Emergency Nurse Responsibilities for Mechanical Ventilation: A National Survey

Abstract

Few data describe the role of registered nurses working in emergency departments in caring for ventilated patients, yet these patients may remain in the emergency department for prolonged durations because of the unavailability of intensive care unit beds. Our objective was to examine the exposure of emergency nurses to patients requiring mechanical ventilation, as well as their responsibilities and education on ventilation received. A cross-sectional mailed survey was sent to members of the National Emergency Nursing Association in Canada. Domains and items were refined from a survey of ventilation roles and responsibilities in intensive care. The response rate was 247 of 526 (47%); 39% of respondents provided care to 10 ventilated patients or fewer over a period of 2 weeks, 32% up to 5 patients or fewer monthly, and 27% to 5 patients or fewer over a period of 6 months. A 1:1 nurse-patient ratio for ventilated patients was reported by 38% of respondents, whereas 45% managed 1 or 2 additional patients and 15% managed 3 or more additional patients. Most respondents (54%) reported that respiratory therapists (RTs) remained in the emergency department until patients' condition stabilized, 28% reported that an RT was on call, 11% reported that an RT remained until patient transfer, and 7% reported that no RT was available. Few nurses reported primary responsibility for initial ventilator setting selection (7%) or titration of ventilation (6%); nurse responsibility was influenced by RT availability (P < .001). Primary responsibility for monitoring patient response to ventilation, alarm troubleshooting, and oxygenation management was reported by 44%, 36%, and 30% of respondents, respectively. Education was received by 51% of respondents before exposure to ventilated patients; most (57%) indicated that competency was never assessed. Emergency nurses had variable exposure to ventilated patients. Responsibility for ventilator management was influenced by RT availability. Low nurse-patient ratios; inconsistent availability of education; lack of competency assessment; and infrequent use of guidelines, protocols, or pre-printed order sets pose potential concerns for patient safety while ventilated in the emergency department.