Exploration of a nursing role in emergency department waiting rooms

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The waiting room nurse role was introduced into emergency department waiting rooms in response to increased waiting times, poor patient outcomes and failure to meet key performance indicators. The aim of role was to decrease waiting times, reassess patients and improve communication. There is a paucity of literature relating to the role. The aim of the research was to explore nurses perception of the implementation of a nurse allocated to care for patients in emergency department waiting rooms. An exploratory sequential mixed-methods design was used. In Phase 1, data exploring factors contributing to the development of the role were collected from key informant (n=6) through semi-structured interviews. In Phase 2 waiting room nurses (n=8) from a major metropolitan and regional hospital in Victoria (Australia) were observed in clinical practice over 13 periods of observation. Phase 3 surveyed members of the College of Emergency Nursing Australasia, the peak professional body, on the implementation of the role across Australia and their perception of the role. There was a total of 197 survey responses. The key findings of the research were that nurses perceived the role contributed to care quality and patient safety in the waiting room. Waiting Room Nurses developed therapeutic relationships to deliver holistic patient-centred care and facilitated the flow of patients out the waiting room. Variations in preparation, experience and supporting policy were found. A number of challenges including role confusion, funding issues and high exposure to occupational stressors were noted. Integration of the results identified the characteristics and attributes of nurses performing the role, along with the organisational resources required. The activities of the WRN were found to be assessment, secondary triage interventions, communication and facilitating patient flow. Finally, expediting care, patient advocacy, therapeutic relationships, de-escalation, empowerment, improving care quality and safety and deliver of patient-centred care were identified as outcomes of the role. A standardised approach, with considerations for local priorities and work practices, to the preparation, education and supporting policies is required. In addition, policy relating to high exposure of WRNs to occupational stressors is necessary. Further research into the role is essential, including exploring patient outcomes and experiences of the role.
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