To lead or not to lead? Prospective controlled study of emergency nurses' provision of advanced life support team leadership

Abstract

Background and objectives: In many emergency departments advanced life support (ALS) trained nurses do not assume a lead role in advanced resuscitation. This study investigated whether emergency nurses with previous ALS training provided good team leadership in a simulated cardiac arrest situation. Methods: A prospective study was conducted at five emergency departments and one nurses' association meeting. All participants went through the same scenario. Details recorded included baseline blood pressure and pulse rate, time in post, time of ALS training, and subjective stress score (1 = hardly stressed; 10 = extremely stressed). Scoring took into account scenario understanding, rhythm recognition, time to defibrillation, appropriateness of interventions, and theoretical knowledge. Results: Of 57 participants, 20 were ALS trained nurses, 19 were ALS trained emergency senior house officers (SHOs), and 18 were emergency SHOs without formal ALS training. The overall mean score for doctors without ALS training was 69.5%, compared with 72.3% for ALS trained doctors and 73.7% for ALS trained nurses. Nurses found the experience less stressful (subjective stress score 5.78/10) compared with doctors without ALS training (6.5/10). The mean time taken to defibrillate from the appearance of a shockable rhythm on the monitor by the nurses and those SHOs without ALS training was 42 and 40.8 seconds, respectively. Conclusion: ALS trained nurses performed as well as ALS trained and non ALS trained emergency SHOs in a simulated cardiac arrest situation and had greater awareness of the potentially reversible causes of cardiac arrest. Thus if a senior or middle grade doctor is not available to lead the resuscitation team, it may be appropriate for experienced nursing staff with ALS training to act as ALS team leaders rather than SHOs.

Resuscitation Team Organization for Emergency Departments: A Conceptual Review and Discussion

“…The occurrence of a "discordant array of specialists each intent on an individual treatment plan" must be avoided [7,[91][92][93][94]. Well-defined but integrated nursing leadership is also critically important [95,96].…”

Leadership of the nurse: an integrative literature review

“…The possibility exists of strengthening it through continued education (40) and improving it in MSc and PhD programs, where many leaders flourish fully in all the domains of nursing: practice, education, administration and research (21,41) . For success in the formation of young nurse leaders, the importance is stressed for a positive atmosphere of supervision and "good leadership" (42) , with well-qualified professors that posses a leadership profile, aimed at the exchanging of experience and the appropriation of the main characteristics to act as leader (43)(44)(45)(46) .…”

Improving Providers Role Definitions to Decrease Overcrowding and Improve In-Hospital Cardiac Arrest Response

“…Additionally, nurses with advanced life support training found these events less stressful and initiated defibrillation sooner than senior house staff did. 15 Our work differs from that study in that here we describe the role of nurse leader in actual clinical practice. The paradigm of dual physician/nurse leadership in code situations presented here is a logical extension of the multidisciplinary care provided to critically ill patients in other settings, which has been strongly endorsed by international organizations such as the Society of Critical Care Medicine.…”

“…After the intervention, no differences were seen in the numbers of providers at the first pulse check, but by the second pulse check, the number of physicians present had decreased significantly (median [interquartile range]: 6 [5][6][7][8] before vs 5 [3][4][5][6] after, P = .02; see Table). At the third pulse check, the median number of physicians present was lower after the intervention than before (7 [5-9] before vs 4 [4][5] after, P = .004) as was the number of total providers overall (18 [14][15][16][17][18][19][20][21][22] before vs 14 [12][13][14][15][16] after, P = .04).…”

“…In a prospective simulation study of cardiac arrest, Gilligan et al 15 reported that nurses trained in advanced life support performed better than senior house staff with or without training in advanced life support performed. Additionally, nurses with advanced life support training found these events less stressful and initiated defibrillation sooner than senior house staff did.…”