Registered children’s nurses in emergency departments in england: an exploratory survey

Abstract

Recent reports suggest that emergency departments in England are some way from achieving universal provision of specific facilities for children and young people staffed by practitioners with appropriate qualifications. In 1998, 74 per cent of emergency departments employed children's nurses, but only 8 per cent employed them in sufficient numbers to provide 24-hour cover (Smith 1998). To establish whether there has been an increase in the number of children's nurses employed within emergency departments and to identify their specific roles and responsibilities. A postal questionnaire was sent to senior managers of 99 general emergency departments in England with annual new attendance figures of between 45,000 and 100,000. Specific paediatric emergency departments and general departments in the London region were excluded. Analysis of data from the 52 valid responses suggest that although children comprise around 25 per cent of workload, registered children's nurses make up 10 per cent of the workforce in general emergency departments. The number employed in each department varied from one to 13 whole time equivalents (WTEs), and three departments did not employ any at all. In 11 of the 52 departments children's nurses were employed to specifically care for children; in other departments their main responsibilities were training other staff and developing and implementing policies and protocols. Fifty one of the 52 departments employed emergency nurse practitioners (ENPs). Children's nurses were employed as ENPs in 30 of the departments (total 46), a mean of 1.5 WTE per department. A quarter of the ENPs who were not registered children's nurses were reported to have received no additional training before being deemed competent to assess and treat children. There has been an increase in the numbers of children's nurses employed in general emergency departments but the numbers are still too low to comply with policy requirements. Managers should ensure that the skills of children's nurses are used to the full, and ENPs need to consider legal and accountability issues if they are asked to assess and treat children without having accessed appropriate training.