocols In New South Wales, Australia, 74 nurse-initiated protocols have been developed for implementation. The aim of this paper is to identify the barriers and enablers to nurses' use of these protocols to inform and maximise future implementation.

Methods: Data were collected via surveys informed by the theoretical domains' framework and the Practice Environment Scale of the Nursing Work Index (PES-NWI). Descriptive statistics summarised quantitative data and content analysis was performed on qualitative data. Results were integrated and classified as barriers or enablers to nurses' use of protocols.

Results: The nurses' response rate was 82 % (n = 76) and doctors 72 % (n = 34) Six categories were generated; one barrier (lack of resources), three enablers (patient and organisational benefits, nurses' motivation, nurses' desire to develop their practice) and two were both a barrier and enabler ( nurse confidence and the work environment).

Conclusion: Emergency nurses are highly motivated to use nurse-initiated protocols to positively impact patient outcomes. However, a lack of resources, time, access to education and confidence are barriers to use that need to be addressed when designing implementation.