Research paperProfiling nursing resources in Australian emergency departments
Introduction
Staff in Australian emergency departments (EDs) manage over 7 million patient presentations annually,1 providing a fundamental role as a key access point for health care. Most EDs treat a mix of adults and children, and in 2011–2012, the median number of patients treated in each Australian ED was 34,645.2 Nurses have an essential role in ED patient management3 from triage to disposition, and spend more time with patients and families than other ED staff. Emergency nurses are the first point of contact for patients, and triage nurses are responsible for patient assessment, judgement of clinical risk and prioritisation of care.4 In the waiting room, emergency nurses commence interventions such as analgesia, and arrange investigations including pathology and X-ray.5 Following triage assessment, emergency nurses are responsible for comprehensive patient assessment and ongoing surveillance for the patient's entire ED episode of care. They are also responsible for initiating investigations and interventions within their scope of practice, before the patient has been assessed by medical staff, and for discharge planning.6 The management provided in ED often resolves the patient's presenting complaint, and 65% of all patients attending an ED are able to return to their place of residence without hospital admission.1 The demand on EDs, and key role nurses have in patient management, highlight the need for appropriately prepared emergency nurses.
Patient care requirements are essentially the same, regardless of the ED patients’ attend,7 yet inconsistent resource availability8, 9 including the level of educational and clinical preparation of emergency nurses, can reduce equitable access to healthcare. The Australian Institute of Health and Welfare (AIHW) identified 183 hospitals with EDs in 2010,10 yet there is no single source of information which describes the patient demand or resources available within these EDs. The aim of this paper is to provide a detailed profile of nursing resources in Australian EDs, including ED locations, annual patient attendances, nurse staffing including level of education, and educational resources.
Section snippets
Method
Data were collected using surveys. Ethics approval was obtained from Deakin University and 17 health care networks around Australia. Research governance approval was obtained from 140 hospitals around Australia, and the EDs at those hospitals were included in the sample (76.5% of all Australian EDs11). ED attendance data were recorded from the MyHospitals website (www.myhospitals.gov.au/).2 Nurse Unit Managers completed a survey about the ED and staffing profile (number of ED treatment spaces,
Results
Surveys were emailed to Nurse Unit Managers and Nurse Educators at 140 Australian EDs (280 surveys). There was a 75.7% response rate (Nurse Unit Managers n = 101, Nurse Educators n = 111), and 58.9% (n = 165) completion rate, providing data on 118 EDs (Table 2). There were more responses from participants in NSW, Victoria, and Queensland, which is representative of the geographical distribution of EDs in Australia. There were more responses from principal referral EDs than any other peer group, which
Discussion
There are four major findings in this study: (i) emergency nursing resources vary substantially between states, (ii) Australian EDs have a high percentage of RNs, (iii) organisations valued and supported professional development of emergency nurses, and (iv) only one-third of emergency nurses holds a relevant postgraduate qualification.
There was wide variation in emergency nursing staff resources (FTE, percentage of RNs, and percentage of RNs with relevant postgraduate qualifications) when
Limitations
This study used peer groups to collate and compare data. There were substantial variations within peer groups, and the Australasian College for Emergency Medicine ED delineations3 may have provided more similar data within groups, however, these definitions are not used in all states (for example Queensland21), and therefore a standard list was not available.
Conclusion
This is the first study to describe the emergency nursing resources available nationally. It is clear that there is significant variation in the nursing resources available between states and territories in Australia. The high percentage of RNs in Australian EDs is a positive finding and should instill confidence in the emergency nursing workforce. In order to optimise patient safety outcomes and keep pace with the evolving nature of emergency nursing, strategies to increase the percentage of
Provenance and conflict of interest
No conflict of interest exists among the authors. This paper was not commissioned. Professor Julie Considine is a Deputy Editor of the Australasian Emergency Nursing Journal but had no role in the peer review or editorial management and decision-making whatsoever.
Acknowledgement
The authors wish to acknowledge the generous support of the Nurses Memorial Centre and Australian College of Nursing, who provided scholarships to support this study.
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