The why and how of introducing a waiting room nurse role into the Emergency Department

Kelli Innes1,3, Professor Doug Elliott1, Professor Debra Jackson2, Associate Professor Virginia Plummer3, 4

1 University of Technology Sydney, 15 Broadway, Ultimo, N.S.W., 2007, kelli.innes@monash.edu
2 Oxford University Hospitals NHS Foundation Trust, Faculty of Health and Life Sciences, Oxford Brookes University, Headington Hill Oxford, U.K., OX3 OFL.
3 Monash University Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, McMahons Road Frankston, Vic. 3199
4 Peninsula Health, Hastings Road Frankston, Australia 3199.

Introduction: Multiple factors, including increasing patient presentations and access block, are placing emergency departments (EDs) under increasing pressure. As a result waiting times are increasing, patient outcomes are compromised and EDs find meeting key performance indicators challenging. To improve patient care, transition and flow, some emergency departments (EDs) have introduced a waiting room nurse role, to enhance patient safety by commencing care early, identifying deteriorating patients and improving communication between patients and staff. There is however limited published literature on the benefits, challenges and effectiveness of this role. The aim of this research was to identify why and how the waiting room nurse was initially introduced into Australian EDs.

Method: Semi-structured interviews with five key informants were conducted (data saturation achieved), and supported by analysis of related government and health service documents, to identify and explore the rationale for development of the role and subsequent implementation.

Results: The role was primarily implemented to improve quality of care and decrease the potential for clinical risk for patients in the ED waiting room. The primary aim was to decrease waiting times by commencing interventions early, reassessing patients more frequently and improving communication with patients, relatives and the multidisciplinary team in the ED. Practice was commonly underpinned by standing orders. Education and preparation was not standardised, with nurses in the role having varied backgrounds and levels of experience. There was limited evaluation of the role noted by the key informants. Document analysis supported the findings of the key informant interviews.

Discussion: Although the waiting room nurse role was primarily developed to improve outcomes and safety, and decrease clinical risk, it remains unclear what the benefits and effectiveness of the position have been, given the limited evaluation. These findings supported the available literature that the scope of practice was commonly defined by standing orders, and preparation and education of nurses varied. Further evaluation of the role is recommended, to inform some standardisation in preparation and practice.

Biography

Kelli has an extensive background in emergency nursing and education. Currently a lecturer at Monash University where she teaches into the postgraduate emergency nursing stream and the undergraduate nursing program. She is also a PhD candidate at The University of Technology Sydney where she is evaluating the emergency department waiting room nurse role.