A profile of the waiting room nurse in emergency departments: An online survey of Australian nurses exploring implementation and perceptions

Abstract

Background In response to increasing waiting times, adverse patient outcomes and patient dissatisfaction, some emergency departments introduced a Waiting Room Nurse role. Despite implementation into routine practice, there remains limited formal evaluation of the role. Aim To explore the implementation of a Waiting Room Nurse role in Australian emergency departments and emergency nurses' perceptions. Methods Survey design. A 40-item survey was developed, piloted and then distributed to members of a professional College for online completion. Responses for closed-ended and openended items were reported using frequencies or proportions, and quantitative content analysis, respectively. Results Respondents (n=197) reported that 51 emergency departments allocated a Waiting Room Nurse, with varying hours of operation. Five key areas of responsibility were: patient care, patient safety, escalation of care, triage and communication. Role variations were identified in experience, preparation and supporting policies. Challenges, including workload and personal safety issues, were reported. Conclusions The role was perceived as vital, especially at times of high demand, in ensuring that patients were safe to wait, detecting deterioration and escalating care as needed. 2 Communication and therapeutic relationships were key to effective performance. Challenges identified had clear implications for the welfare of nurses performing the role.

The Triage Capability of Laypersons: Retrospective Exploratory Analysis

“…To mitigate these problems, each patient’s urgency is assessed upon arrival in the ED—a process called triage. Usually, triage decisions are made by nurses and trained specialists, whose workload is generally high [ 5 ]. Increased workload and overcrowding pose huge risks as triage errors currently occur in roughly 16% of all cases [ 6 ] and nurses often rely on their intuition and speed up triage by not collecting further information, for example, medical history and physiological data [ 7 , 8 ].…”

A scoping review of barriers, facilitators and tools to escalation of care processes in the emergency department

“…Formalized protocols instructed healthcare professionals who detected patient deterioration (typically an ED nurse) to document it [23,[27][28][29][30], and report it to the most appropriate colleague [23,25,26,29]. Care was frequently escalated to a charge/shift leader nurse [23,25,26,29,30] and/or the treating ED physician [23,25,29].…”

“…While five care escalation policies allowed for nurses to directly activate an external medical emergency or rapid response team (RRT) [30], a more common response was to seek a second opinion from an additional clinician, typically the MRP, who was expected to re-examine a patient's status within 5 min to determine whether further escalation was warranted [23,25,27]. If the additional clinician confirmed the need for care escalation, a RRT would be activated [24,27,29,31].…”

“…Finally, the flow and layout of the ED influenced escalation of care. Three studies suggested that a common point of weakness in care escalation pathways was a failure of clinicians to properly communicate and/or respond to deterioration because of interruptions or distractions [26,30,31]. Escalation of care also varied between geographic areas in the ED.…”