Mapping Nurses’ Advanced Roles in Emergency Departments Globally

Abstract

Introduction:It is widely recognized that there is an increasing demand for healthcare in emergency departments (ED) around the world as well as a global shortage of healthcare workers (HCWs). This has led to ED overcrowding, which increases risks of avoidable complications and suboptimal care provision. Since ED overcrowding impacts patients, staff and quality of care, new strategies are needed for optimizing patient throughput and reducing waiting times. One such strategy is to reconsider the specific roles and professional duties of different cadres of HCWs. Empowering nurses to take on some of the tasks historically performed by physicians is a promising solution for improving ED healthcare provision. However, nurses’ professional responsibilities and competencies differ significantly from country to country. There are few studies about best practices and how to effectively implement such task-shifting strategies. The aim of this study is to map the evidence published in the scholarly literature on nurses’ advanced roles in ED as a strategy for reducing overcrowding, facilitating ED throughput, and, ultimately, improving quality of care.Method:A mapping review was performed by searching the following databases: PubMed, Embase, Scopus and Web of Science.Results:A total of 168 studies were analyzed and the data were grouped according to the countries where advanced tasks were implemented. The type of tasks that were carried out were: autonomous management of patients with minor injuries, triage-based ordering of exams and administration of therapy and management of patient flow.Conclusion:In some high-income countries having nurses take on advanced roles is well-established, and it contributes to reducing overcrowding in ED. Further evidence is needed to assess the barriers and facilitating factors to implementing this strategy in other contexts.