Conflicts of practice confronting second line nurse managers in an accident and emergency department. Part I

Emergency nurses' perceptions of their role in responding to escalations of care for clinical deterioration

BACKGROUND

Clinical leadership is fundamental to patient safety. The Emergency Department (ED) nurse-in-charge is a key leadership role; however, few studies have explored the management of clinical deterioration from the ED nurse-in-charge perspective. The aim of this study was to explore ED nurses-in-charge' perceptions of their role in responding to episodes of escalation of care for clinical deterioration of ED patients.

METHODS

A prospective exploratory descriptive design was used to address the study aims. The study was conducted in an urban ED in Melbourne, Australia. Senior emergency nurses who fulfilled the role of being in charge of the ED were invited to participate. In-depth semi-structured interviews were conducted between December 2015 and March 2016. Interview transcripts were analysed using thematic analysis.

RESULTS

Two major themes, each with two subthemes were identified. The first major theme of Clinical Risk Management comprised sub-themes of Clinical Skills and Confidence. The second major theme of Resource Management comprised sub-themes of Human Resource Management and Logistical Resource Management.

CONCLUSIONS

Strong collaboration, logistical and clinical risk management roles were perceived as fundamental to the nurse-in-charge's capacity to respond to escalations of care for clinical deterioration within in a complex team environment such as the ED.

Advanced clinical roles: investigating dilemmas and changing practice through action research

A new career structure for clinical nurses was implemented in 1987 in Victoria with the intention of providing clinical advancement and material rewards for nurses in clinical settings. This paper explains how participatory action research was used to explore some of the issues inherent in the role of the associate charge nurse. The clinical/management tension and the role expectations formed within the taken-for-granted rituals and routines of the ward and the hospital managerial structure are examined.