NURSING ADMINISTRATION IN THE EMERGENCY DEPARTMENT

Nursing Administration in the Emergency Department

Table of Contents

CHAPTER 1: INTRODUCTION4

Background of the study4

Research Objectives:5

Rationale of the study6

Significance of the Study7

CHAPTER 2: LITERATURE REVIEW10

CHAPTER 3: METHODOLOGY13

Study Design13

Justification/Rationale for Design13

Sampling Procedures13

Eligibility Criteria14

Sample Size14

Data Collection14

Survey Instruments15

Data Analysis16

Dissemination Plans17

Ethical Considerations17

REFRENCES19

Chapter 1: Introduction

Background of the study

Over the past decade, the role of the Emergency Nurse Practitioner (ENP) has been well established in Accident and Emergency (A&E) departments in the United Kingdom (Read et al. 1992; Tye et al., 2000; Cooper et al. 2001). By 1991, 6% of A & E departments in England and Wales had implemented the NP role (Read et al. 1992). It is now estimated that as many as 30-70% of A & E departments in some areas have implemented the role (Cole and Ramirez 2002). The initial role of the NP in emergency care in the United States resulted from a need to provide care for a growing number of non-urgent patients presenting for health care to rural emergency departments (Curry, 2000). NPs now provide services in various ED settings, and guidelines for the role of NPs in emergency departments have been endorsed and published by the American College of Emergency Physicians with the last update in June 2000 (ACEP, 2000).

In America, the initial role of the Nurse Practitioner was in primary care, and the first training program was established in the 1960s for NPs working in northern nursing stations (NPAO, 2001). Today, the most common setting for NPs is in community clinics, but with the recent strains in emergency services delivery, interest has been expressed in the possible role of the NP in emergency departments. In April 2001, the American Association of Emergency Physicians and the National Emergency Nurses Affiliation published a joint position statement on emergency department overcrowding (CAEP & NENA, 2000). They outlined multiple contributing factors and proposed several strategies to address some of the problems associated with over-crowding. They suggested the implementation of Nurse Practitioners (NPs) in Emergency Departments as one of these strategies (CAEP & NENA, 2000).

Research Objectives:

The objectives of this study are:

to determine the current utilization of Nurse Practitioners (NPs) among academic paediatric emergency departments (ED) in America and

to examine paediatric emergency department physicians' attitudes and confidence in NPs assuming traditional physician duties.

Rationale of the study

Studies have been undertaken in the US on the role of NPs in emergency departments and on attitudes toward them (Alongi et al., 1979; Cairo, 1996). In America, however, there are no data on the number of emergency departments that employ NPs nor do we know the nature of NPs' roles within these departments or physicians' views regarding which current physician duties they believe NPs could assume (including patient care and administrative duties). Collecting such information is an essential first step in understanding possible benefits and roles of NPs in the ED, possible barriers to implementing NP programs, and assessing the efficacy of NPs in the ED. Our study will be the first to ascertain the number of American EDs that ...