This article, “A Qualitative Study: What Do Nurses in Charge in Emergency Departments Do?” by Singhal, Hosking, Ward, and Boyle, published on September 12, 2021, offers a comprehensive look into the critical role of the nurse-in-charge (NIC) in emergency departments (EDs). The study aims to delineate the problem-solving approaches, also known as heuristics, employed by NICs, and to understand how their role is coordinated with other team members to ensure efficient and smooth ED operations.
The research, conducted as a qualitative explorative study using grounded theory methodology, involved observations and semi-structured interviews with NICs at a single center. Key findings include the identification of eight distinct problem-solving approaches utilized by NICs:
- Placing: Moving patients to optimize care or free resources.
- Targeting: Deploying specific resources to aid flow.
- Guiding: Providing advice to staff.
- Juggling: Reallocating resources to alleviate bottlenecks.
- Chasing: Following up on investigations, consultations, and decisions.
- Team-leading: Managing staff rotas and skill mix.
- Escalating: Raising issues to hospital site matrons or operations centers.
- De-escalating: Managing difficult incidents and supporting junior nurses.
It’s noted that “team-leading,” “escalating,” and “de-escalating” are exclusive to NICs, while other approaches are shared to some extent with the emergency physician in charge (EPIC). The study highlights that NICs primarily focus on operational opportunities for patient flow, complementing the EPIC’s focus on clinical aspects of patient flow.
Furthermore, the research identifies seven team situational awareness processes critical for NICs’ coordination with other team members, emphasizing the importance of team synchronization and shared awareness mechanisms. A significant insight is the presence of shared internal models among NICs and other ED team members, which facilitates effective teamwork, crucial for patient safety and outcomes. This shared understanding helps provide stability amidst the unpredictable nature of an ED, allowing team members to rely on each other and streamline efforts.
The study concludes that understanding these problem-solving approaches and the dynamics of shared awareness between NICs and other team members significantly enhances the comprehension of the NIC role and offers valuable insights for training nurses and devising solutions for improving patient flow within emergency departments.
Reference: Singhal, S., Hosking, I., Ward, J., & Boyle, A. A. (2021). A qualitative study: What do nurses in charge in emergency departments do? Cureus, 13(9), e17912. https://doi.org/10.7759/cureus.17912
