From the Guidelines
Nursing autonomy in the emergency department can be effectively promoted by utilizing nurse practitioners or physician assistants to assess and treat lower-acuity patients, thereby freeing up emergency physicians for more complex cases. This approach has been shown to have positive effects on both patient flow and patient satisfaction, as indicated in a study published in Pediatrics 1. The use of innovative staffing models, such as nurse practitioners or physician assistants in lower-acuity settings during peak hours, can alleviate the stress on the system and increase patient satisfaction.
Some key strategies to promote nursing autonomy in the emergency department include:
- Implementing shared governance models to allow nurses to participate in decision-making processes
- Establishing clear scope-of-practice guidelines to enable nurses to make independent clinical decisions
- Providing ongoing education and certification opportunities to enhance nurses' knowledge base and confidence
- Creating standardized protocols for common emergency presentations to empower nurses to initiate critical interventions
- Developing nurse-driven order sets for specific conditions to allow nurses to implement evidence-based interventions promptly
Utilizing nurse practitioners or physician assistants in triage or treatment areas can also create a more efficient system, as it allows emergency physicians to focus on higher-acuity patients. However, this model requires flexibility in both scheduling and backup, as patients with seemingly minor issues may turn out to be more complicated. As noted in the study published in Pediatrics 1, physician-led team triage models have also been associated with improved throughput and quality of care, and can be used in conjunction with nurse practitioners or physician assistants to promote nursing autonomy.
By promoting nursing autonomy, emergency departments can improve efficiency, enhance patient outcomes, and increase nurse job satisfaction and retention. This can be achieved by implementing the strategies mentioned above and utilizing innovative staffing models, such as those described in the study published in Pediatrics 1.
From the Research
Promoting Nursing Autonomy in the Emergency Department
To promote nursing autonomy in the emergency department, several strategies can be employed:
- Teamwork between nurses and physicians is essential for a positive job environment, autonomy, and control over practice 2
- Nurse practitioners should be allowed to practice to the maximum extent of their advanced education, participate in productive collaborations, and influence healthcare decisions 3
- Barriers to nurse practitioner role implementation in the emergency department should be addressed, and facilitators such as the use of a Participatory Evidence-informed Patient-focused Process for Advanced practice nursing role development, implementation, and evaluation (PEPPA framework) should be utilized 4
- Nurse managers play a crucial role in promoting nurses' professional autonomy by enhancing their independence, competence, and expert role in multi-professional cooperation 5
- Education and training programs for nurses in the emergency department can improve their self-reported confidence in professional skills, especially when based on cooperation between nurses and physicians 6
Key Factors Influencing Nursing Autonomy
Some key factors that influence nursing autonomy in the emergency department include:
- Individual qualities behind independent actions, such as confidence and competence
- Limited influencing opportunities in the organization, such as lack of involvement in decision-making
- Physicians' central effect on nursing practice, such as their role in supervising and collaborating with nurses
- Nurse managers' leadership style, such as shared leadership and support for nurse autonomy
- Organizational culture, such as an open and appreciative work community
Strategies for Enhancing Nursing Autonomy
Strategies for enhancing nursing autonomy in the emergency department include:
- Promoting nurse independence and self-leadership
- Providing opportunities for advanced training and education
- Encouraging multi-professional cooperation and collaboration
- Fostering an open and appreciative work community
- Addressing barriers to nurse practitioner role implementation and utilizing facilitators such as the PEPPA framework 4