Experienced nurses' perceptions of essential nursing care in the emergency department – A focus group study

AIM: To explore experienced nursing staff's perceptions of essential nursing care in the emergency department (ED). BACKGROUND: Nurse staffing levels in the ED are known to influence a variety of patient outcomes, such as time to medication, incidence of unexpected cardiac arrest, and flow indications such as length of stay. In addition, studies highlight an issue with missed nursing care in the ED setting, particularly for basic care needs. This suggests a need for deeper understanding of the content of ED nursing, and nursing staff's perceptions of their responsibilities towards ED patients' needs. METHODS: A qualitative focus group interview study with an exploratory design, interviewing experienced nursing staff at four Swedish EDs of various sizes and locations. Data were analysed through inductive, reflexive thematic analysis. RESULTS: Three main themes of essential ED nursing emerged, which were for nursing staff to Create control, Take Action and Be a safety net. The themes were united by the overarching theme of Making knowledge-based priorities in an ever-changing environment. CONCLUSION: ED nursing is complex and requires skill to prioritise among multiple essential nursing tasks constantly in an environment that itself is constantly changing. A priority is to identify warning signs quickly, ensure patient safety and keep length of stay as short as possible. Due to variation in patients' symptoms, almost all nursing tasks, such as performing various medical interventions and meeting physical and psychosocial needs, were considered to be essential nursing. However, the need to prioritise among essential tasks may lead to less urgent tasks being postponed or missed.